Neurological Disorders
Select all the TRUE statements about the pathophysiology of multiple sclerosis: A. "The dendrites on the neuron are overstimulated leading to the destruction of the axon." B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon." C. "This disease affects the insulating structure found on the neuron in the central nervous system." D. "The dopaminergic neurons in the part of the brain called substantia nigra have started to die."
B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon." C. "This disease affects the insulating structure found on the neuron in the central nervous system."
During your discharge teaching to a patient with multiple sclerosis, you educate the patient on how to avoid increasing symptoms and relapses. You tell the patient to avoid: A. Cold temperatures B. Infection C. Overexertion D. Salt F. Stress
B. Infection C. Overexertion F. Stress
Which medications below can help treat muscle spasms in a patient with multiple sclerosis? Select all that apply: A. Propranolol B. Isoniazid C. Baclofen D. Diazepam E. Modafinil
C. Baclofen D. Diazepam
A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is incorrect about this medication: A. It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication. B. Body fluids can turn a dark color and stain clothes. C. This medication is most commonly prescribed with a vitamin B6 supplement. D. Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain.
C. This medication is most commonly prescribed with a vitamin B6 supplement. -------------- Explanation: All the other answers are correct
As the nurse you know that Parkinson's Disease tends to affect the _____________ of the midbrain, which leads to the depletion of the neurotransmitter _______________ A. red nucleus, acetylcholine B. leminisci, norepinephrine C. substantia nigra, dopamine D. tectum nigra, dopamine
C. substantia nigra, dopamine
A patient diagnosed with multiple sclerosis (MS) is prescribed baclofen (Gablofen). Which question will the healthcare provider ask when evaluating the effectiveness of the medication? a) "Has the stiffness in your muscles decreased?" b) "Did you have a bowel movement this morning?" c) "Are you feeling stronger and less fatigued today?" d) "Have you been able to urinate without difficulty?"
a) "Has the stiffness in your muscles decreased?"
The nurse has been educating a client newly diagnosed with MS. Which statement by the client indicates an understanding of the education? a) "I will stretch daily as directed by the physical therapist." b) "The exercises should be completed quickly to reduce fatigue." c) "I should participate in non-weight-bearing exercises." d) "I will take hot tub baths to decrease spasms."
a) "I will stretch daily as directed by the physical therapist." ----------------------------------------- Explanation: A stretching routine should be established. Stretching can help prevent contractures and muscle spasticity.
A patient with a diagnosis of Parkinson disease (PD) has been prescribed levodopa. Which of the following statements will the healthcare provider include when teaching the patient about this medication? Select all that apply. a) "Let us know if you notice if the medication begins to lose its effectiveness" b) "Call our office if you notice the development of a tic or facial grimace" c) "If you experience nausea, you may take you medication with a high protein meal" d) "This medication will reverse the disease process and give you a normal life" e) "It may take a few months for you to experience the full effects of the medication."
a) "Let us know if you notice if the medication begins to lose its effectiveness" b) "Call our office if you notice the development of a tic or facial grimace" e) "It may take a few months for you to experience the full effects of the medication."
A client with Parkinson's disease asks the nurse what their treatment is supposed to do since the disease is progressive. What would be the nurse's best response? a) "Treatment aims at keeping you independent as long as possible." b) "Treatment aims at keeping you emotionally healthy by making you think you are doing something to fight this disease." c) "Treatment for Parkinson's is only palliative; it keeps you comfortable." d) "Treatment really doesn't matter; the disease is going to progress anyway."
a) "Treatment aims at keeping you independent as long as possible." -------------------------------------- Explanation: Treatment aims at prolonging independence. Treatment does matter, it is not palliative, and it is not aimed at keeping you emotionally healthy.
Myasthenia gravis occurs when antibodies attack which receptor sites? a) Acetylcholine b) Dopamine c) Gamma-aminobutyric acid d) Serotonin
a) Acetylcholine ------------------------------------- Explanation: In myasthenia gravis, antibodies directed at the acetylcholine receptor sites impair transmission of impulses across the myoneural junction.
Which nursing intervention is appropriate for a client with double vision in the right eye due to MS? a) Apply an eye patch to the right eye. b) Place needed items on the right side. c) Administer eye drops as needed. d) Exercise the right eye twice a day.
a) Apply an eye patch to the right eye. ------------------------------- Explanation: An eye patch to the affected eye would help the client with double vision see more clearly, thus promoting safety.
