Patho/Pharm Week 4
Which current multiple sclerosis drug treatments are designed to slow the progress of myelin degeneration? Antidepressants Immunomodulators Antibiotics Anticonvulsants
Immunomodulators Immunomodulators reduce inflammation and improve nerve conduction, thus improving outcomes of disease.
The registered nurse (RN) is giving home care instructions to a client who was treated for injuries due to a fall. Which statement made by the client indicates a need for additional instruction?" I should walk on soft scatter rugs at home." 2"I should drink 3000 mL of water every day." 3"I should eat fruits and vegetables six times a day." 4"I should exercise the joints above and below the cast daily."
"I should walk on soft scatter rugs at home." A client with injuries due to a fall must avoid having throw or scattered rugs at home to reduce the incidence of falls. The registered nurse (RN) would encourage the client to drink 3000 mL of water per day to promote optimal bladder and bowel function. The client would eat six small meals with foods rich in fiber, such as fruits and vegetables, to prevent constipation. The RN has to encourage the client to perform exercise above and below the cast daily for a speedy recovery.
Which is a common cognitive problem associated with Parkinson's disease? 1. Emotional lability. 2. Depression. 3. Memory deficits. 4. Paranoia.
3. Memory deficits are cognitive impairments. The client may also develop a dementia.
The nurse enters the room of a client diagnosed with acute exacerbation of multiple sclerosis and finds the client crying. Which statement is the most therapeutic response for the nurse to make? 1. "Why are you crying? The medication will help the disease." 2. "You seem upset. I will sit down and we can talk for awhile." 3. "Multiple sclerosis is a disease that has good times and bad times." 4. "I will have the chaplain come and stay with you for a while
2.This is stating a fact and offering self. Both are therapeutic techniques for conversations. 1. "Why" is requesting an explanation, and the client does not owe the nurse an explanation. 3. The client did not ask about the nature of MS. The client needs to be able to verbalize feelings. 4. This is "passing the buck." Therapeutic communication is an integral part of nursing.
The client diagnosed with PD is being discharged on carbidopa/levodopa (Sinemet),an antiparkinsonian drug. Which statement is the scientific rationale for combining these medications? 1. There will be fewer side effects with this combination than with carbidopa alone. 2. Dopamine D requires the presence of both of these medications to work. 3. Carbidopa makes more levodopa available to the brain. 4. Carbidopa crosses the blood-brain barrier to treat Parkinson's disease.
3. Carbidopa enhances the effects of levodopa by inhibiting decarboxylase in the periphery, thereby making more levodopa available to the central nervous system. Sinemet is the most effective treatment for PD.
Which phase of bone healing does continued growth of the callus occur? 1. Hematoma Formation 2. Remodeling Phase 3. Reparative Phase 4. Inflammatory Phase
3. Reparative Phase In hematoma formation, the hematoma develops from torn blood vessels in the periosteum and adjacent muscles and soft tissue. In the inflammatory phase, clot is invaded by blood vessels and fibrosis-fibrin mesh-development of fibroblasts and capillary buds-osteoblasts begin to synthesize bone-granulation tissue creates callus In the remodeling phase, osteoclastic and osteoblastic functions continue at a rapid rate until the fracture site is healed and bone is reconstructed
The client diagnosed with Parkinson's disease is being discharged. Which statement made by the significant other indicates an understanding of the discharge instructions? 1. "All of my spouse's emotions will slow down now just like his body movements." 2. "My spouse may experience hallucinations until the medication starts working." 3. "I will schedule appointments late in the morning after his morning bath." 4. "It is fine if we don't follow a strict medication schedule on weekends."
3. Scheduling appointments late in the morning gives the client a chance to complete ADLs without pressure and allows the medications time to give the best benefits.
The 30-year-old female client is admitted with complaints of numbness, tingling, a crawling sensation affecting the extremities, and double vision which has occurred two(2) times in the month. Which question is most important for the nurse to ask the client? 1. "Have you experienced any difficulty with your menstrual cycle?" 2. "Have you noticed a rash across the bridge of your nose?" 3. "Do you get tired easily and sometimes have problems swallowing?" 4. "Are you taking birth control pills to prevent conception?"
