Neurological Disorders
Q. Client reports numbness and tingling & blurred vision. CT scan show disruption in myelin sheath in the CNS. The nurse knows that the client has
A. Rationale: MS is a chronic CNS disorder in which myelin and nerve axons in brain and spinal cord are destroyed.
A client is admitted with Parkinson's disease. The client's face is expressionless and monotone speech. Which of the following observation of the nurse is most accurate?
A. Client is most likely depressed and should be left alone
B. These are common symptoms of Parkinson's that produce an undesired fasade of an alert and responsive individual
C. The client's antipsychotic med may need to be adjusted
D. The client probably has dementia
B. Rationale: The nurse should recognize these are common symptoms of Parkinson's disease.
A sudden, uncontrolled electrical disturbance in the brain. It can cause changes in your behavior, movements or feelings, and in levels of consciousness.
A. Meningitis
B. Huntington's Disease
C. Seizure
D. Parkinson's Disease
C. Seizures
The client is admitted to the hospital with a diagnosis of Guillain-Barré syndrome. Which past medical history finding makes the client most at risk for this disease?
A. Meningitis or encephalitis during the last 5 years
B. Seizures or trauma to the brain within the last year
C. Back injury or trauma to the spinal cord during the last 2 years
D. Respiratory or gastrointestinal infection during the previous month
D. Rationale: Guillain-Barré syndrome is a clinical syndrome of unknown origin that involves cranial and peripheral nerves. Many clients report a history of respiratory or gastrointestinal infection in the 1 to 4 weeks before the onset of neurological deficits. On occasion, the syndrome can be triggered by vaccination or surgery.
Carbidopa/Levodopa (Sinemet) is prescribed for client with Parkinson’s Disease. The nurse monitors the client for adverse effects to the medication. Which finding indicates that the client is experiencing an adverse effect?
A.Pruritus
B. Tachycardia
C. Hypertension
D. Impaired voluntary movement
D. RATIONALE: Dyskinesia and impaired voluntary movement may occur with high levodopa dosages.
Name the neurodegenerative disorder that affects predominately dopamine-producing (“dopaminergic”) neurons in a specific area of the brain called substantia nigra?
A. MS
B. Huntington's Disease
C. Myasthenia Gravis
D. Parkinson Disease
D Rationale: Parkinson is a neurodegenerative disorder that affects predominately dopamine-producing (“dopaminergic”) neurons in a specific area of the brain called substantia nigra.
When evaluating the extent of Parkinson's disease, a nurse observes for which condition?
A. Bulging eyeballs
B. Diminished distal sensation
C. Increase dopamine levels
D. Muscle rigidity, stooped posture and resting tremors
D. Rationale: Parkinson's is characterized by the slowing of voluntary muscle movement. Muscular rigidity, and resting tremors.
The nurse is teaching a client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. Which client activity suggests that teaching is most effective? 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. Rationale: Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress.
A client with Guillain-Barré syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which strategy should the nurse incorporate in the plan of care to help the client cope with this illness?
A. Giving client full control over care decisions and restricting visitors
B. Providing positive feedback and encouraging active range of motion
C. Providing information, giving positive feedback, and encouraging relaxation
D. Providing intravenously administered sedatives, reducing distractions, and limiting visitors
Rationale: The client with Guillain-Barré syndrome experiences fear and anxiety from the ascending paralysis and sudden onset of the disorder. The nurse can alleviate these fears by providing accurate information about the client's condition, giving expert care and positive feedback to the client, and encouraging relaxation and distraction. The family can become involved with selected care activities and provide diversion for the client as well.
The home care nurse is visiting a client with a diagnosis of Parkinson's disease. The client is taking benztropine mesylate (Cogentin) orally daily. The nurse provides information to the spouse regarding the side effects of this medication and should tell the spouse to report which side effect if it occurs? A. Shuffling gait B. Inability to urinate C. Decreased appetite D. Irregular bowel movements
B. Rationale: Benztropine mesylate is an anticholinergic, which causes urinary retention as a side effect. The nurse would instruct the client or spouse about the need to monitor for difficulty with urinating, a distended abdomen, infrequent voiding in small amounts, and overflow incontinence. Options 1, 3, and 4 are unrelated to the use of this medication.
This is a rare, inherited disease that causes the progressive breakdown (degeneration) of nerve cells in the brain. It has a broad impact on a person's functional abilities and usually results in movement, thinking (cognitive) and psychiatric disorders.
The symptoms can develop at any time, but they often first appear when people are in their 30s or 40s
A. Parkinson's Disease
B. Seizures
C. Huntington's disease
D. Multiple Sclerosis
C. Huntington's disease
A client with Parkinson's disease is at risk for falls because of an abnormal gait. The nurse assesses the client, expecting to observe which type of gait? A. Unsteady and staggering
B. Shuffling and propulsive
C. Broad-based and waddling
D. Accelerating with walking on the toes
B. Rationale: The parkinsonian gait is characterized by short, accelerating, shuffling steps. The client leans forward with the head, hips, and knees flexed and has difficulty starting and stopping. An ataxic gait is unsteady and staggering. A dystrophic gait is broad-based and waddling. A festinating gait is accelerating with walking on the toes.
