Patho PrepU Chp 36
Loss of diaphragm control would most likely occur with a spinal injury at which level?
C1-2
A middle-aged woman is brought to the emergency room after a minor auto accident. Her gait is staggering and unsteady, her speech is slurred, and she displays slight nystagmus. The police officer who brought her in says she has not been drinking. Her blood pressure is very high. Which of the following health problems most likely underlies her present state?
Cerebellar damage caused by a cerebrovascular accident
A client had an arm cast fitted after suffering a right humeral fracture in a hockey game. The client reported a loss of sensation in the right hand, but sensation returned upon removal of the cast. Which was the most likely cause of the client's loss of sensation?
Compression lesion of the musculocutaneous nerve.
Select the laboratory blood test that would be a used to suggest a diagnosis of muscular dystrophy (MD).
Creatine kinase
A client with Parkinson disease presents with bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain?
Dopamine nigrostriatal system
A client who sustained a complete C6 spinal cord injury 6 months ago has been admitted to the hospital for pneumonia. The nurse observes the client with diaphoresis above the level of C6 and the blood pressure is 260/140 mm Hg. What is the first intervention the nurse should provide?
Elevate the head of the bed.
The underlying causative problem in Parkinsonism is which of the following?
Failure of dopamine release
Bradykinesia occurring in Parkinson's disease places the Parkinson's client most at risk for which of the following?
Falls and injury
A nurse is assessing a client with symptoms of botulism. The nurse will question the client regarding ingestion of which of the following?
Home-grown and canned vegetables
Reflexes are basically "hard-wired" into the CNS. Anatomically, the basis of a reflex is an afferent neuron that synapses directly with an effector neuron that causes muscle movement. Sometimes the afferent neuron synapses with what intermediary between the afferent and effector neurons?
Interneuron
Which of the following neurons connect sensory and motor neurons?
Interneurons
A client sustained a spinal cord injury and is immediately brought to the emergency department. The client asks the physician if there is any medication he can get to possibly help him, regardless of risks. The physician assesses the client and determines the most important medication to administer would be:
Methylprednisone
Antibiotics such as gentamicin can produce a disturbance in the body that is similar to botulism by preventing the release of acetylcholine from nerve endings. In persons with preexisting neuromuscular transmission disturbances, these drugs can be dangerous. What disease falls into this category?
Myasthenia gravis
Which of the following diseases is associated with fewer acetylcholine receptors, resulting in a lower-amplitude endplate potential, muscle weakness, and fatigability?
Myasthenia gravis
The brain stem contains gray matter that is made up of which of the following?
Neurons
A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as:
Normal manifestations of Parkinson disease
After being thrown off the back of a bull, the bull rider can move their arms but has loss of motor function in the lumbar and sacral segments of the spinal cord. This is usually referred to as being a:
Paraplegia.
Guillain-Barré syndrome is characterized by which of the following forms of neuron damage?
Polyneuropathy
Which of the following treatments should take place immediately in a patient experiencing autonomic dysreflexia?
Position the patient in upright position, and correct the initiating stimulus.
The nurse is performing an assessment for a client suspected of having symptoms that correlate with carpal tunnel disorder. The client states he feels a tingling sensation that radiates into the palm of the hand when the nurse lightly percusses over the median nerve. How would the nurse document this finding?
Positive Tinel sign
A patient is asked to stand with feet together, eyes open and hands by the sides. Then the patient is asked to close their eyes while the nurse observes for a full minute. What assessment is the nurse performing?
Proprioception.
The parent of a toddler with Duchenne muscular dystrophy reports that the child has an increase in muscle size but a decrease in strength. The nurse documents this using which of the following medical terms?
Pseudohypertrophy
A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which of the following can best explain this?
Psychological manifestation due to involvement of white matter of cerebral cortex
Amyotrophic lateral sclerosis is considered a disease of the upper motor neurons. What is the most common clinical presentation of amyotrophic lateral sclerosis?
Rapidly progressive weakness and atrophy in distal muscles of both upper extremities
Nystagmus due to cerebellar dysfunction would most likely interfere with which activity?
Reading
Death caused by muscular dystrophy in early adulthood is usually due to which of the following?
Respiratory and cardiac muscle involvement
Which of the following complications of spinal cord injury is the most preventable in a paraplegic patient?
Skin breakdown
The nurse is caring for a client with myasthenia gravis. Which symptoms displayed by the client would indicate to the nurse that the client may be experiencing mysasthenia crisis?
The client has a sudden onset of severe weakness.
A client has been recovering from a stroke for several weeks and has been reluctant to participate in physical therapy. As a result, the client has experienced disuse atrophy. The nurse should recognize that the client is experiencing the consequences of which physiologic process?
The diameter of the client's muscle cells has decreased
A nurse is providing education to a client newly diagnosed with Guillain-Barre' syndrome. Which statement reflects accurate information about the course of the disease?
The disorder may present with rapid life-threatening symptoms or may present as a slow insidious process.