3.These are clinical manifestation of MS and can go un diagnosed for years be-cause of the remitting-relapsing nature of the disease. Fatigue and difficulty swallowing are other symptoms of MS. 1. MS does not affect the menstrual cycle. 2. A rash across the bridge of the nose suggests systemic lupus erythematosus 4. Taking birth control medications should not produce these symptoms or the pattern of occurrence.
The nurse is planning the care for a client diagnosed with Parkinson's disease. Which would be a therapeutic goal of treatment for the disease process? 1. The client will experience periods of akinesia throughout the day. 2. The client will take the prescribed medications correctly. 3. The client will be able to enjoy a family outing with the spouse. 4. The client will be able to carry out activities of daily living.
4. The client will be able to carry out activities of daily living. The major goal of treating PD is to maintain the ability to function. Clients diagnosed with PD experience slow, jerky movements and have difficulty performing routine daily tasks.
The nurse recognizes that the primary indication for the administration of morphine is to do what? A. Relieve pain B. Reduce anxiety C. Treat left ventricular failure D. Decrease level of consciousness
A. Relieve pain The principal indication for morphine is relief of moderate to severe pain. The drug can relieve postoperative pain, the chronic pain of cancer, and pain associated with labor and delivery. In addition, morphine can be used to relieve pain of myocardial infarction and dyspnea associated with left ventricular failure and pulmonary edema. Morphine may also be administered before surgery for sedation and reduction of anxiety.
After a below-the-knee amputation, a client is refusing to eat, talk, or perform any rehabilitative activities. Which approach would the nurse take when interacting with this client? 1 Explain why there is a need to increase activity. 2 Emphasize that with a prosthesis, there will be a return to the previous lifestyle. 3 Appear cheerful and noncritical regardless of the client's response to attempts at intervention. 4 Acknowledge that the client's withdrawal is an expected and necessary part of initial grieving
Acknowledge that the client's withdrawal is an expected and necessary part of initial grieving. The withdrawal provides time for the client to assimilate what has occurred and to integrate the change in body image. The client is not ready to hear explanations about why there is a need to increase activity until assimilation of the surgery has occurred. Emphasizing a return to the previous lifestyle does not acknowledge that the client must grieve; it also does not allow the client to express any feelings that life will never be the same again. In addition, it may be false reassurance. The client might feel that the nurse has no comprehension of the situation or understanding of feelings if the nurse appears cheerful and noncritical regardless of the client's response to attempts at intervention.
Which finding during a home health visit would prompt the nurse to provide a client with home safety instructions? Select all that apply. One, some, or all responses may be correct. 1 Area rugs on the floor 2 Clogged, dirty fireplace 3 Multiple electrical cords 4 Multiple prescribed medications 5 Wheeled walker with uneven leg
All are correct. There are multiple potential hazards in the home clients should be educated about to avoid injury. Area rugs and multiple electrical cords on the floor pose a fall risk. A clogged, dirty fireplace could lead to carbon monoxide poisoning. Polypharmacy can cause mental status changes, confusion, and orthostatic blood pressure changes; these can increase the client's fall risk. If the nurse observes a wheeled walker with uneven legs, the physical therapist would be notified as they can follow-up to evaluate the mobility aid's safety.
A client has just been diagnosed with multiple sclerosis (MS). The nurse recognizes that the client's condition is a result of: 1. 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 2, Degenerative changes in the musculoskeletal system 3. Degeneration of the lower cell bodies of the lower motor neurons in the gray matter 4. Circulating antibodies attacking the postsynaptic acetylcholine levels
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 MS is an immune response against the components of the myelin sheath. There is a progressive demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and the optic nerve. The other options do not describe MS.
In preparing an inservice about opioids, the nurse includes which problem as the most serious adverse effect? A. Suppressed cardiac automaticity B. Respiratory depression C. Profound sedation D. Hyperthermia
B. Respiratory depression Respiratory depression is the most serious adverse effect of the opioids. At equianalgesic doses, all of the pure opioid agonists depress respiration to the same extent. Death following overdose is almost always a result of respiratory arrest.