A nurse is instructing a client regarding Carbidopa-levodopa (Sinemet) for the treatment of Parkinson's disease. The nurse tells the client that which of the following is a side effect of the medication? a) Difficulty performing a voluntary movement. b) Increased blood pressure. c) Increased heart rate. d) Itchiness of the skin.
a) Difficulty performing a voluntary movement. -------------------------------------- Explanation: -Dyskinesia (difficulty performing a voluntary movement) is one of the symptoms of a levodopa overdose. -Other side effects include nausea, diarrhea, vomiting, hypotension, bradycardia, confusion and hallucinations.
The diagnosis of multiple sclerosis is based on which test? a) Magnetic resonance imaging b) CSF electrophoresis c) Evoked potential studies d) Neuropsychological testing
a) Magnetic resonance imaging --------------------------------------- Explanation: The diagnosis of MS is based on the presence of multiple plaques in the central nervous system observed with magnetic resonance imaging.
A patient diagnosed with multiple sclerosis (MS) has ataxia. Which of the following medications could be used to treat this clinical manifestation? a) Neurontin b) Baclofen c) Dantrium d) Valium
a) Neurontin ----------------------------------- Explanation: Ataxia is a chronic problem most resistant to treatment. -Medications used to treat ataxia include beta-adrenergic blockers (Inderal), antiseizure agents (Neurontin), and benzodiazepines (Klonopin). -Baclofen, Dantrium, and Valium are used in the treatment of spasticity.
A student is assisting the healthcare provider with the care of a patient diagnosed with multiple sclerosis (MS). The student correctly identifies which of the following as part of the pathophysiological process of MS? a) Scarring and plaque development b) Hypoxic damage to cerebral tissue c) Deficiency of acetylcholine at the neuromuscular junction d) Axonal loss in the CNS e) Myelin regeneration and remission of symptoms f) Autoimmune damage to myelin sheath
a) Scarring and plaque development d) Axonal loss in the CNS e) Myelin regeneration and remission of symptoms f) Autoimmune damage to myelin sheath
The home health nurse is caring for a client with Parkinson's disease. The nurse understands that the purpose of adding selegiline with carbidopa-levodopa to the medication regime should result in which purpose? a) Slows the progression of the disease b) Replaces dopamine c) Prevents side effects from carbidopa-levodopa d) Relieves symptoms of dyskinesia
a) Slows the progression of the disease ------------------------------------- Explanation: -Selegiline increases dopaminergic activity and slows the progression of the disease. -Carbidopa-levodopa is a dopamine replacement drug. -Anticholinergic drugs are used to reduce the symptoms of dyskinesia and other side effects.
The nurse is assessing a 37-year-old client diagnosed with multiple sclerosis. Which of the following symptoms would the nurse expect to find? a) Vision changes b) Absent deep tendon reflexes c) Tremors at rest d) Flaccid muscles
a) Vision changes ----------------------------------- Explanation: Vision changes, such as diplopia, nystagmus, and blurred vision, are symptoms of multiple sclerosis.
A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by: a) a positive edrophonium (Tensilon) test. b) Kernig's sign. c) a positive sweat chloride test. d) Brudzinski's sign.
a) a positive edrophonium (Tensilon) test. ------------------------------------ Explanation: -A positive edrophonium test confirms the diagnosis of myasthenia gravis. -After edrophonium administration, most clients with myasthenia gravis show markedly improved muscle tone.
A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order: a) electromyography (EMG). b) Doppler ultrasonography. c) Doppler scanning. d) quantitative spectral phonoangiography.
a) electromyography (EMG). ------------------------------ Explanation: To help confirm ALS, the physician typically orders EMG, which detects abnormal electrical activity of the involved muscles.
A nurse is teaching a client with multiple sclerosis (MS). When teaching the client how to reduce fatigue, the nurse should tell the client to: a) rest in an air-conditioned room. b) avoid naps during the day. c) increase the dose of muscle relaxants. d) take a hot bath.
a) rest in an air-conditioned room. ------------------------------------ Explanation: -Fatigue is a common symptom in clients with MS. Lowering the body temperature by resting in an air-conditioned room may relieve fatigue; however, extreme cold should be avoided. -A hot bath or shower can increase body temperature, producing fatigue. -Muscle relaxants, ordered to reduce spasticity, can cause drowsiness and fatigue. -Frequent rest periods and naps can relieve fatigue. -Other measures to reduce fatigue in the client with MS include treating depression, using occupational therapy to learn energy-conservation techniques, and reducing spasticity.