A client comes to the clinic and informs the nurse that he believes he is suffering from Parkinson's disease. What objective data assessed by the nurse would correlate with the client's concern? Select all that apply.
Tremor Rigidity Bradykinesia
A 70 year-old male has been diagnosed with a stroke that resulted in an infarct to his cerebellum. Which of the following clinical findings would be most closely associated with cerebellar insult?
Unsteady gait and difficulty speaking and swallowing
The nurse has just completed an assessment on a client admitted with Guillain-Barré syndrome. The nurse determines that a priority of care will be:
Ventilatory assessment and support
The friends and family members of a client who is being treated for a spinal cord injury are troubled by the appearance of the client's abnormal flexion and muscle spasticity. When explaining the reason for this phenomenon, the nurse should describe:
the client's muscle tone is no longer under the control of upper motor neurons.
The unique clinical presentation of a 3 month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis?
"Have you ever given your child any honey or honey-containing products?"
Which statement accurately reflects the typical person afflicted with multiple sclerosis (MS)?
A 25 year old woman
A 22 year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem?
A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins
What best explains symptoms of ALS including dysphagia, muscle weakness and spasticity, and dysphonia?
ALS is caused by both an upper motor neuron and lower motor neuron disturbance.
Reflex activity involves which of the following?
All of the above
A client has just been diagnosed with multiple sclerosis (MS). The nurse recognizes that the client's condition is a result of:
An immune-mediated response that is caused by the demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and optic nerve
Neurotoxins such as the botulism organism can produce paralysis by what mechanism?
By blocking release of acetylcholine
The nurse asks the client to hold her left wrist in complete flexion for approximately 1 minute. The client states she feels tingling and numbness when she does this, pointing to the medial nerve. What does the nurse anticipate the client will be prepared for after this assessment?
The client will be prepared for further diagnostic tests such as an electromyogram (EMG).
The health care provider is assessing a client for carpal tunnel syndrome. The health care provider performs light percussion over the median nerve at the wrist. This assessment is known as:
Tinel sign
In myasthenia gravis, periods of stress can produce myasthenic crisis. When does myasthenic crisis occur?
When muscle weakness becomes severe enough to compromise ventilation
A 60 year-old male office worker presents to a clinic complaining of new-onset of lower back pain that has been worsening over the last six weeks. The nurse knows which of the following components of his physical assessment and history is most indicative of a serious pathological process (like aortic aneurysm or cancer)?
His onset of pain has been gradual and he has no prior history of lower back problems.
The nurse is suctioning a client with a C3 spinal cord injury when the client's heart rate drops from 86 bpm to 42 bpm. What intervention does the nurse understand should be provided prior to suctioning to prevent this vasovagal response from occurring?
Hyperoxygenate prior to suctioning.
A 47 year-old woman was diagnosed with amyotrophic lateral sclerosis three years ago and has experienced a progressive onset and severity of complications. She has been admitted to a palliative care unit due to her poor prognosis? What assessments and interventions should the nursing staff of the unit prioritize in their care?
Assessment of swallowing ability and respiratory status.
When assessing the motor system, on which of the following will the nurse focus? Select all that apply.
Body position Presence of involuntary muscle movement Muscle strength Coordination
The nurse expects that loss of respiratory effort occurs with a spinal injury at which of the following levels?
C1-3
A client is experiencing pain, tingling, and numbness of the thumb and first, second, third, and half of the fourth digits of the hand. She states that she has pain in the wrist and hand, which worsens at night, and she has noticed that they have become clumsy. The nurse recognizes these manifestations as:
Carpal tunnel syndrome
Regarding the pathophysiology of Parkinson disease, which of the following statements is true?
Degeneration of the nigrostriatal dopamine neurons occurs.
Select the statement that best describes the pathophysiology of Parkinson disease.
Degeneration of the nigrostriatal dopamine system occurs.
Peripheral neuropathy occurs most commonly with which one of the following disorders?
Diabetes
A client affected by postural hypotension will likely display what symptoms?
Dizziness and pallor when moved to upright position
A nurse working in a busy orthopedic clinic is asked to perform the Tinel sign on a patient having problems in their hand/wrist. In order to test Tinel sign, the nurse should give the patient which of the following directions?
I'm going to tap (percuss) over the median nerve in your wrist, tell me what sensation you feel while I am doing this. Does the sensation stay in the wrist or go anywhere else?
The geriatrician providing care for a 74 year-old man with diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem?
Increasing the functional ability of the underactive dopaminergic system.
Myasthenic crisis may be precipitated by which of the following? Select all that apply.
Infection Pregnancy Surgery
A client who has experienced a spinal cord injury still has use of the arms and has impaired motor and sensory function of the trunk, legs, and pelvic organs. The injury would be classified as:
Paraplegia
What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia?
Parkinson disease
A comprehensive assessment of motor function must include which of the following? Select all that apply.
Spinal reflexes Body position Coordination Muscle characteristics
