Multiple Sclerosis, Myasthenia Gravis, Parkinsons e11, e12, flashcards, P,D, +A
68. A client with Parkinson's disease is prescribed levodopa (l-dopa) therapy. Improvement in which area indicates effective therapy? 1. mood 2. muscle rigidity 3. appetite 4. alertness
68. 2. Levodopa is prescribed to decrease severe muscle rigidity. Levodopa does not improve mood, appetite, or alertness in a client with Parkinson's disease.
72.Which of the following is an expected outcome for a client with Parkinson's disease who has a pallidotomy improved? 1.Functional ability. 2.Emotional stress. 3.Alertness. 4.Appetite.
72. 1. The goal of a pallidotomy is to improve functional ability for the client with Parkinson's disease. This is a priority. The pallidotomy creates lesions in the globus pallidus to control extrapyramidal disorders that affect control of movement and gait. If functional ability is improved by the pallidotomy, the client may experience a secondary response of an improved emotional response, but this is not the primary goal of the surgical procedure. The procedure will not improve alertness or appetite. CN: Basic care and comfort; CL: Apply
75.Which of the following is not a typical clinical manifestation of multiple sclerosis (MS)? 1.Double vision. 2.Sudden bursts of energy. 3.Weakness in the extremities. 4.Muscle tremors.
75. 2. With MS, hyperexcitability and euphoria may occur, but because of muscle weakness, sudden bursts of energy are unlikely. Visual disturbances, weakness in the extremities, and loss of muscle tone and tremors are common symptoms of MS. CN: Physiological adaptation; CL: Analyze
66.Which goal is the most realistic for a client diagnosed with Parkinson's disease? 1.To cure the disease. 2.To stop progression of the disease. 3.To begin preparations for terminal care. 4.To maintain optimal body function.
66. 4. Helping the client function at his or her best is most appropriate and realistic. There is no known cure for Parkinson's disease. Parkinson's disease progresses in severity, and there is no known way to stop its progression. Many clients live for years with the disease, however, and it would not be appropriate to start planning terminal care at this time. CN: Physiological adaptation; CL: Synthesize
79. A client with multiple sclerosis (MS) is experiencing bowel incontinence and is starting a bowel retraining program. Which strategy is not appropriate? 1. eating a diet high in fiber 2. setting a regular time for elimination 3. using an elevated toilet seat 4. limiting fluid intake to 1,000 mL/day
79. 4. Limiting fluid intake is likely to aggravate rather than relieve symptoms when a bowel retraining program is being implemented. Furthermore, water imbalance, as well as electrolyte imbalance, tends to aggravate the signs and symptoms of MS. A diet high in fiber helps keep bowel movements regular. Setting a regular time each day for elimination helps train the body to maintain a schedule. Using an elevated toilet seat facilitates transfer of the client from the wheelchair to the toilet or from a standing to a sitting position.
76. A client has had multiple sclerosis (MS) for 15 years and has received various drug therapies. What is the primary reason why the nurse has found it difficult to evaluate the effectiveness of the drugs that the client has used? 1. The client exhibits intolerance to many drugs. 2. The client experiences spontaneous remissions from time to time. 3. The client requires multiple drugs simultaneously. 4. The client endures long periods of exacerbation before the illness responds to a particular drug.
76. 2. Evaluating drug effectiveness is difficult because a high percentage of clients with MS exhibit unpredictable episodes of remission, exacerbation, and steady progress without apparent cause. Clients with MS do not necessarily have increased intolerance to drugs, nor do they endure long periods of exacerbation before the illness responds to a particular drug. Multiple drug use is not what makes evaluation of drug effectiveness difficult.
33. The nurse is supervising an LPN/LVN who says, "I gave the client with myasthenia gravis 90 mg of neostigmine instead of the ordered 45 mg!" In which order should the nurse perform the following actions? 1. Assess the client's heart rate. 2. Complete a medication error report. 3. Ask the LPN/LVN to explain how the error occurred. 4. Notify the health care provider of the incorrect medication dose.
33. Ans: 1, 4, 3, 2 The first action after a medication error should be to assess the client for adverse outcomes. The nurse should evaluate this client for symptoms such as bradycardia and excessive salivation, which indicate 129 cholinergic crisis, a possible effect of excessive doses of anticholinesterase medications such as neostigmine. The health care provider should be rapidly notified so that treatment with atropine can be ordered to counteract the effects of the neostigmine, if necessary. Determining the circumstances that led to the error will help decrease the risk for future errors and will be needed to complete the medication error report. Focus: Prioritization.
61.A health care provider has prescribed carbidopa-levodopa (Sinemet) four times per day for a client with Parkinson's disease. The client wants "to end it all now that the Parkinson's disease has progressed." What should the nurse do? Select all that apply. 1.Explain that the new prescription for Sinemet will treat the depression. 2.Encourage the client to discuss feelings as the Sinemet is being administered. 3.Contact the health care provider before administering the Sinemet. 4.Determine if the client is on antidepressants or monoamine oxidase (MAO) inhibitors. 5.Determine if the client is at risk for suicide.
61. 3, 4, 5. The nurse should contact the health care provider before administering Sinemet because this medication can cause further symptoms of depression. Suicide threats in clients with chronic illness should be taken seriously. The nurse should also determine if the client is on an MAO inhibitor because concurrent use with Sinemet can cause a hypertensive crisis. Sinemet is not a treatment for depression. Having the client discuss feelings is appropriate when the prescription is finalized. CN: Pharmacological and parenteral therapies; CL: Synthesize
61. A healthcare provider (HCP) has prescribed carbidopa-levodopa four times per day for a client with Parkinson's disease. The client wants "to end it all now that the Parkinson's disease has progressed." What should the nurse do? Select all that apply. 1. Explain that the new prescription for carbidopa-levodopa will treat the depression. 2. Encourage the client to discuss feelings as the carbidopa-levodopa is being administered. 3. Contact the HCP before administering the carbidopa-levodopa. 4. Determine if the client is on antidepressants or monoamine oxidase (MAO) inhibitors. 5. Determine if the client is at risk for suicide.