The nurse cautions clients with ALS and their families to be aware that: (Select all that apply) a. activities should be spaced throughout the day. b. clients experience incontinence, an early cause of falling. c. cognition will usually decline late in the disease. d. muscle weakness may cause a risk for injury.
a. activities should be spaced throughout the day. d. muscle weakness may cause a risk for injury.
Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem? a) Huntington disease b) Amyotrophic lateral sclerosis c) Parkinson disease d) Alzheimer disease
b) Amyotrophic lateral sclerosis
A client is undergoing testing to confirm a diagnosis of myasthenia gravis. The nurse explains that a diagnosis is made if muscle function improves after the client receives an IV injection of a medication. What is the medication the nurse tells the client he'll receive during this test? a) Azathioprine (Imuran) b) Edrophonium (Tensilon) c) Cyclosporine (Sandimmune) d) Immunoglobulin G (Iveegam EN)
b) Edrophonium (Tensilon)
A client is experiencing muscle weakness and an ataxic gait. The client has a diagnosis of multiple sclerosis (MS). Based on these symptoms, the nurse formulates "Impaired physical mobility" as one of the nursing diagnoses applicable to the client. What nursing intervention should be most appropriate to address the nursing diagnosis? a) Use a footboard and trochanter rolls. b) Help the client perform range-of-motion (ROM) exercises every 8 hours. c) Use pressure-relieving devices when the client is in bed or in a wheelchair. d) Change body position every 2 hours.
b) Help the client perform range-of-motion (ROM) exercises every 8 hours. ---------------------------------------- Explanation: Helping the client perform ROM exercises every 8 hours helps in promoting joint flexibility and muscle tone in a client with muscle weakness.
Which nursing diagnosis takes the highest priority for a client with parkinsonian crisis? a) Imbalanced nutrition: Less than body requirements b) Ineffective airway clearance c) Impaired urinary elimination d) Risk for injury
b) Ineffective airway clearance ------------------------------------- Explanation: In parkinsonian crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. -A client confined to bed during such a crisis is at risk for aspiration and pneumonia. -Also, excessive drooling increases the risk of airway obstruction.
The nursing assistant reports to you, the RN, that the patient with myasthenia gravis (MG) has an elevated temperature (102.20 F), heart rate of 120/minute, rise in blood pressure (158/94), and was incontinent off urine and stool. What is your best first action at this time? a) Administer an acetaminophen suppository. b) Notify the physician immediately. c) Recheck vital signs in 1 hour. d) Reschedule patient's physical therapy.
b) Notify the physician immediately. ------------------------------------- Explanation: The changes that the nursing assistant is reporting are characteristics of myasthenia crisis, which often follows some type of infection. The patient is at risk for inadequate respiratory function.
The most common cause of cholinergic crisis includes which of the following? a) Compliance with medication b) Overmedication c) Infection d) Undermedication
b) Overmedication ------------------------------------- Explanation: A cholinergic crisis, which is essentially a problem of overmedication, results in severe generalized muscle weakness, respiratory impairment, and excessive pulmonary secretion that may result in respiratory failure.
A patient with amyotrophic lateral sclerosis (ALS) asks if the nurse has heard of a drug that will prolong the patient's life. The nurse knows that there is a medication that may prolong the life by 3 to 6 months. To which medication is the patient referring? a) Dantrolene sodium b) Riluzole c) Baclofen d) Diazepam
b) Riluzole -------------------------------------- Explanation: Riluzole, a glutamate antagonist, has been shown to prolong survival for persons with ALS for 3 to 6 months.
The nurse is assisting with administering a Tensilon test to a patient with ptosis. If the test is positive for myasthenia gravis, what outcome does the nurse know will occur? a) The patient will have recovery of symptoms for at least 24 hours after the administration of the Tensilon. b) Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes. c) Eight hours after administration, the acetylcholinesterase begins to regenerate the available acetylcholine and will relieve symptoms. d) After administration of the medication, there will be no change in the status of the ptosis or facial weakness.
b) Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes.
A client is being treated in the clinic for an exacerbation of multiple sclerosis. The nurse would anticipate administering which drug? a. Diazepam (Valium) b. Interferon b1b (Betaseron) c. Lioresal (Baclofen) d. Methylprednisolone (Solu-Cortef)
b. Interferon b1b (Betaseron) ------------------------------------ Explanation: Drugs used to treat exacerbations in ambulatory clients include Interferon b1b, Interferon b1a (Avonex), and glatiramer acetate (Copaxone). Diazepam and lioresal could be used to treat spasticity, while steroids are used for acute relapses.