The nurse correlates orthostatic hypotension resulting from opioid administration with which cause? A. Decreased heart rate B. Impaired contractility C. Dilation of peripheral veins D. Elevated circulating catecholamines
C. Dilation of peripheral veins Morphine-like drugs lower blood pressure by blunting the baroreceptor reflex and by dilating peripheral arterioles and veins. Peripheral vasodilation results primarily from morphine-induced release of histamine. Hypotension is mild in the recumbent patient but can be substantial when the patient stands up
The nurse prepared to administer which drug to the patient with suspected opioid overdose? A. Glucose B. Caffeine C. Naloxone D. Tramadol
C. Naloxone Naloxone is the drug of choice for treating overdose with pure opioid agonists. The drug reverses respiratory depression, coma, and other signs of opioid toxicity. Naloxone can also reverse toxicity from agonist-antagonist opioids (e.g., pentazocine, nalbuphine). However, the doses required may be higher than those needed to reverse poisoning by pure agonists. Tramadol is a moderately strong analgesic with minimal potential for dependence, abuse, or respiratory depression. The drug relieves pain through a combination of opioid and nonopioid mechanisms.
A patient is admitted with the following vital signs: 37.6 °C, P 96, R 16, 140/90 mm Hg. If the patient is scheduled for a dose of opioid, which of the vital sign parameters would require an immediate intervention? A. Pulse rate of 110 B. Temperature of 38 °C C. Respiratory rate of 10 D. Blood pressure of 160/86 mm Hg
C. Respiratory rate of 10 Before an opioid is administered, respiratory rate, blood pressure, and pulse rate should be determined. The drug should be withheld and the physician notified if respiratory rate is at or below 12 breaths per minute, if blood pressure is significantly below the pretreatment value, or if pulse rate is significantly above or below the pretreatment value.
A 7-year-old child sustains a fractured femur in a bicycle accident. The admission x-ray films reveal evidence of fractures of other long bones in various stages of healing. Which would the nurse suspect as the cause of the fracture? 1 Child abuse 2 Vitamin D deficiency 3 Osteogenesis imperfecta 4 Inadequate calcium intake
Child abuse Injuries in various stages of healing are the classic sign of child abuse. Vitamin D deficiency, osteogenesis imperfecta, and inadequate calcium intake may all be investigated after child abuse has been ruled out.
A 73-year-old patient who sustained a right hip fracture in a fall requests pain medication from the nurse. Based on his injury, which type of pain is this patient most likely experiencing? a.Phantom b.Visceral c.Deep somatic d.Referred
Deep somatic
Which statement best describes the pathophysiology of Parkinson disease Failure of the cerebral cortex, which does not allow the use of acetylcholine Increase in the number of dopamine receptors by an alternate basal ganglion Degeneration of the nigrostriatal dopamine system Rise in acetylcholine levels, causing an inhibition of voluntary movement
Degeneration of the nigrostriatal dopamine system Parkinson disease presents with degenerative changes in the basal ganglia. Dopamine depletion results from degeneration in the nigrostriatal system. The cause of Parkinson disease is still unknown; it is widely believed that most cases are caused by an interaction of environmental and genetic factors.
Motor pathway that involves fibers of the LMN (Lower Motor Neuron) and extensor muscles that do not intersect the pyramid neurons. Alterations to these pathways result in involuntary movements, rigidity, and immobility without paralysis Pyramidal Extrapyramidal
Extrapyramidal
A nurse working in a busy orthopedic clinic is asked to perform the Tinel sign on a client having problems in her hand/wrist. In order to test Tinel sign, the nurse should give the client which direction? Hold your wrist in complete flexion, keep it in this position for 60 seconds. How does your hand feel after placing it in a neutral position? Stand tall, arms at your side, shut your eyes; place the tip of your index finger to your nose. 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? I'm going to tap this tuning fork; place it on the side of your thumb, then tell me what you are feeling in your hand and wrist.
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? A positive Tinel sign will help diagnose carpel tunnel syndrome. The client will have a tingling sensation radiating into the palm of the hand when lightly percussed over the median nerve at the wrist. The holding of the wrist in complete flexion is Phalen sign, which is also a test to help diagnose carpel tunnel syndrome.
Which is the basic unit of motor control? Motor Unit Spinal Cord Spinal Reflexes
Motor unit-Motor neuron and the associated muscle fibers
Which disease is thought to be caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction? Huntington disease Guillain-Barré syndrome Parkinson syndrome Myasthenia gravis
Myasthenia gravis Myasthenia gravis is an autoimmune disease caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction. Guillain-Barré syndrome is an acute immune-mediated polyneuropathy characterized by rapidly progressive, ascending symmetrical limb weakness and loss of tendon reflexes. Parkinson disease is a degenerative disorder of basal ganglia function associated with denervation of the nigrostriatal dopamine neurons. Huntington disease is a hereditary disorder which produces localized death of brain cells.
a progressive neurodegenerative condition caused by insufficient quantities of the neurotransmitter Dopamine in the brain, this deficiency causes motor and non-motor symptoms.
