Neurological Disorders

Multiple Sclerosis

100

Multiple Sclerosis is a degeneration of which part of the nerve fiber? A. Axon terminal B. Myelin sheath C. Subarachnoid D. Dura mater

B Rationale: MS is a chronic CNS disorder in which myelin and nerve axons in brain and spinal cord are destroyed.

200

Which instruction would the nurse give to a client with MS who has urinary retention? A. "Run water whenever you experience difficulty initiating urination." B. "Decrease your fluid intake to prevent urgency." C. "Drink a caffeinated beverage to promote the ability to form urine." D. "Catheterize your bladder according to the schedule we discussed."

D Rationale: Performing self-catherization will drain the bladder and help prevent urinary tract infection.

300

The home health nurse has been discussing interventions to prevent constipation in a client with multiple sclerosis. The nurse determines that the client is using the information most effectively if the client reports which action? A. Drinking a total of 1000 mL/day B. Giving herself an enema every morning before breakfast C. Taking stool softeners daily and a glycerin suppository once a week D. Initiating a bowel movement every other day, 45 minutes after the largest meal of the day

D Rationale: To manage constipation, the client should take in a high-fiber diet, bulk formers, and stool softeners. A fluid intake of 2000 mL/day is recommended. The client should initiate the bowel program on an every-other-day basis. This should be done approximately 45 minutes after the largest meal of the day to take advantage of the gastrocolic reflex. A glycerin suppository, bisacodyl suppository, or digital stimulation may be used to initiate the process. Laxatives and enemas should be avoided whenever possible because they lead to dependence.

400

A client with multiple sclerosis tells a home health care nurse that she is having increasing difficulty in transferring from the bed to a chair. What is the initial nursing action? A. Observe the client demonstrating the transfer technique. B. Start a restorative nursing program before an injury occurs. C. Seize the opportunity to discuss potential nursing home placement. D. Determine the number of falls that the client has had in recent weeks.

A Rationale: Observation of the client's transfer technique is the initial intervention. Starting a restorative program is important but not unless an assessment has been completed first. Discussing nursing home placement would be inappropriate in view of the information provided in the question. Determining the number of falls is another important intervention, but observing the transfer technique should be done first.

500

A client is admitted with an exacerbation of multiple sclerosis. The nurse is assessing the client for possible precipitating risk factors. Which factor, if reported by the client, should the nurse identify as being unrelated to the exacerbation? A. Annual influenza vaccination B. Ingestion of increased fruits and vegetables C. An established routine of walking 2 miles each evening D. A recent period of extreme outside ambient temperatures

B. Rationale: The onset or exacerbation of multiple sclerosis can be preceded by a number of different factors, including physical stress (e.g., vaccination, excessive exercise), emotional stress, fatigue, infection, physical injury, pregnancy, extremes in environmental temperature, and high humidity. No methods of primary prevention are known. Intake of fruits and vegetables is an unrelated item.

Parkinson's Disease

100

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 facade 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.

200

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

D. Rationale: Parkinson's is characterized by the slowing of voluntary muscle movement. Muscular rigidity, and resting tremors.

300

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.

400

Which symptom occurs initially in Parkinson's? A. Akinesia B. Aspiration of food C. Dementia D. Pill rolling movement of hand

D. Rationale: Early symptoms include coarse resting tremors of fingers and thumbs.

500

Which client would be at risk for secondary Parkinson's disease caused by pharmacotherapy? A. 30 year old client with schizophrenia taking chlorpromazine B. 50 year old taking nitorglycerine for angina C. 60 year old client taking prednisone for COPD D. 75 year old using naproxen for rheumatoid arthritis

A. Rationale: Chlorpromazine depletes dopamine which may lead to tremor rigidity.

Myasthenia Gravis

100

A client with suspected myasthenia gravis is to undergo a tensilon test, tensilon is used to diagnose, but not treat myasthenia gravis, why isn't it used for treatment? A. It isn't available in oral form B. With repeated use, immunosuppression may occur C. Dry mouth and abdominal camps may be intolerable adverse effect D. The short half-life of tensilon makes it impractical for long-term use

D. Rationale: The duration of action of tensilon is 1-2 minutes, making it impractical for long-term management of myasthenia gravis.

200

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.

300

The nurse has instructed a client with myasthenia gravis about strategies for self-management at home. The nurse determines a need for more information if the client makes which statement? A. "Here's the Medic-Alert bracelet I obtained." B. "I should take my medications an hour before mealtime." C. "Going to the beach will be a nice, relaxing form of activity." D. "I've made arrangements to get a portable resuscitation bag and home suction equipment."

C. Rationale: Most ongoing treatment for myasthenia gravis is done in outpatient settings, and the client must be aware of the lifestyle changes needed to maintain independence. The client should carry medical identification about the presence of the condition. Taking medications an hour before mealtime gives greater muscle strength for chewing and is indicated. The client should have portable suction equipment and a portable resuscitation bag available in case of respiratory distress. The client should avoid situations and other factors, including stress, infection, heat, surgery, and alcohol, that could worsen the symptoms.

400

A client with myasthenia gravis arrives at the hospital emergency department in suspected crisis. The health care provider plans to administer edrophonium to differentiate between myasthenic and cholinergic crises. The nurse ensures that which medication is available in the event that the client is in cholinergic crisis? A. Atropine sulfate B. Morphine sulfate C. Protamine sulfate D. Pyridostigmine bromide

A. Rationale: Clients with cholinergic crisis have experienced overdosage of medication. Edrophonium will exacerbate symptoms in cholinergic crisis to the point at which the client may need intubation and mechanical ventilation. Intravenous atropine sulfate is used to reverse the effects of these anticholinesterase medications. Morphine sulfate and pyridostigmine bromide would worsen the symptoms of cholinergic crisis. Protamine sulfate is the antidote for heparin.

500

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.

Guillain-Barré

100

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.

200

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.

300

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.

400

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. Lung vital capacity of 10 mL/kg 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 when the vital capacity is less than 15 mL/kg. Options 1 and 3 are expected, depending on the degree of paralysis that occurs. 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.

500

The nurse reviews the health care provider's (HCP) prescriptions for a client with Guillain-Barré syndrome. Which prescription written by the HCP should the nurse question? A. Clear liquid diet B. Bilateral calf measure C. Monitor vital signs frequently D. Passive range-of-motion (ROM) exercises

A. Rationale: Clients with Guillain-Barré syndrome have dysphagia. Clients with dysphagia are more likely to aspirate clear liquids than thick or semisolid foods. Passive ROM exercises can help prevent contractures, and assessing calf measurements can help detect deep vein thrombosis, for which these clients are at risk. Because clients with Guillain-Barré syndrome are at risk for hypotension or hypertension, bradycardia, and respiratory depression, frequent monitoring of vital signs is required.

Pharmacotherapy

100

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.

200

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.

300

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.

400

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.

500

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.