The nurse is admitting a client with Guillain-Barré syndrome to the nursing unit, the client has ascending paralysis to the level of the waist, knowing the complications of the disorder, the nurse should bring which most essential items into the client's room?
A. Nebulizer and pulse oximeter
B. Blood pressure cuff and flashlight
C. Flashlight and incentive spirometer
D. Electrocardiogrpahic monitoring of electrodes and intubation tray
D. Rationale: The client with Guillain-Barré syndrome is at risk for respiratory failure because of ascending paralysis. An intubation tray should be available for use. Another complication of this syndrome is cardiac dysrhythmias, which necessitates the use of electrocardiographic monitoring. Because the client is immobilized, the nurse should assess for deep vein thrombosis and pulmonary embolism routinely. Although items in the incorrect options may be used in care, they are not the most essential items from the options provided.
A client with myasthenia gravis has become increasingly weaker. The health care providers prepare to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or an increasing severity of the disease. An injection of edrophonium is administered. Which finding would indicate that the client is in cholinergic crisis? A. No change in condition B. Complaints of muscle spasms C. An improvement in weakness D. A temporary worsening of the condition
D. RATIONALE: Edrophonium injection makes the client in cholinergic crisis temporarily worse. An improvement in the weakness indicates myasthenia gravis.
Inflammation of the fluid and membranes surrounding your brain and spinal cord.
The swelling of the membranes typically triggers signs and symptoms such as headache, fever, nuchal rigidity and photophobia.
This disorder is?
A. Meningitis
B. Myasthenia Gravis
C. Multiple sclerosis
D. Huntington's Disease
B. Meningitis
Which symptom occurs initially in Parkinson's?
A. Anxiety and disorientation
B. Aspiration of food
C. Dementia
D. Pill rolling movement of hand
D. Rationale: Early symptoms include coarse resting tremors of fingers and thumbs.
The nurse is performing an assessment on a client with Guillain-Barré syndrome. The nurse determines that which finding would be of most concern?
A. Difficulty articulating words
B. Cough and sneezing
C. Paralysis progressing from the toes to the waist D. A blood pressure (BP) decrease from 110/78 to 102/70 mm Hg
C. Rationale: Respiratory compromise is a major concern in clients with Guillain-Barré syndrome. Clients often are intubated and mechanically ventilated Although orthostatic hypotension is a problem with these clients, the BP drop in option 4 is less than 10 mm Hg and is not significant.
The home health nurse is visiting a client with a diagnosis of multiple sclerosis. The client has been taking oxybutynin (Ditropan XL). The nurse evaluates the effectiveness of the medication by asking the client which assessment question? A. "Are you consistently fatigued?" B. "Are you having muscle spasms?" C. "Are you getting up at night to urinate?" D. "Are you having normal bowel movements?"
C. Rationale: Oxybutynin is an antispasmodic used to relieve symptoms of urinary urgency, frequency, nocturia, and incontinence in clients with uninhibited or reflex neurogenic bladder. Expected effects include improved urinary control and decreased urinary frequency, incontinence, and nocturia. Options 1, 2, and 4 are unrelated to the use of this medication.
To look for this sign in your client
What is kernig sign?
The home health nurse is visiting a client with myasthenia gravis and is discussing methods to minimize the risk of aspiration during meals related to decreased muscle strength. Which suggestions should the nurse give to the client? Select all that apply. A. Chew food thoroughly. B. Cut food into very small pieces. C. Sit straight up in the chair while eating. D. Lift the head while swallowing liquids. E. Swallow when the chin is tipped slightly downward to the chest.
A, B, C, E Rationale: The client avoids swallowing any type of food or drink with the head lifted upward, which could actually cause aspiration by opening the glottis. The client should be advised to sit upright while eating, not to talk with food in the mouth (talking requires opening the glottis), cut food into very small pieces, chew thoroughly, and tip the chin downward to swallow.
Assessment of which system is a priority for clients with Guillain-Barré syndrome?
A. Neurological system
B. Respiratory system
C. GI System due to heavy secretions
D. Vision and hearing
A. Rationale: Clients with Guillain-Barré syndrome are at risk for hypotension or hypertension, bradycardia, and respiratory depression, frequent monitoring of respiratory system is a priority.
The clinic nurse is reviewing the record of a client scheduled to be seen in the clinic. The nurse notes that the client is taking selegiline hydrochloride (Eldepryl). The nurse suspects that the client has which disorder? A. Myasthenia Gravis B. Parkinson's disease C. Alzheimer's disease D. Multiple Sclerosis
B. Rationale: Selegiline hydrochloride is an antiparkinsonian medication. The medication increases dopaminergic action, assisting in the reduction of tremor, akinesia, and the rigidity of parkinsonism. This medication is not used to treat diabetes mellitus, Alzheimer's disease, or coronary artery disease.