61. 3,4,5. The nurse should contact the HCP before administering carbidopa-levodopa because this medication can cause further symptoms of depression. Suicide threats in clients with chronic illness should be taken seriously.The nurse should also determine if the client is on an MAO inhibitor because concurrent use with carbidopa-levodopa can cause a hypertensive crisis. Carbidopa-levodopa is not a treatment for depression. Having the client discuss feelings is appropriate when the prescription is finalized.
63.The nurse develops a teaching plan for a client newly diagnosed with Parkinson's disease. Which of the following topics that the nurse plans to discuss is the most important? 1.Maintaining a balanced nutritional diet. 2.Enhancing the immune system. 3.Maintaining a safe environment. 4.Engaging in diversional activity.
63. 3. The primary focus is on maintaining a safe environment because the client with Parkinson's disease usually has a propulsive gait, characterized by a tendency to take increasingly quicker steps while walking. This type of gait commonly causes the client to fall or to have trouble stopping. The client should maintain a balanced diet, enhance the immune system, and enjoy diversional activities; however, safety is the primary concern. CN: Reduction of risk potential; CL: Synthesize
64. The nurse observes that a when a client with Parkinson's disease unbuttons the shirt, the upper arm tremors disappear. Which statement best guides the nurse's analysis of this observation about the client's tremors? 1. The tremors are probably psychological and can be controlled at will. 2. The tremors sometimes disappear with purposeful and voluntary movements. 3. The tremors disappear when the client's attention is diverted by some activity. 4. There is no explanation for the observation; it is a chance occurrence.
64. 2. Voluntary and purposeful movements often temporarily decrease or stop the tremors associated with Parkinson's disease. In some clients, however, tremors may increase with voluntary effort. Tremors associated with Parkinson's disease are not psychogenic but are related to an imbalance between dopamine and acetylcholine. Tremors cannot be reduced by distracting the client.
64.The nurse observes that a when a client with Parkinson's disease unbuttons the shirt, the upper arm tremors disappear. Which statement best guides the nurse's analysis of this observation about the client's tremors? 1.The tremors are probably psychological and can be controlled at will. 2.The tremors sometimes disappear with purposeful and voluntary movements. 3.The tremors disappear when the client's attention is diverted by some activity. 4.There is no explanation for the observation; it is a chance occurrence.
64. 2. Voluntary and purposeful movements often temporarily decrease or stop the tremors associated with Parkinson's disease. In some clients, however, tremors may increase with voluntary effort. Tremors associated with Parkinson's disease are not psychogenic but are related to an imbalance between dopamine and acetylcholine. Tremors cannot be reduced by distracting the client. CN: Physiological adaptation; CL: Analyze
65.At what time of day should the nurse encourage a client with Parkinson's disease to schedule the most demanding physical activities to minimize the effects of hypokinesia? 1.Early in the morning, when the client's energy level is high. 2.To coincide with the peak action of drug therapy. 3.Immediately after a rest period. 4.When family members will be available.
65. 2. Demanding physical activity should be performed during the peak action of drug therapy. Clients should be encouraged to maintain independence in self-care activities to the greatest extent possible. Although some clients may have more energy in the morning or after rest, tremors are managed with drug therapy. CN: Physiological adaptation; CL: Synthesize
66. Which goal is the most realistic for a client diagnosed with Parkinson's disease? 1. to cure the disease 2. to stop progression of the disease 3. to begin preparations for terminal care 4. to maintain optimal body function
66. 4. Helping the client function at his or her best is most appropriate and realistic. There is no known cure for Parkinson's disease. Parkinson's disease progresses in severity, and there is no known way to stop its progression. However, many clients live for years with the disease, and it would not be appropriate to start planning terminal care at this time.
67. Which of the goals is collaboratively established by the client with Parkinson's disease, nurse, and physical therapist? 1. to maintain joint flexibility 2. to build muscle strength 3. to improve muscle endurance 4. to reduce ataxia
67. 1. The primary goal of physical therapy and nursing interventions is to maintain joint flexibility and muscle strength. Parkinson's disease involves a degeneration of dopamine-producing neurons; therefore, it would be an unrealistic goal to attempt to build muscles or increase endurance. The decrease in dopamine neurotransmitters results in ataxia secondary to extrapyramidal motor system effects. Attempts to reduce ataxia through physical therapy would not be effective.
67.Which of the following goals is collaboratively established by the client with Parkinson's disease, nurse, and physical therapist? 1.To maintain joint flexibility. 2.To build muscle strength. 3.To improve muscle endurance. 4.To reduce ataxia.
67. 1. The primary goal of physical therapy and nursing interventions is to maintain joint flexibility and muscle strength. Parkinson's disease involves a degeneration of dopamine-producing neurons; therefore, it would be an unrealistic goal to attempt to build muscles or increase endurance. The decrease in dopamine neurotransmitters results in ataxia secondary to extrapyramidal motor system effects. Attempts to reduce ataxia through physical therapy would not be effective. CN: Physiological adaptation; CL: Synthesize
68.A client with Parkinson's disease is prescribed levodopa (l-dopa) therapy. Improvement in which of the following indicates effective therapy? 1.Mood. 2.Muscle rigidity. 3.Appetite. 4.Alertness.
68. 2. Levodopa is prescribed to decrease severe muscle rigidity. Levodopa does not improve mood, appetite, or alertness in a client with Parkinson's disease. CN: Pharmacological and parenteral therapies; CL: Evaluate
69. A client is being switched from levodopa (l-dopa) to carbidopa-levodopa. The nurse should monitor for which possible complication during medication changes and dosage adjustment? 1. euphoria 2. jaundice 3. vital sign fluctuation 4. signs and symptoms of diabetes
69. 3. Vital signs should be monitored, especially during periods of adjustment. Changes, such as orthostatic hypotension, cardiac irregularities, palpitations, and light-headedness, should be reported immediately. The client may actually experience suicidal or paranoid ideation instead of euphoria. The nurse should monitor the client for elevated liver enzyme levels, such as lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, and alkaline phosphatase, but the client should not be jaundiced. The client should not experience signs and symptoms of diabetes or a low serum glucose level, but the nurse should check the hemoglobin and hematocrit levels.
