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PHARMACOLOGY
CLIENT EDUCATION
ASSESSMENT
NURSING PRIORITY
MISCELLANEOUS
100
When administering neostigmine (Prostigmin) to a client with myasthenia gravis. Which nursing intervention should the nurse implement? A. Give the medication on an empty stomach B. Warn the client that he'll experience mouth dryness C. give the medication before meals with a small amount of food D. administer the medication for complaints of muscle weakness or difficulty swallowing
C. Neostigmine's onset of action is 45-75min, it should be administered at least 45 min before eating to improve chewing and swallowing. Taking neostigmine with a small amount of food rather than on a completely empty stomach reduces GI adverse effects. Adverse effects of the medication include increased salivation, bradycardia, sweating, nausea, and abdominal cramps. Neostigmine must be given at scheduled times to ensure consistent blood levels.
100
The nurse has given instructions to a client with Parkinson's disease about maintaining mobility. Which action demonstrates that the client understands the directions? A. Sits in soft, deep chairs to promote comfort B. Exercises in the evening to combat fatigue C. Rocks back and forth to start movement with bradykinesia D. Buys clothes with many buttons to maintain finger dexterity.
C. The client with Parkinson's disease should exercise in the morning when energy levels are highest. The client should avoid sitting in soft deep chairs because they are difficult to get up from. The client can rock back and forth to initiate movement. The client should buy clothes with Velcro fasteners and slide-locking buckles to support the ability to dress self
100
The client is admitted to the hospital with a diagnosis of Guillain-Barre 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. Guillain-Barre 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 1-4 weeks before the onset of neurological deficits. On occasion, the symptom can be triggered by vaccination or surgery.
100
A client with respiratory complications of multiple sclerosis is admitted to the medical-surgical unit. What equipment is most important for the nurse to keep at the clients bedside? A. Sphygmomanometer B. Padded tongue blade C. Nasal Cannula and oxygen D. Suction machine with catheters
D. MS weakens the respiratory muscles and impairs swallowing, putting the client at risk for aspiration. to ensure a patent oral airway, the nurse should keep a suction machine and suction catheters at the bedside. A sphygmomanometer is no more important for this client than for any other. A padded tongue blade is an appropriate seizure precaution but shouldn't be used in this client because it's large size could cause oral airway obstruction. A nasal cannula and oxygen would be ineffective to ensure adequate oxygen delivery; this client requires a mechanical ventilator.
100
A client suspected of having ALS. To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order: A. Electromyograpy B. Doppler scanning C. Doppler Ultrasonography D. Quantative Spectral Phonangography
A. To help confirm ALS, the physician typically orders EMG, which detects electrical activity of the involved muscles. To help establish the diagnosis of ALS, EMG must show widespread anterior horn cell dysfunction with fibrillations, positive waves, and chronic changes in the potentials of neurogenic motor units in the multiple nerve root distributions in at least three limbs and the para-spinal muscles.
200
A client with an exacerbation of multiple sclerosis. The physician orders dantrolene(Dantrium) 25mg PO daily which assessment finding indicates the medication is effective? A. Increased ability to sleep B. Relief from constipation C. Relief from pain D. Reduced muscle spasticity
D. Dantrolene reduces muscle spasticity, it doesn't increase the ability to sleep or relieve constipation or pain.
200
The nurse is teaching a client with Myasthenia Gravis about the prevention of myasthenia 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. Clients with Myasthenia graves 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.
200
A nurse is assessing a client diagnosed with multiple sclerosis. Which symptom would you expect to find? A. Vision Changes B. Absent deep tendon reflexes C. Tremors at rest D. Flaccid muscles
A. Vision changes such as diplopia, nystagmus, and blurred vision are symptoms of MS.
200
In a client with amyotrophic lateral sclerosis and respiratory distress, which finding is the earliest sign of reduced oxygenation? A. Decreased heart rate B. increased restlessness C. Increased blood pressure D. Decreased level of Consciousness
B. In ALS an early sign of respiratory distress is increased restlessness, which results from inadequate oxygen flow to the brain. As the body tries to compensate for inadequate oxygenation the heart rate increases and blood pressure drops. A decreased LOC is a later sign of poor tissue oxygenation in a client with respiratory distress.
200
Which of the following is not a typical clinical manifestation of multiple sclerosis (MS)? a. Double vision b. Sudden bursts of energy c. Weakness in the extremities. d. Muscle tremors.