A patient diagnosed with multiple sclerosis (MS) tells the healthcare provider, "I'm not sure if I'll be able to exercise anymore." Which of these is the most appropriate response? a) "It's important for you to conserve your strength by not being too active." b) "You should get a personal trainer to help you plan a fitness program." c) "Swimming or exercising in the water can be both enjoyable and beneficial." d) "Exercise often causes a relapse of the disease, so it should be avoided."
c) "Swimming or exercising in the water can be both enjoyable and beneficial."
A client with myasthenia gravis is admitted with an exacerbation. The nurse is educating the client about plasmapherisis and explains this in which of the following statements? a) Immune globulin is given intravenously. b) The thymus gland is removed. c) Antibodies are removed from the plasma. d) Mestinon therapy is initiated.
c) Antibodies are removed from the plasma. ----------------------------- Explanation: Plasmapheresis is a technique in which antibodies are removed from plasma and the plasma is returned to the client.
Which drug should be available to counteract the effect of edrophonium chloride? a) Pyridostigmine bromide b) Azathioprine c) Atropine d) Prednisone
c) Atropine
A client is who is receiving edrophonium chloride suddenly is complaining of abdominal cramps and the nurse observes the client is experiencing increased perspiration and salivation. The nurse makes sure the availability of which of the following? a) Levodopa. b) Methylphenidate hydrohloride (Ritalin). c) Atropine sulfate. d) Carbamazepine (Tegretol)
c) Atropine sulfate. ----------------------------- Explanation: The client is experiencing signs of cholinergic crisis. When administering edrophonium chloride, have emergency resuscitation equipment on hand and atropine sulfate available.
A patient is exhibiting bradykinesia, rigidity, and tremors related to Parkinson's disease. The nurse understands that these symptoms are directly related to what decreased neurotransmitter level? a) Acetylcholine b) Serotonin c) Dopamine d) Phenylalanine
c) Dopamine
The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding? a) Micrographia b) Hypokinesia c) Dysphonia d) Dysphagia
c) Dysphonia ----------------------------------- Explanation: Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.
A client with a neurological impairment experiences urinary incontinence. Which nursing action should help the client adapt to this alteration? a) Using adult diapers b) Inserting a Foley catheter c) Establishing a toileting schedule d) Padding the bed with an absorbent cotton pad
c) Establishing a toileting schedule ---------------------------------------- Explanation: A bladder retraining program, such as use of a toileting schedule, may be helpful to clients experiencing urinary incontinence. A Foley catheter should be used only when necessary because of risk of infection. Use of diapers or pads is the least acceptable alternative because the risk of skin breakdown exists.
A client is admitted to the hospital with pneumonia. He has a history of Parkinson disease, which his family says is worsening. Which assessment should the nurse expect? a) Muscle flaccidity b) Pleasant and smiling demeanor c) Impaired speech d) Tremors in the fingers that increase with purposeful movement
c) Impaired speech ------------------------------------ Explanation: -In Parkinson's disease, dysarthria, or impaired speech, results from a disturbance in muscle control. -Muscle rigidity, not flaccidity, causes resistance to passive muscle stretching. -The client may exhibit a masklike appearance rather than a pleasant and smiling demeanor. -Tremors should decrease, not increase, with purposeful movement and sleep.
All of the following statements about amyotrophic lateral sclerosis are true except: a) It causes degeneration and death of upper and lower motor neurons b) Patients lose strength and control of voluntary muscles c) It impairs cognition and senses d) It progresses rapidly and is fatal
c) It impairs cognition and senses
Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of small patches of demyelination in the brain and spinal cord? a) Huntington disease b) Creutzfeldt-Jakob disease c) Multiple sclerosis d) Parkinson disease
c) Multiple sclerosis
A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: a) Getting too little exercise b) Taking excess medication c) Omitting doses of medication d) Increasing intake of fatty foods
c) Omitting doses of medication -------------------------------------- Explanation: Myasthenic crisis often is caused by undermedication and responds to the administration of cholinergic medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon).