69.A client is being switched from levodopa (l-dopa) to carbidopa-levodopa (Sinemet). The nurse should monitor for which of the following possible complications during medication changes and dosage adjustment? 1.Euphoria. 2.Jaundice. 3.Vital sign fluctuation. 4.Signs and symptoms of diabetes.
69. 3. Vital signs should be monitored, especially during periods of adjustment. Changes, such as orthostatic hypotension, cardiac irregularities, palpitations, and light-headedness, should be reported immediately. The client may actually experience suicidal or paranoid ideation instead of euphoria. The nurse should monitor the client for elevated liver enzyme levels, such as lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, and alkaline phosphatase, but the client should not be jaundiced. The client should not experience signs and symptoms of diabetes or a low serum glucose level, but the nurse should check the hemoglobin and hematocrit levels. CN: Pharmacological and parenteral therapies; CL: Analyze
70. A client with Parkinson's disease needs a long time to complete morning care but becomes annoyed when the nurse offers assistance and refuses all help. Which action is the nurse's best initial response in this situation? 1. Tell the client firmly that he or she needs assistance and help with the morning care. 2. Praise the client for the desire to be independent and give extra time and encouragement. 3. Tell the client that he or she is being unrealistic about the abilities and must accept the fact that he or she needs help. 4. Suggest to the client to at least modify the morning care routine if he or she insists on self-care.
70. 2. Ongoing self-care is a major focus for clients with Parkinson's disease. The client should be given additional time as needed and praised for efforts to remain independent. Firmly telling the client that he or she needs assistance will undermine self-esteem and defeat efforts to be independent. Telling the client that perception of the situation is unrealistic does not foster hope in the ability to perform self-care measures. Suggesting that the client modify the morning routine seems to put the hospital or the nurse's time schedule before the client's needs. This will only decrease the client's self-esteem and the desire to try to continue self-care, which is obviously important to the client.
70.A new medication regimen is prescribed for a client with Parkinson's disease. At which time should the nurse make certain that the medication is taken? 1.At bedtime. 2.All at one time. 3.Two hours before mealtime. 4.At the time scheduled.
70. 4. While the client is hospitalized for adjustment of medication, it is essential that the medications be administered exactly at the scheduled time, for accurate evaluation of effectiveness. For example, levodopa-carbidopa (Sinemet) is taken in divided doses over the day, not all at one time, for optimum effectiveness. CN: Pharmacological and parenteral therapies; CL: Apply
71. Which is an expected outcome for a client with Parkinson's disease who has had a pallidotomy? 1. improved functional ability 2. reduced emotional stress 3. increased alertness 4. better appetite
71. 1. The goal of a pallidotomy is to improve functional ability for the client with Parkinson's disease. This is a priority. The pallidotomy creates lesions in the globus pallidus to control extrapyramidal disorders that affect control of movement and gait. If functional ability is improved by the pallidotomy, the client may experience a secondary response of an improved emotional response, but this is not the primary goal of the surgical procedure. The procedure will not improve alertness or appetite.
71.A client with Parkinson's disease needs a long time to complete morning care, but becomes annoyed when the nurse offers assistance and refuses all help. Which action is the nurse's best initial response in this situation? 1.Tell the client firmly that he or she needs assistance and help with the morning care. 2.Praise the client for the desire to be independent and give extra time and encouragement. 3.Tell the client that he or she is being unrealistic about the abilities and must accept the fact that he or she needs help. 4.Suggest to the client to at least modify the morning care routine if he or she insists on self-care.
71. 2. Ongoing self-care is a major focus for clients with Parkinson's disease. The client should be given additional time as needed and praised for efforts to remain independent. Firmly telling the client that he or she needs assistance will undermine self-esteem and defeat efforts to be independent. Telling the client that perception of the situation is unrealistic does not foster hope in the ability to perform self-care measures. Suggesting that the client modify the morning routine seems to put the hospital or the nurse's time schedule before the client's needs. This will only decrease the client's self-esteem and the desire to try to continue self-care, which is obviously important to the client. CN: Psychosocial adaptation; CL: Synthesize
74.The nurse is teaching a client with bladder dysfunction from multiple sclerosis (MS) about bladder training at home. Which instructions should the nurse include in the teaching plan? Select all that apply. 1.Restrict fluids to 1,000 mL/24 hours. 2.Drink 400 to 500 mL with each meal. 3.Drink fluids midmorning, midafternoon, and late afternoon. 4.Attempt to void at least every 2 hours. 5.Use intermittent catheterization as needed.
74. 2, 3, 4, 5. Maintaining urinary function in a client with neurogenic bladder dysfunction from MS is an important goal. The client should ideally drink 400 to 500 mL with each meal; 200 mL midmorning, midafternoon, and late afternoon; and attempt to void at least every 2 hours to prevent infection and stone formation. The client may need to catheterize herself to drain residual urine in the bladder. Restricting fluids during the day will not produce sufficient urine. However, in bladder training for nighttime continence, the client may restrict fluids for 1 to 2 hours before going to bed. The client should drink at least 2,000 mL every 24 hours. CN: Physiological adaptation; CL: Create
74. Which is not a typical clinical manifestation of multiple sclerosis (MS)? 1. double vision 2. sudden bursts of energy 3. weakness in the extremities 4. muscle tremors
74. 2. With MS, hyperexcitability and euphoria may occur, but because of muscle weakness, sudden bursts of energy are unlikely. Visual disturbances, weakness in the extremities, and loss of muscle tone and tremors are common symptoms of MS.
75. A client with multiple sclerosis (MS) is receiving baclofen. The nurse determines that the drug is effective when it: 1. induces sleep. 2. stimulates the client's appetite. 3. relieves muscular spasticity. 4. reduces the urine bacterial count.
75. 3. Baclofen is a centrally acting skeletal muscle relaxant that helps relieve the muscle spasms common in MS. Drowsiness is an adverse effect, and driving should be avoided if the medication produces a sedative effect. Baclofen does not stimulate the appetite or reduce bacteria in the urine.
