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."

Accepted Answer

The primary feature of MG is increasing weakness with sustained muscle contraction. After a period of rest the muscles regain their strength. Muscle weakness is greatest after exertion or at the end of the day. Ocular manifestations are most common, with ptosis or diplopia occurring in a majority of clients.

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.

Accepted Answer

With myasthenic crisis, if an increase in the dosage of the anticholinesterase drug does not improve the weakness, endotracheal intubation and mechanical ventilation may be required. None of the other options is used to treat a myasthenic crisis.

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.

Accepted Answer

Clasping change tightly in the pocket, using both hands to complete tasks, and sleeping on the tremorous side will help lessen the tremor.

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)

Accepted Answer

Drugs used to treat exacerbations in ambulatory clients include Interferon b1b, Interferon b1 (Avonex), and glatiramer acetate (Copaxone). Diazepam and lioresal could be used to treat spasticity, while steroids are used for acute relapses.

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.

Accepted Answer

The two most dangerous features of GBS are respiratory muscle weakness and autonomic neuropathy involving both the sympathetic and the parasympathetic systems.

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.

Accepted Answer

Memory impairment occurs in all stages of AD and the nurse must use interventions that are designed to enhance memory. Because clients' long-term memory is retained longer than their short-term memory, allow them to reminisce about past experiences. Reminiscing is a normal activity; there is no need to assess orientation. Distracting the client not only will negatively impact memory but also may agitate the client. Recent memory is impaired, so encouraging the client to discuss recent events that he/she may not remember may also be agitating.

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.

Accepted Answer

Clients with CJD do not need isolation although it can be transmitted person-to-person. Standard precautions are used for every client and are sufficient for clients with CJD. There is no effective treatment for this unique disease that can arise from genetic mutations or from infection with an agent that is neither bacterial nor viral.

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.

Accepted Answer

The course of the disease is relentlessly progressive. Cognition, as well as bowel and bladder sphincters, remains intact. The client may be malnourished because of dysphagia. Encourage small, frequent, high-nutrient feedings. The nurse should assess for aspiration and choking. A feeding tube may be considered during the course of the illness.

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).

Accepted Answer

The neuritic plaque is a cluster of degenerating nerve terminals, both dendritic and axonal, that contains amyloid protein.

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."

Accepted Answer

Several medications are used to retain Ach in the neurojunctions of the brain. They can have small but noticeable effects and may temporarily lead to improvements. However, no drug stops the progression of AD. Aricept does not work to block oxygen free radical action, however; some studies show that alpha-tocopherol (vitamin E) and selegiline have this action. Aricept does not work on depression; often clients with AD also need antidepressants.

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.

Accepted Answer

Although plaques may occur anywhere in the white matter of the CNS, the areas most commonly involved are the optic nerves, cerebrum, and cervical spinal cord.

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.

Accepted Answer

Excessive movements and falling can cause injury in the client with Huntington's disease. Interventions include padding wheelchairs and beds, providing shin guards, and using gait belts for ambulation. Communication does become difficult and alternative forms of communication are appropriate before the client becomes completely demented, but this does not take priority over safety precautions. The client does not need an exercise regimen as the client is already hyperactive, and seizures do not occur.

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.

Accepted Answer

A high-fiber diet, bulk formers, and stool softeners are useful for maintaining stool consistency. Explain that laxatives and enemas should be avoided because they lead to dependence.

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.

Accepted Answer

Occasionally, clients with PD experience a parkinsonian crisis as a result of emotional trauma or sudden or inadvertent withdrawal of anti-parkinsonian medication. Severe exacerbation of tremor, rigidity, and bradykinesia, accompanied by acute anxiety, sweating, tachycardia, and hyperpnea occur. The client should be placed in a quiet room with subdued lighting. Medical treatment may include barbiturates in addition to anti-parkinsonian drugs.

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.

Accepted Answer

Huntington's disease is inherited in an autosomal-dominant pattern. Genetic testing is available to families in which a member has Huntington's disease. The availability of the testing has created some ethical conflicts.

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.

Accepted Answer

The degeneration of the caudate nucleus leads to a reduction in several neurotransmitters, including gamma-aminobutyric acid, acetylcholine, substance P, and metenkephalin, and their synthetic enzymes. This change leaves relatively higher concentrations of the other neurotransmitters, dopamine and norepinephrine.

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.

Accepted Answer

Disease management in ALS includes topics such as tube feedings and mechanical ventilation. Planning for an acceptable level of care should begin early in the disease, before a crisis occurs. Of course, decisions should be re-evaluated occasionally as the client's wishes may changes with their experiences with the disease. ALS is not a genetically-acquired disorder. Pain control is usually not an issue in the disease, and as the disease is relentlessly progressive (rather than characterized by remissions and exacerbations), extensive rehabilitation is not utilized.

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.

Accepted Answer

Range-of-motion exercises should be performed at least twice daily.

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).

Accepted Answer

Early in PD the client may notice a slight slowing in the ability to perform ADLs. A general feeling of stiffness may be noticed, along with mild, diffuse muscular pain. Tremor is a common early manifestation that usually occurs in one of the upper limbs.

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."

Accepted Answer

A common clinical manifestation of mild AD would include indifference or apathy. Other changes in mild AD are memory disturbances, impaired judgment and problem- solving skills, confusion, taking longer to do routine tasks, inability to adapt to new situations, and becoming irritable or suspicious. The inability to use familiar objects appears in the moderate stage. Incontinence is occasional in the moderate stage and frequent in the severe stage. Using words in the wrong context is moderate AD.

Quiz 72: Management of Clients with Degenerative Neurologic Disorders

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 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

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

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

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

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

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

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

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 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

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

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

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

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

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

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

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

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 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 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