Deck 72: Management of Clients with Degenerative Neurologic Disorders

Question 1

A nurse is performing an assessment on a client who is suspected of having MG. The complaint made by the client that reflects a manifestation commonly seen in clients with this disease is

A) "By the end of the day, my eyelids usually are drooping."
B) "I have a great deal of difficulty getting up after I rest for a while."
C) "I perspire more then I ever have in the past."
D) "When I have a cold, I usually have a strong cough with it."

Answer 1

"By the end of the day, my eyelids usually are drooping."

Question 2

A client with MG began to experience a sudden worsening of her condition with difficulty in breathing. The nurse explains that this complication of MG is usually initially treated with

A) admission and administration of IV corticosteroids.
B) an increased dose of anticholinesterase drugs.
C) bolus doses of atropine titrated to effect.
D) rest and increased sleep.

Answer 2

an increased dose of anticholinesterase drugs.

Question 3

To assist the client with Parkinson's disease to reduce tremor, the nurse suggests that the client

A) clasp arms about self and squeeze.
B) sleep on the non-tremorous side.
C) tightly hold change in the pocket.
D) visualize stilling the tremor.

Answer 3

tightly hold change in the pocket.

Question 4

A client is being treated in the clinic for an exacerbation of multiple sclerosis. The nurse would anticipate administering which drug?

A) Diazepam (Valium)
B) Interferon b1b (Betaseron)
C) Lioresal (Baclofen)
D) Methylprednisolone (Solu-Cortef)

Question 5

When a client is admitted to the hospital with Guillain-Barré syndrome (GBS), the most important assessment the nurse should make is for

A) decreasing alertness.
B) respiratory difficulty.
C) seizure activity.
D) urinary retention.

Question 6

A client with AD begins to tell the nurse about his early-married life. The nurse should

A) assess orientation to time and place.
B) distract the client from this activity.
C) encourage the client to talk about recent memories.
D) listen to his stories.

Question 7

A nurse is caring for a client diagnosed with Creutzfeldt-Jakob Disease (CJD). Appropriate nursing care includes

A) administering broad-spectrum antibiotics until culture results are known.
B) giving the client anti-viral medications as ordered.
C) placing the client in contact and airborne isolation.
D) using standard precautions when handling body fluids.

Question 8

A client with advanced ALS is admitted to the hospital. Because of manifestations that are common in clients with ALS, the nurse should

A) attempt to institute bowel-training activities.
B) provide the client with small, frequent feedings.
C) obtain an order for intermittent catheterization.
D) orient the client to his or her surroundings frequently.

Question 9

The nurse instructs a group of nursing students that the pathologic changes that occur in the brain of a person with dementia of Alzheimer's disease include

A) abnormal accumulation of proteins.
B) damage to the myelin sheath of neurons.
C) destruction of neurons.
D) increase in production of cerebrospinal fluid (CSF).

Question 10

A client is receiving donepezil (Aricept) for moderate Alzheimer's disease. The nurse would assess that teaching goals for this medication have been met when the client's spouse says

A) "Aricept works by blocking oxygen free radicals in the brain."
B) " Depression has been the worst part so I'm glad this pill will control it."
C) "I'm anxious to see how much improvement the medications allows."
D) "This medicine will prevent further deterioration in condition."

Question 11

The nurse reminds a group of students about the major component of pathophysiology in multiple sclerosis (MS), which is

A) damage occurs primarily to the dendrites and oligodendrites.
B) once damaged, myelin cannot regenerate at all.
C) plaques occur anywhere in the white matter of the central nervous system (CNS).
D) Schwann cells are destroyed slowly but relentlessly.

Question 12

To prevent complications caused by a common problem of Huntington's disease, the nurse should

A) institute seizure precautions.
B) pad wheelchairs and beds.
C) start an exercise regimen.
D) teach different communication signals.

Question 13

A client with MS is being taught self-care measures to prevent constipation. The nurse would realize goals for teaching had been met when the client states he/she will avoid

A) a high-fiber diet.
B) citrus fruits.
C) laxatives.
D) stool softeners.

Question 14

The most helpful intervention by the nurse for a client experiencing a parkinsonian crisis would be to

A) administer oxygen by nasal catheter.
B) give the client IV fluids that contain potassium.
C) place the client in a nonstimulating environment.
D) provide the client with foods high in calcium.

Question 15

Health promotion activities the nurse could suggest to a community group for Huntington's disease include

A) Eating foods high in omega-3 fatty acids.
B) genetic screening for high-risk individuals.
C) limiting exposure to heavy metals.
D) taking 400 International Units of vitamin E daily.

Question 16

The nurse explains that the pathology of Huntington's disease involves

A) a decrease in the neurotransmitter norepinephrine.
B) an excess of the neurotransmitter dopamine.
C) destruction of white matter in the brain.
D) formation of neurofibrillary tangles and plaques.

Question 17

Nursing activities for a client with ALS and family include helping them

A) decide on an acceptable level of care early in the course of the disease.
B) determine if they want to share the diagnosis to allow genetic testing.
C) incorporate nonpharmacologic pain control techniques in the plan of care.
D) plan for extensive rehabilitation after exacerbations.

Question 18

The nurse formulates the following nursing diagnosis for a client with MS: Impaired Physical Mobility related to muscle weakness. Useful interventions the nurse could plan include

A) encouraging long naps or rest periods.
B) encouraging strengthening exercises for affected muscles every 4 hours.
C) having the client perform ROM exercises at least two times daily.
D) performing all the activities of daily living (ADLs) for the client.

Question 19

A client tells the nurse that he is experiencing some leg stiffness when walking and slowness when performing ADLs. Occasionally he has noted slight tremors in his hands at rest. This information leads the nurse to suspect

A) amyotrophic lateral sclerosis (ALS).
B) Huntington's disease.
C) myasthenia gravis (MG).
D) Parkinson's disease (PD).

Question 20

A client is assessed as being in the mild stage of Alzheimer's disease (AD). The nurse recognizes the complaint made by the client's family that is most closely related to the diagnosis is that the client

A) "has difficulty using simple things, such as her toothbrush or comb."
B) "seems to have lost control over her bowels."
C) "seems indifferent about things she used to care about."
D) "uses words in the wrong context."

Question 21

Important self-care measures a nurse can teach a client with Parkinson's disease in order to prevent contractures and improve mobility include which of the following? (Select all that apply.)

A) Bend over with your head over your toes to get out of chairs.
B) Exercise first thing in the morning.
C) Keep a narrow-based gait.
D) Look up when you walk, not down at the floor.
E) Use a firm surface, like the floor, for exercising.

Question 22

The nurse would suggest to the family of a client who is in the moderate stages of AD and is being cared for in the home to (Select all that apply)

A) assess orientation hourly by hiring a sitter if necessary.
B) disable the stove but find ways for the client to participate in meal preparation.
C) have the client wear an identification badge.
D) move knickknacks to the middle of tables.
E) secure the environment with a fence so the client cannot leave the home.

Question 23

Nursing interventions to support the family caring for a client with Alzheimer's disease include (Select all that apply)

A) encouraging emotion-focused coping mechanisms.
B) helping the family identify safety concerns and modifying the home.
C) showing the family how to deal with behavioral problems.
D) teaching the family alternative communication techniques.

Question 24

The nurse cautions clients with ALS and their families to be aware that (Select all that apply)

A) activities should be spaced throughout the day.
B) clients experience incontinence, an early cause of falling.
C) cognition will usually decline late in the disease.
D) muscle weakness may cause a risk for injury.