77.A client has had multiple sclerosis (MS) for 15 years and has received various drug therapies. What is the primary reason why the nurse has found it difficult to evaluate the effectiveness of the drugs that the client has used? 1.The client exhibits intolerance to many drugs. 2.The client experiences spontaneous remissions from time to time. 3.The client requires multiple drugs simultaneously. 4.The client endures long periods of exacerbation before the illness responds to a particular drug.
77. 2. Evaluating drug effectiveness is difficult because a high percentage of clients with MS exhibit unpredictable episodes of remission, exacerbation, and steady progress without apparent cause. Clients with MS do not necessarily have increased intolerance to drugs, nor do they endure long periods of exacerbation before the illness responds to a particular drug. Multiple drug use is not what makes evaluation of drug effectiveness difficult. CN: Physiological adaptation; CL: Analyze
77. When the nurse talks with a client with multiple sclerosis who has slurred speech, which nursing intervention is contraindicated? 1. encouraging the client to speak slowly 2. encouraging the client to speak distinctly 3. asking the client to repeat indistinguishable words 4. asking the client to speak louder when tired
77. 4. Asking a client to speak louder even when tired may aggravate the problem. Asking the client to speak slowly and distinctly and to repeat hard-to-understand words helps the client to communicate effectively.
78. The right hand of a client with multiple sclerosis trembles severely whenever she attempts a voluntary action. She spills her coffee twice at lunch and cannot get her dress fastened securely. Which is the best legal documentation in nurses' notes of the medical record for this client assessment? 1. "Has an intention tremor of the right hand." 2. "Right-hand tremor worsens with purposeful acts." 3. "Needs assistance with dressing and eating due to severe trembling and clumsiness." 4. "Slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup."
78. 4. The nurses' notes should be concise, objective, clearly stated, and relevant. This client trembles when she attempts voluntary actions, such as drinking a beverage or fastening clothing. This activity should be described exactly as it occurs so that others reading the note will have no doubt about the nurse's observation of the client's behavior. Identifying the "intentional" activity of daily living will help the interdisciplinary team individualize the client's plan of care. Clarifying what is meant by "worsening" with a purposeful act will facilitate the interrater reliability of the team. It is better to state what the client did than to give vague nursing orders in the nurses' notes.
79.The right hand of a client with multiple sclerosis trembles severely whenever she attempts a voluntary action. She spills her coffee twice at lunch and cannot get her dress fastened securely. Which is the best legal documentation in nurses' notes of the chart for this client assessment? 1."Has an intention tremor of the right hand." 2."Right-hand tremor worsens with purposeful acts." 3."Needs assistance with dressing and eating due to severe trembling and clumsiness." 4."Slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup."
79. 4. The nurses' notes should be concise, objective, clearly stated, and relevant. This client trembles when she attempts voluntary actions, such as drinking a beverage or fastening clothing. This activity should be described exactly as it occurs so that others reading the note will have no doubt about the nurse's observation of the client's behavior. Identifying the "intentional" activity of daily living will help the interdisciplinary team individualize the client's plan of care. Clarifying what is meant by "worsening" with a purposeful act will facilitate the interrater reliability of the team. It is better to state what the client did than to give vague nursing orders in the nurses' notes. CN: Management of care; CL: Apply
8. A client with Parkinson disease has a problem with decreased mobility related to neuromuscular impairment. The nurse observes the unlicensed assistive personnel (UAP) performing all of these actions. For which action must the nurse intervene? 1. Helping the client ambulate to the bathroom and back to bed 2. Reminding the client not to look at his feet when he is walking 3. Performing the client's complete bathing and oral care 4. Setting up the client's tray and encouraging the client to feed himself
8. Ans: 3 Although all of these actions fall within the scope of practice for a UAP, the UAP should help the client with morning care as needed, but the goal is to keep this client as independent and mobile as possible. The client should be encouraged to perform as much morning care as possible. Assisting the client in ambulating, reminding the client not to look at his feet (to prevent falls), and encouraging the client to feed himself are all appropriate to the goal of maintaining independence. Focus: Delegation, Supervision.
80. Which outcome is not realistic to establish with a client who has multiple sclerosis (MS)? The client will develop: 1. increased joint mobility. 2. improved muscle strength. 3. clearer thinking. 4. mood elevation
80. 3. MS is a progressive, chronic neurologic disease characterized by patchy demyelination throughout the central nervous system. This interferes with the transmission of electrical impulses from one nerve cell to the next. MS affects speech, coordination, and vision, but not cognition. Care for the client with MS is directed toward maintaining joint mobility, preventing deformities, maintaining muscle strength, rehabilitation, preventing and treating depression, and providing client motivation.
80.A client with multiple sclerosis (MS) is experiencing bowel incontinence and is starting a bowel retraining program. Which strategy is not appropriate? 1.Eating a diet high in fiber. 2.Setting a regular time for elimination. 3.Using an elevated toilet seat. 4.Limiting fluid intake to 1,000 mL/day.
80. 4. Limiting fluid intake is likely to aggravate rather than relieve symptoms when a bowel retraining program is being implemented. Furthermore, water imbalance, as well as electrolyte imbalance, tends to aggravate the signs and symptoms of MS. A diet high in fiber helps keep bowel movements regular. Setting a regular time each day for elimination helps train the body to maintain a schedule. Using an elevated toilet seat facilitates transfer of the client from the wheelchair to the toilet or from a standing to a sitting position. CN: Physiological adaptation; CL: Synthesize
81. The nurse is preparing a client with multiple sclerosis (MS) for discharge from the hospital to home. The nurse should tell the client: 1. "You will need to accept the necessity for a quiet and inactive lifestyle." 2. "Keep active, use stress reduction strategies, and avoid fatigue." 3. "Follow good health habits to change the course of the disease." 4. "Practice using the mechanical aids that you will need when future disabilities arise."
81. 2. The nurse's most positive approach is to encourage a client with MS to keep active, use stress reduction strategies, and avoid fatigue because it is important to support the immune system while remaining active. A quiet, inactive lifestyle is not necessarily indicated. Good health habits are not likely to alter the course of the disease, although they may help minimize complications. Practicing using aids that will be needed for future disabilities may be helpful but also can be discouraging.