A patient diagnosed with MS 2 years ago has been admitted to the hospital with another relapse. The previous relapse was followed by a complete recovery with the exception of occasional vertigo. What type of MS does the nurse recognize this patient most likely has? a) Primary progressive b) Benign c) Relapsing-remitting (RR) d) Disabling
c) Relapsing-remitting (RR) -------------------------------------- Explanation: Approximately 85% of patients with MS have a relapsing-remitting (RR) course. With each relapse, recovery is usually complete; however, residual deficits may occur and accumulate over time, contributing to functional decline.
The healthcare provider is teaching a patient with a new diagnosis of Parkinson disease (PD) about lifestyle changes to make the disease more manageable. Which of the following will the healthcare provider include in the teaching? Select all that apply. a) Maintain a low calorie, low fat diet b) wear shoes with rubber soles c) perform ROM exercises daily d) choose clothing that doesn't require buttons e) eat small, frequent meals
c) perform ROM exercises daily d) choose clothing that doesn't require buttons e) eat small, frequent meals
The most helpful intervention by the nurse for a client experiencing a parkinsonian crisis would be to: a. administer oxygen by nasal catheter. b. give the client IV fluids that contain potassium. c. place the client in a nonstimulating environment. d. provide the client with foods high in calcium.
c. place the client in a nonstimulating environment. -------------------------------------- Explanation: Occasionally, clients with PD experience a parkinsonian crisis as a result of emotional trauma or sudden or inadvertent withdrawal of anti-parkinsonian medication. Severe exacerbation of tremor, rigidity, and bradykinesia, accompanied by acute anxiety, sweating, tachycardia, and hyperpnea occur. The client should be placed in a quiet room with subdued lighting. Medical treatment may include barbiturates in addition to anti-parkinsonian drugs.
The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe? a) Loss of proprioception b) Numbness c) Patchy blindness d) Diplopia and ptosis
d) Diplopia and ptosis --------------------------------- Explanation: -The initial manifestation of myasthenia gravis involves the ocular muscles, such as diplopia and ptosis. -The remaining choices relate to multiple sclerosis.
A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following? a) Bradykninesia b) Dysphonia c) Micrographia d) Dyskinesia
d) Dyskinesia ------------------------------------ Explanation: Most clients within 5 to 10 years of taking levodopa develop a response to the medication called dyskinesia, manifested as ~facial grimacing ~rhythmic jerking movements of the hands ~head bobbing ~chewing and smacking movements ~involuntary movements of the trunk and extremities.
Which topic is most important for the nurse to include in the teaching plan for a client newly diagnosed with Parkinson's disease? a) Enhancement of the immune system b) Involvement with diversion activities c) Establishing balanced nutrition d) Maintaining a safe environment
d) Maintaining a safe environment
The nurse teaches the client with which disorder that the disease is due to decreased levels of dopamine in the basal ganglia of the brain? a) Multiple sclerosis b) Creutzfeldt-Jakob disease c) Huntington disease d) Parkinson disease
d) Parkinson disease
55-year-old female client presents at the walk-in clinic complaining of feeling like a mask is on her face. While doing the initial assessment, the nurse notes the demonstration of a pill-rolling movement in the right hand and a stooped posture. Physical examination shows bradykinesia and a shuffling gait. What would the nurse suspect is the causative factor for these symptoms? a) Multiple sclerosis b) Myesthenia gravis c) Huntington's disease d) Parkinson's disease
d) Parkinson's disease
A client in a long-term nursing facility has severe dysphagia. Which of the following would best assist this client in preventing further complications? a) Placement of a colostomy tube b) Placement of a urinary catheter c) Placement of a tracheostomy tube d) Placement of a feeding tube
d) Placement of a feeding tube ------------------------------------ Explanation: Clients with severe dysphagia have difficulty swallowing and are at risk for aspiration. A feeding tube may need to be placed if the deficit is prolonged and if the client is unable to eat.
The patient with multiple sclerosis tells the nursing assistant that after physical therapy she is too tired to take a bath. What is your priority nursing diagnosis at this time? a) Fatigue related to disease state b) Activity Intolerance due to generalized weakness c) Impaired Physical Mobility related to neuromuscular impairment d) Self-care Deficit related to fatigue and neuromuscular weakness
d) Self-care Deficit related to fatigue and neuromuscular weakness
The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by: a) Eating large, well-balanced meals b) Doing muscle-strengthening exercises c) Doing all chores early in the day while less fatigued d) Taking medications on time to maintain therapeutic blood levels
d) Taking medications on time to maintain therapeutic blood levels