Parkinson's Disease
Which assessment of motor function should be included in a comprehensive physical assessment? Select all that apply. Spinal reflexes Body position Body mass index Coordination Muscle strength
Spinal reflexes Body position Coordination Muscle strength Assessment of motor function must include spinal reflexes; body position; coordination; muscle characteristics like strength, bulk, and tone; and involuntary movements. BMI is not pertinent.
A drug could be classified as an analgesic if it a. reduces fever. b. reduces swelling. c. reduces redness. d. reduces pain
a. reduces fever.
A patient is receiving morphine sulfate intravenously (IV) for right flank pain associated with a kidney stone in the right ureter. The patient also complains of right inner thigh pain and asks the nurse whether something is wrong with the right leg. In responding to the question, the nurse understands that the patient a.is experiencing referred pain from the kidney stone. b.has neuropathic pain from nerve damage caused by inflammation. c.has acute pain that may be progressing into chronic pain. d.is experiencing pain perception that has been affected by the morphine received earlier.
a.is experiencing referred pain from the kidney stone.
1. The health care provider plans to titrate a patient-controlled analgesia (PCA) machine to provide pain relief for a patient with acute surgical pain who has never received opioids in the past. Which of the following nursing actions regarding opioid administration are appropriate at this time (select all that apply)? a. Assessing for signs that the patient is becoming addicted to the opioid b. Monitoring for therapeutic and adverse effects of opioid administration c. Emphasizing that the risk of some opioid side effects increases over time d. Educating the patient about how analgesics improve postoperative activity level e. Teaching about the need to decrease opioid doses by the second postoperative day
b. Monitoring for therapeutic and adverse effects of opioid administration d. Educating the patient about how analgesics improve postoperative activity level Monitoring for pain relief and teaching the patient about how opioid use will improve postoperative outcomes are appropriate actions when administering opioids for acute pain. Although postoperative patients usually need decreasing amount of opioids by the second postoperative day, each patient's response is individual. Tolerance may occur, but addiction to opioids will not develop in the acute postoperative period. The patient should use the opioids to achieve adequate pain control, and so the nurse should not emphasize the adverse effects.
The nonsteroidal NSAIDs affect the COX-1 and COX-2 enzymes. By blocking COX-2 enzymes the NSAIDs block inflammation and the signs and symptoms of inflammation at the site of injury or trauma. By blocking COX-1 enzymes, these drugs block a. fever regulation. b. prostaglandins that protect the stomach lining. c. swelling in the periphery. d. liver function.
b. prostaglandins that protect the stomach lining.
A patient with chronic back pain is seen in the pain clinic for follow-up. In order to evaluate whether the pain management is effective, which question is best for the nurse to ask? .a. "Can you describe the quality of your pain?" b. "Has there been a change in the pain location?" c. "How would you rate your pain on a 0 to 10 scale?" d. "Does the pain keep you from doing things you enjoy?"
d. "Does the pain keep you from doing things you enjoy?" The goal for the treatment of chronic pain usually is to enhance function and quality of life. The other questions also are appropriate to ask, but information about patient function is more useful in evaluating effectiveness.
A patient who uses a fentanyl (Duragesic) patch for chronic cancer pain complains to the nurse of the rapid onset of pain at a level 9 (0 to 10 scale) and requests "something for pain that will work quickly." The nurse will document this as a. somatic pain. b. referred pain. c. neuropathic pain. d.breakthrough pain.
d.breakthrough pain. Pain that occurs beyond the chronic pain already being treated by appropriate analgesics is termed breakthrough pain. Neuropathic pain is caused by damage to peripheral nerves or the central nervous system (CNS). Somatic pain is localized and arises from bone, joint, muscle, skin, or connective tissue. Referred pain is pain that is localized in uninjured tissue.
Which risk factors are highest when it comes to spinal cord injuries. Select all that apply Teens Middle Age Group high risk activities accidents elderly population
middle aged, high risk activities, accidents