81.Which of the following is not a realistic outcome to establish with a client who has multiple sclerosis (MS)? The client will develop: 1.Joint mobility. 2.Muscle strength. 3.Cognition. 4.Mood elevation.
81. 3. MS is a progressive, chronic neurologic disease characterized by patchy demyelination throughout the central nervous system. This interferes with the transmission of electrical impulses from one nerve cell to the next. MS affects speech, coordination, and vision, but not cognition. Care for the client with MS is directed toward maintaining joint mobility, preventing deformities, maintaining muscle strength, rehabilitation, preventing and treating depression, and providing client motivation. CN: Reduction of risk potential; CL: Synthesize
82. Which information should the nurse include in the discharge plan for a client with multiple sclerosis who has an impaired peripheral sensation? Select all that apply. 1. Carefully test the temperature of bath water. 2. Avoid kitchen activities because of the risk of injury. 3. Avoid hot water bottles and heating pads. 4. Inspect the skin daily for injury or pressure points. 5. Wear warm clothing when outside in cold temperatures.
82. 1,3,4,5. A client with impaired peripheral sensation does not feel pain as readily as does someone whose sensation is unimpaired; therefore, water temperatures should be tested carefully. The client should be advised to avoid using hot water bottles or heating pads and to protect against cold temperatures. Because the client cannot rely on minor pain as an indicator of damaged skin or sore spots, the client should carefully inspect the skin daily to visualize any injuries that he or she cannot feel. The client should not be instructed to avoid kitchen activities out of fear of injury; independence and self-care are also important. However, the client should meet with an occupational therapist to learn about assistive devices and techniques that can reduce injuries, such as burns and cuts that are common in kitchen activities.
82.The nurse is preparing a client with multiple sclerosis (MS) for discharge from the hospital to home. The nurse should tell the client: 1."You will need to accept the necessity for a quiet and inactive lifestyle." 2."Keep active, use stress reduction strategies, and avoid fatigue." 3."Follow good health habits to change the course of the disease." 4."Practice using the mechanical aids that you will need when future disabilities arise."
82. 2. The nurse's most positive approach is to encourage a client with MS to keep active, use stress reduction strategies, and avoid fatigue because it is important to support the immune system while remaining active. A quiet, inactive lifestyle is not necessarily indicated. Good health habits are not likely to alter the course of the disease, although they may help minimize complications. Practicing using aids that will be needed for future disabilities may be helpful but also can be discouraging. CN: Physiological adaptation; CL: Synthesize
83.Which of the following should the nurse include in the discharge plan for a client with multiple sclerosis who has an impaired peripheral sensation? Select all that apply. 1.Carefully test the temperature of bath water. 2.Avoid kitchen activities because of the risk of injury. 3.Avoid hot water bottles and heating pads. 4.Inspect the skin daily for injury or pressure points. 5.Wear warm clothing when outside in cold temperatures.
83. 1, 3, 4, 5. A client with impaired peripheral sensation does not feel pain as readily as someone whose sensation is unimpaired; therefore, water temperatures should be tested carefully. The client should be advised to avoid using hot water bottles or heating pads and to protect against cold temperatures. Because the client cannot rely on minor pain as an indicator of damaged skin or sore spots, the client should carefully inspect the skin daily to visualize any injuries that he cannot feel. The client should not be instructed to avoid kitchen activities out of fear of injury; independence and self-care are also important. However, the client should meet with an occupational therapist to learn about assistive devices and techniques that can reduce injuries, such as burns and cuts that are common in kitchen activities. CN: Reduction of risk potential; CL: Create
83. Which intervention should the nurse suggest to help a client with multiple sclerosis avoid episodes of urinary incontinence? 1. Limit fluid intake to 1,000 mL/day. 2. Insert an indwelling urinary catheter. 3. Establish a regular voiding schedule. 4. Administer prophylactic antibiotics, as prescribed.
83. 3. Maintaining a regular voiding pattern is the most appropriate measure to help the client avoid urinary incontinence. Fluid intake is not related to incontinence. Incontinence is related to the strength of the detrusor and urethral sphincter muscles. Inserting an indwelling catheter would be a treatment of last resort because of the increased risk of infection. If catheterization is required, intermittent self-catheterization is preferred because of its lower risk of infection. Antibiotics do not influence urinary incontinence.
85. When planning care for a client with myasthenia gravis, the nurse understands that the client is at highest risk for: 1. aspiration. 2. bladder dysfunction. 3. hypertension. 4. sensory loss.
85. 1. Loss of motor function to the face and throat can cause dysphagia and places the client at risk for aspiration. Bladder dysfunction and hypertension are not associated with myasthenia gravis. Myasthenia affects nerve impulses at the neuromuscular junction, causing loss of motor function; there is no sensory deficit.
86.When caring for a client with myasthenia gravis, the nurse should assess the client for which of the following manifestations of cholinergic crisis? Select all that apply. 1.Ptosis. 2.Fasciculation. 3.Abdominal cramps. 4.Increased heart rate. 5.Decreased secretions and saliva. 6.Respiratory rate of 6 and irregular rhythm.
86. 1, 2, 6. Cholinergic crisis is caused by overstimulation at the neuromuscular junction due to increased acetylcholine. The crisis affects the muscles that control eye and eyelid movement, causing fasciculation, ptosis (drooping eyelids) and difficulty chewing, talking, and swallowing. The muscles that control breathing and neck and limb movements are also affected, and respirations become slowed. Salivation is increased. The crisis is reversed with atropine. CN: Physiological Integrity; CL: Analyze
86. The nurse is discussing discharge instructions with a client with myasthenia gravis who is taking pyridostigmine. The nurse should tell the client to: 1. administer artificial tears. 2. avoid contact with crowds. 3. take pyridostigmine in the afternoon. 4. decrease protein in the diet.
86. 1. The nurse instructs the client regarding use of artificial tears because eyelid and extraocular muscles are frequently affected by myasthenia gravis and there is a risk of corneal abrasion if the eyelids do not close completely. The client is encouraged to maintain social contacts and prevent social isolation by staying at home. Medication is taken in the morning, prior to activities, so the client is able to complete them. A nutritious diet is encouraged, and there is no indication to limit protein.