Answer B Rationale: With MS, hyperexcitability and euphoria may occur, but because of muscle weakness, sudden bursts of energy are unlikely.
300
When teaching a client about carbidopa-levodopa (Sinemet) therapy for Parkinson's disease a nurse should include which instructions? A. Report any eye spasms B. Take this medication at bedtime C. stop taking this drug when your symptoms disappear D. Be aware that your urine may appear darker than usual
D. Carbidopa-levodopa is used to replace insufficient dopamine in the client with Parkinson's disease, may cause harmless darkening of the urine. The drug doesn't cause eye spasms, although blurred vision is an expected adverse effect. The client should take levodopa-carbidopa shortly before meals, not at bedtime, and must continue to take it for life.
300
When providing discharge teaching for a client with multiple Sclerosis, the nurse should include which instructions? A. Avoid taking daytime naps B. Avoid hot baths and showers C. limit your fruit and vegetable intake D. restrict fluid intake to 1500ml/day
B. The nurse should instruct a client with MS to avoid hot baths and showers because they can exacerbate the disease. The nurse should encourage daytime naps because fatigue is a common symptom of MS. A client with MS doesn't require food or fluid restrictions.
300
A client with weakness and tingling in both legs is admitted to the medical-surgical floor with a tentative diagnosis of Guillain-Barre syndrome. On admission, which assessment is most important for the client? A. Lung auscultation and measurements of vital capacity and tidal volume B. Evaluation for signs and symptoms of increase intracranial pressure C. Evaluation of pain and discomfort D. Evaluation of nutritional status and metabolic state
A. In Guillain-Barre syndrome, polyneuritis commonly causes weakness and paralysis, which may ascend to the truck and involve the respiratory muscles. Lung auscultation and measurement of vital capacity, tidal volume, and negative inspiratory force are crucial in detecting and preventing respiratory failure- The most serious complication of polyneuritis.
300
A client with Guillain-Barre syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about paralysis, how should the nurse respond? A. The paralysis caused by the disease is temporary B. You will be permanently paralyzed, however you won't have any sensory loss C. It must be hard to accept the permanency of your paralysis D. You'll first regain use of your legs and then your arms
A. The nurse should inform the client that the paralysis that accompanies Guillain-Barre syndrome is only temporary. Return of motor function begins proximally and extends distally in the legs.
300
Which goal is the most realistic for a client diagnosed with Parkinson's disease? a. To cure the disease b. To stop progression of the disease. c. To begin preparations for terminal care. d. To maintain optimal body function.
Answer D Rationale: Helping the client function at his or her best is most appropriate and realistic.
400
A client with Parkinson’s disease is prescribed levodopa (L-dopa) therapy. Improvement in which of the following indicates effective therapy? a. Mood b. Muscle rigidity c. Appetite d. Alertness
Answers b Rationale: Levodopa is prescribed to decrease severe muscle rigidity. Levodopa does not improve mood, appetite, or alertness in a client with Parkinson’s disease.
400
A nurse is teaching a client with Multiple Sclerosis. When teaching the client how to reduce fatigue, the nurse should teach the client to: a. take a hot bath. b. rest in an air-conditioned room. c. increase the dose of muscle relaxants. d. Avoid naps during the day.
Answer B. Rationale: 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 avoided. A hot bath shower will increase body temperature, producing fatigue.
400
When caring for a client with myasthenia graves, the nurse should assess the client for which of the following manifestations of cholinergic crisis? Select all that apply. A. Ptosis B. Fasciculation C. Abdominal cramps D. Increased Heart Rate E. Decreased secretions and saliva F. Respiratory rate of 6 and irregular rhythm
A, B and F- Cholinergic crisis is cause by overstimulation at the neuromuscular junction due to increased acetylcholine. The crisis affects the muscles that control eye and eyelid movement, causing fasciculation,ptosis,and difficulty chewing, talking and swallowing. The muscles that control breathing and neck and limb movements are also affected, and respirations become slowed. Salivation is increased. The crisis is reversed with atropine.
400
A new medication regimen is prescribed for a client with Parkinson's disease. At which time should the nurse make certain that the medication is taken? a. At bedtime b. All a one time c. Two hours before mealtime d. At the time scheduled
Answer: D Rationale: While the client is hospitalized for adjustment of medication, it is essential that the medication be administered exactly at the scheduled time, for accurate evaluation of effectiveness.