87.A client with refractory myasthenia gravis (MG) undergoes plasmapheresis therapy. The nurse determines that the therapy was effective if the client demonstrates improvement in: 1.Vital capacity. 2.Leg strength. 3.Ptosis. 4.Diplopia.
87. 1. Plasmapheresis therapy removes the antibodies that cause MG; therefore, the lung muscles will function with greater strength delivering more vital capacity. MG affects the upper limbs, and an increase in leg strength is not an outcome of plasmapheresis. Once the MG client has symptoms of ptosis and diplopia, they will not be reversed by plasmapheresis therapy. CN: Physiological Integrity; CL: Evaluate
Parkinson's Disease Cause? Symptoms?
Cause: Degeneration of substantia nigra, resulting in too little dopamine and too much acetylcholine. Symptoms: Tremor, muscle rigidity, slow/shuffling gait, bradykinesia (slow movement), mask like expression, drooling, difficulty swallowing
Myasthenia Gravis (MG) What is it? Symptoms
MG: Autoimmune disorder that causes severe muscle weakness. Caused by antibodies that interfere with Ach at neuromuscular junction (NMJ). Characterized by periods of exacerbation and remission. Associated with thymus hyperplasia. Symptoms: Muscle weakness (worse w/activity), diplopia, dysphagia, impaired respiration, drooping eyelids incontinence
21. The RN notes that a client with myasthenia gravis has an elevated temperature (102.2°F [39°C]), an increased heart rate (120 beats/min), and a rise in blood pressure (158/94 mm Hg) and is incontinent of urine and stool. What is the nurse's best action at this time? 1. Administer an acetaminophen suppository. 2. Notify the health care provider immediately. 3. Recheck vital signs in 1 hour. 4. Reschedule the client's physical therapy.
21. Ans: 2 The changes that the RN notes are characteristic of myasthenic crisis, which often follows some type of infection. The client is at risk for inadequate respiratory function. In addition to notifying the health care provider or Rapid Response Team, the nurse should carefully monitor the client's respiratory status. The client may need intubation and mechanical ventilation. Focus: Prioritization.
Parkinson's Disease Nursing Care Medications?
Nursing care: Monitor swallowing/food intake, thicken food, sit patient upright to eat have suction equipment available. Encourage ROM and exercise, assist w/ADLS Meds: Levodopa/carbidopa (increases dopamine levels), benztropine (decreases acetylcholine levels)
Myasthenia Gravis (MG) Medications
Medications: Anticholinesterase agents (pyridostigmine or neostigmine), immunosuppressants.
Multiple Sclerosis What is it? Triggers
Multiple Sclerosis: Autoimmune disorder where plaque develops in white matter of the CNS. Age of onset is typically 20-40 years of age, more common in women. Characterized by periods of relapsing and remitting. Triggers: Temperature extremes, stress/injury, pregnancy, fatigue
Myasthenia Gravis (MG) Nursing care
Nursing care: Maintain patent airway (oxygen, suction and intubation equipment at bedside) Encourage periods of rest Provide small/frequent/high-calorie meals, have patient sit upright while eating, thicken liquids
Myasthenia Gravis (MG) Therapeutic procedures and surgical intervention Diagnosis?
Procedures/surgeries: Plasmapheresis- remove antibodies from plasma. Thymectomy-removal of thymus. Diagnosis: Administer edrophonium, which increases Ach at NMJ. If symptoms improve, it is MG If not, it is a cholinergic crisis (Atropine is antidote).
Multiple Sclerosis Symptoms Medications
Symptoms: Eye problems (Diplopia/nystagmus), muscle spasticity and weakness, bowel/bladder dysfunction, cognitive changes, ear problems (tinnitus/hearing issues), dysphagia, fatigue. Meds: Immunosuppressive agents (cyclosporine), prednisone
11. Which client should the charge nurse assign to a new graduate RN who is orientating to the neurologic unit? 1. A 28-year-old newly admitted client with a spinal cord injury 2. A 67-year-old client who had a stroke 3 days ago and has left-sided weakness 3. An 85-year-old client with dementia who is to be transferred to long-term care today 4. A 54-year-old client with Parkinson disease who needs assistance with bathing
11. Ans: 2 The new graduate RN who is on orientation to the unit should be assigned to care for clients with stable, noncomplex conditions, such as the client with stroke. The task of helping the client with Parkinson disease to bathe is best delegated to the unlicensed assistive personnel (UAP). The client being transferred to the nursing home, and the newly admitted client with spinal cord injury should be assigned to experienced nurses. Focus: Assignment.
19. A client with multiple sclerosis tells the unlicensed assistive personnel (UAP) after physical therapy that she is too tired to take a bath. What is the priority nursing concern at this time? 1. Fatigue 2. Inability to perform activities of daily living (ADLs) 3. Decreased mobility 4. Muscular weakness
19. Ans: 1 At this time, based on the client's statement, the priority is inability to perform ADLs most likely related to being tired (fatigue) after physical therapy. The other three nursing concerns are appropriate to a client with MS but are not related to the client's statement. Focus: Prioritization.
73.The nurse should conduct a focused assessment with the client with multiple sclerosis for risk of which of the following? Select all that apply. 1.Dehydration. 2.Falls. 3.Seizures. 4.Skin breakdown. 5.Fatigue.
73. 2, 4, 5. The client with multiple sclerosis is at risk for falls due to muscle weakness, skin breakdown due to bowel and bladder incontinence, and fatigue. The client is not at risk for dehydration; seizures are not associated with myelin destruction. CN: Physiological integrity; CL: Analyze
85.A client with multiple sclerosis (MS) lives with her daughter and 3-year-old granddaughter. The daughter asks the nurse what she can do at home to help her mother. Which of the following measures would be most beneficial? 1.Psychotherapy. 2.Regular exercise. 3.Day care for the granddaughter. 4.Weekly visits by another person with MS.
85. 2. An individualized regular exercise program helps the client to relieve muscle spasms. The client can be trained to use unaffected muscles to promote coordination because MS is a progressive, debilitating condition. The data do not indicate that the client needs psychotherapy, day care for the granddaughter, or visits from other clients. CN: Physiological adaptation; CL: Synthesize
115. The nurse notices that a client with Parkinson's disease is coughing frequently when eating. Which intervention should the nurse consider? 1. Have the client hyperextend the neck when swallowing. 2. Tell the client to place the chin firmly against the chest when eating. 3. Thicken all liquids before offering to the client. 4. Place the client on a clear liquid diet.
115. 3. Clients with Parkinson's disease can experience dysphagia. Thickening liquids assists with swallowing, preventing aspiration. Hyperextending the neck opens the airway and can increase risk of aspiration. Pressing the chin firmly on the chest makes swallowing more difficult. The chin should be slightly tucked to promote swallowing. The nurse should suggest a speech therapy consult for evaluation of the client's ability to swallow.
117. The nurse has asked the unlicensed assistive personnel (UAP) to ambulate a client with Parkinson's disease. The nurse observes the UAP pulling on the client's arms to get the client to walk forward. The nurse should: 1. have the UAP keep a steady pull on the client to promote forward ambulation. 2. explain how to overcome a freezing gait by telling the client to march in place. 3. assist the UAP with getting the client back in bed. 4. give the client a muscle relaxant.
117. 2. Clients with Parkinson's disease may experience a freezing gait when they are unable to move forward. Instructing the client to march in place, step over lines in the flooring, or visualize stepping over a log allows them to move forward. It is important to ambulate the client and not keep him or her on bed rest. A muscle relaxant is not indicated.
65. At what time of day should the nurse encourage a client with Parkinson's disease to schedule the most demanding physical activities to minimize the effects of hypokinesia? 1. early in the morning, when the client's energy level is high 2. to coincide with the peak action of drug therapy 3. immediately after a rest period 4. when family members will be available
65. 2. Demanding physical activity should be performed during the peak action of drug therapy. Clients should be encouraged to maintain independence in self-care activities to the greatest extent possible. Although some clients may have more energy in the morning or after rest, tremors are managed with drug therapy.
78.When the nurse talks with a client with multiple sclerosis who has slurred speech, which nursing intervention is contraindicated? 1.Encouraging the client to speak slowly. 2.Encouraging the client to speak distinctly. 3.Asking the client to repeat indistinguishable words. 4.Asking the client to speak louder when tired.
78. 4. Asking a client to speak louder even when tired may aggravate the problem. Asking the client to speak slowly and distinctly and to repeat hard-to-understand words helps the client to communicate effectively. CN: Psychosocial adaptation; CL: Synthesize
31. After the nurse receives the change-of-shift report at 7:00 am, which client must the nurse assess first? 1. A 23-year-old client with a migraine headache who reports severe nausea associated with retching 2. A 45-year-old client who is scheduled for a craniotomy in 30 minutes and needs preoperative teaching 3. A 59-year-old client with Parkinson disease who will need a swallowing assessment before breakfast 4. A 63-year-old client with multiple sclerosis (MS) who has an oral temperature of 101.8°F (38.8°C) and flank pai
31. Ans: 4 Urinary tract infections (UTIs) are a frequent complication in clients with MS because of the effect of the disease on bladder function, and UTIs may lead to sepsis in these clients. The elevated temperature and flank pain suggest that this client may have pyelonephritis. The health care provider should be notified immediately so that IV antibiotic therapy can be started quickly. The other clients should be assessed as soon as possible, but their needs are not as urgent as those of this client. Focus: Prioritization.
60. Which nursing approach is most helpful to a client with Parkinson's disease who is experiencing a freezing of gait with difficulty initiating movement? 1. Pull the client forward to initiate walking. 2. Instruct the client to use a wheelchair. 3. Have the client remain still. 4. Tell the client to march in place.
60. 4. When a freezing gait occurs, having the client march in place or step over actual lines, imaginary lines, or objects on the floor can promote walking. Instructing the client to take one step backward and two steps forward may also stimulate walking. Pulling the client forward can cause imbalance. The nurse does not instruct the client to use a wheelchair. The client obtains much exercise as possible; having the client remain still does not help the client obtain the momentum needed to walk.
62. Which is an initial sign of Parkinson's disease? 1. rigidity 2. tremor 3. bradykinesia 4. akinesia
62. 2. The first sign of Parkinson's disease is usually tremors. The client commonly is the first to notice this sign because the tremors may be minimal at first. Rigidity is the second sign, and bradykinesia is the third sign. Akinesia is a later stage of bradykinesia.
62.Which of the following is an initial sign of Parkinson's disease? 1.Rigidity. 2.Tremor. 3.Bradykinesia. 4.Akinesia.
62. 2. The first sign of Parkinson's disease is usually tremors. The client commonly is the first to notice this sign because the tremors may be minimal at first. Rigidity is the second sign, and bradykinesia is the third sign. Akinesia is a later stage of bradykinesia. CN: Physiological adaptation; CL: Analyze
63. The nurse develops a teaching plan for a client newly diagnosed with Parkinson's disease. Which topic is most important to include in the plan? 1. maintaining a balanced nutritional diet 2. enhancing the immune system 3. maintaining a safe environment 4. engaging in diversional activity
63. 3. The primary focus is on maintaining a safe environment because the client with Parkinson's disease usually has a propulsive gait, characterized by a tendency to take increasingly quicker steps while walking. This type of gait commonly causes the client to fall or to have trouble stopping. The client should maintain a balanced diet, enhance the immune system, and enjoy diversional activities; however, safety is the primary concern.
84. A client with multiple sclerosis (MS) lives with her daughter and 3-year-old granddaughter. The daughter asks the nurse what she can do at home to help her mother. Which measure would be most beneficial? 1. psychotherapy 2. regular exercise 3. day care for the granddaughter 4. weekly visits by another person with MS
84. 2. An individualized regular exercise program helps the client to relieve muscle spasms. The client can be trained to use unaffected muscles to promote coordination because MS is a progressive, debilitating condition. The data do not indicate that the client needs psychotherapy, day care for the granddaughter, or visits from other clients.