400
In a client with amyotrophic lateral sclerosis (ALS) and respiratory distress, which finding is the earliest sign of reduced oxygenation? a. decreased heart rate b. Increased restlessness c. Increased blood pressure d. Decreased level of Consciousness
Answer B. Rationale: In ALS, an early sign of respiratory distress is increased restlessness, which results from inadequate oxygen flow to the brain. As the body tries to compensate for inadequate oxygenation the heart rate increases and blood pressure drops. A decreased LOC is a later sign of poor tissue oxygenation in a client with respiratory distress.
500
A health Care provider has prescribed carbidopa-levodopa(Sinemet) Four times per day for a client with Parkinson's disease. The client wants "to end it all now that the Parkinson's disease has progressed". What should the nurse do? Select all that apply. A. Explain that the new prescription for Sinemet will treat the depression B. Encourage the client to discuss feelings as the Sinemet is being administered. C. Contact the health care provider before administering the Sinemet. D. Determine if the client is on antidepressants or monoamine oxidase inhibitors. E. Determine if the client is at risk for suicide.
C, D, and E. The nurse should contact the health care provider before administering Sinemet because this medication can cause further symptoms of depression. Suicide threats in clients with chronic illness should be taken seriously. The nurse should also determine if the client is on an MAO inhibitor because concurrent use with Sinemet can cause a hypertensive crisis. Snippet is not a treatment for depression. Having the client discuss feelings is appropriate when the prescription is finalized.
500
The nurse is teaching a client with bladder dysfunction from multiple sclerosis about bladder training at home. Which instructions should the nurse include in the teaching plan? Select all that apply. A. Restrict fluids to 1,000ml/day B. Drink 400-500ml with each meal C. Drink fluids midmorning, mid afternoon, and late afternoon. D. Attempt to void at least every 2 hours E. Use intermittent catheterization as needed
B, C, D and E. Maintaining urinary function in a client with neurogenic bladder dysfunction from MS is an important goal. The client should ideally drink 400-500ml with each meal; 200ml midmorning, mid afternoon, and late afternoon; and attempt to void at least every 2 hours to prevent infection and stone formation. The client may need to catheterize herself to drain residual urine in the bladder. Restricting fluids during the day will not produce sufficient urine. However, in the bladder training for nighttime continence, the client may restrict fluids for 1 to 2 hours before going to bed. The client should drink at least 2000 ml every 24 hours.
500
The nurse should conduct a focused assessment with the client with multiple sclerosis for risk of the following? Select all that apply. A. Dehydration B. Falls C. Seizures D. Skin Breakdown E. Fatigue
B, D, E- The client with MS is at risk for falls due to muscle weakness, skin breakdown due to bowel and bladder incontinence, and fatigue. The client is not at risk for dehydration; seizures are not associated with myelin destruction.
500
Which intervention should the nurse suggest to help a client with multiple sclerosis avoid episodes of urinary incontinence? a. Limit fluid intake to 1000 ml/day b. Insert an indwelling urinary cathetar. c. Establish a regular voiding schedule. d. Administer prophylactic antibiotics, as prescribed.
Answer C Rationale: Establishing a regular voiding pattern will help the client avoid urinary incontinence. Incontinence is related to the strength of the detrusor and urethral sphincter muscles.
500
which of the following should the nurse include in the discharge plan for a client with multiple sclerosis who has an impaired peripheral sensation? select all that apply. A. Carefully test the temperature of bath water B. Avoid kitchen activities because of the risk of injury C. Avoid hot water bottles and heating pads. D. Inspect the skin daily for injury or pressure points. E. Wear warm clothing when outside in cold temperatures.
A, C, D and E- A client with impaired peripheral sensation does not feel pain as readily as someone whose sensation is unimpaired; therefore, water temperatures should be tested carefully. The client should be advised to avoid using hot water bottles or heating pads and to protect against cold temperatures. Because the client cannot rely on minor pain as an indicator of damaged skin or sore spots, the client should carefully inspect the skin daily to visualize any injuries that he cannot feel. The client should not be instructed to avoid kitchen activities out of fear of injury; independence and self care are also important. However, the client should meet with an occupational therapist to learn about assistive devices and techniques that can reduce injuries, such as burns and cuts that are common in kitchen activities.