87. After teaching a client about myasthenia gravis, the nurse would judge that the client has formed a realistic concept of her health problem when she says that by taking her medication and pacing her activities: 1. she will live longer, but ultimately the disease will cause her death. 2. her symptoms will be controlled, and eventually the disease will be cured. 3. she should be able to control the disease and enjoy a healthy lifestyle. 4. her fatigue will be relieved, but she should expect occasional periods of muscle weakness.
87. 3. With a well-managed regimen, a client with myasthenia gravis should be able to control symptoms, maintain a normal lifestyle, and achieve a normal life expectancy. Myasthenia gravis can be controlled and need not be a fatal disease. Myasthenia gravis can be controlled, not cured. Episodes of increased muscle weakness should not occur if treatment is well managed.
88.After teaching a client about myasthenia gravis, the nurse would judge that the client has formed a realistic concept of her health problem when she says that by taking her medication and pacing her activities: 1.She will live longer, but ultimately the disease will cause her death. 2.Her symptoms will be controlled, and eventually the disease will be cured. 3.She should be able to control the disease and enjoy a healthy lifestyle. 4.Her fatigue will be relieved, but she should expect occasional periods of muscle weakness.
88. 3. With a well-managed regimen, a client with myasthenia gravis should be able to control symptoms, maintain a normal lifestyle, and achieve a normal life expectancy. Myasthenia gravis can be controlled and need not be a fatal disease. Myasthenia gravis can be controlled, not cured. Episodes of increased muscle weakness should not occur if treatment is well managed. CN: Physiological adaptation; CL: Evaluate
76.A client with multiple sclerosis (MS) is receiving baclofen (Lioresal). The nurse determines that the drug is effective when it achieves which of the following? 1.Induces sleep. 2.Stimulates the client's appetite. 3.Relieves muscular spasticity. 4.Reduces the urine bacterial count.
76. 3. Baclofen is a centrally acting skeletal muscle relaxant that helps relieve the muscle spasms common in MS. Drowsiness is an adverse effect, and driving should be avoided if the medication produces a sedative effect. Baclofen does not stimulate the appetite or reduce bacteria in the urine. CN: Pharmacological and parenteral therapies; CL: Evaluate
84.Which intervention should the nurse suggest to help a client with multiple sclerosis avoid episodes of urinary incontinence? 1.Limit fluid intake to 1,000 mL/day. 2.Insert an indwelling urinary catheter. 3.Establish a regular voiding schedule. 4.Administer prophylactic antibiotics, as prescribed.
84. 3. Maintaining a regular voiding pattern is the most appropriate measure to help the client avoid urinary incontinence. Fluid intake is not related to incontinence. Incontinence is related to the strength of the detrusor and urethral sphincter muscles. Inserting an indwelling catheter would be a treatment of last resort because of the increased risk of infection. If catheterization is required, intermittent self-catheterization is preferred because of its lower risk of infection. Antibiotics do not influence urinary incontinence. CN: Physiological adaptation; CL: Synthesize
31. After the nurse receives the change-of-shift report at 7:00 am, which client must the nurse assess first? 1. A 23-year-old client with a migraine headache who reports severe nausea associated with retching 2. A 45-year-old client who is scheduled for a craniotomy in 30 minutes and needs preoperative teaching 3. A 59-year-old client with Parkinson disease who will need a swallowing assessment before breakfast 4. A 63-year-old client with multiple sclerosis (MS) who has an oral temperature of 101.8°F (38.8°C) and flank pai
31. Ans: 4 Urinary tract infections (UTIs) are a frequent complication in clients with MS because of the effect of the disease on bladder function, and UTIs may lead to sepsis in these clients. The elevated temperature and flank pain suggest that this client may have pyelonephritis. The health care provider should be notified immediately so that IV antibiotic therapy can be started quickly. The other clients should be assessed as soon as possible, but their needs are not as urgent as those of this client. Focus: Prioritization.
73. The nurse is teaching a client with bladder dysfunction from multiple sclerosis (MS) about bladder training at home. Which instructions should the nurse include in the teaching plan? Select all that apply. 1. Restrict fluids to 1,000 mL/24 hours. 2. Drink 400 to 500 mL with each meal. 3. Drink fluids midmorning, midafternoon, and late afternoon. 4. Attempt to void at least every 2 hours. 5. Use intermittent catheterization as needed.
73. 2,3,4,5. Maintaining urinary function in a client with neurogenic bladder dysfunction from MS is an important goal. The client should ideally drink 400 to 500 mL with each meal; drink 200 mL midmorning, midafternoon, and late afternoon; and attempt to void at least every 2 hours to prevent infection and stone formation. The client may need to catheterize herself to drain residual urine in the bladder. Restricting fluids during the day will not produce sufficient urine. However, in bladder training for nighttime continence, the client may restrict fluids for 1 to 2 hours before going to bed. The client should drink at least 2,000 mL every 24 hours.
32. All of the following nursing care activities are included in the care plan for a 78-year-old man with Parkinson disease who has been referred to the home health agency. Which activities will the nurse delegate to the unlicensed assistive personnel (UAP)? Select all that apply. 1. Checking for orthostatic changes in pulse and blood pressure 2. Assessing for improvement in tremor after levodopa is given 3. Reminding the client to allow adequate time for meals 4. Monitoring for signs of toxic reactions to anti-Parkinson medications 5. Assisting the client with prescribed strengthening exercises 6. Adapting the client's preferred activities to his level of function
32. Ans: 1, 3, 5 UAP education and scope of practice include checking pulse and blood pressure measurements. The nurse would be sure to instruct the UAP to report heart rate and blood pressure findings. In addition, UAPs can reinforce previous teaching or skills taught by the RN or personnel in other disciplines, such as speech or physical therapists. Evaluating client response to medications and developing and individualizing the plan of care require RN-level education and scope of practice. Focus: Delegation.
72. When assessing the client with multiple sclerosis for potential complications of the disease, the nurse should asses the client for which of the following? Select all that apply. 1. dehydration 2. falls 3. seizures 4. skin breakdown 5. fatigue
72. 2,4,5. The client with multiple sclerosis is at risk for falls due to muscle weakness, skin breakdown due to bowel and bladder incontinence, and fatigue. The client is not at risk for dehydration; seizures are not associated with myelin destruction.
