Chapter 25: Care of Patients with Peripheral Nerve and Degenerative Neurologic Disorders My Nursing Test Banks

Chapter 25: Care of Patients with Peripheral Nerve and Degenerative Neurologic Disorders

MULTIPLE CHOICE

1. The nurse is explaining Parkinsons disease to the student nurse. Which statement by the nurse is correct regarding the pathophysiology of the disease?

a.

Regardless of the actual etiology, Parkinsons is caused by depletion of dopamine and excess of acetylcholine.

b.

The pathophysiology of the disease is caused by the deterioration of the myelin sheath of the basal ganglia.

c.

Excess dopamine and deficient acetylcholine are the cause of Parkinsons disease.

d.

When there is decreased dopamine uptake at receptors in brain cells, Parkinsons disease results.

ANS: A

The specific cause of Parkinsons disease is unknown, but the basic pathophysiology is depletion of dopamine and excess of acetylcholine.

DIF: Cognitive Level: Analysis REF: 551 OBJ: 1 (theory)

TOP: Parkinsons Disease: Pathophysiology

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The nurse is assessing a patient with Parkinsons disease. What does the nurse anticipate to assess in regard to tremors?

a.

Occurring 100% of the time

b.

Decreasing when there is voluntary movement

c.

Being absent when the body is at rest

d.

Characterized by a tonic and clonic muscle activity

ANS: B

The tremor decreases on voluntary movement, is absent during sleep, and occurs when the body is at rest. The muscle activity is that of pill rolling.

DIF: Cognitive Level: Application REF: 552 OBJ: 1 (theory)

TOP: Parkinsons Disease: Signs KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The technical or vocational nurse agrees that an appropriate nursing diagnosis for a person with Parkinsons disease would be:

a.

Risk for falls related to unsteady gait.

b.

Ineffective airway clearance related to drooling.

c.

Risk for impaired skin integrity related to tremor.

d.

Nutrition: less than body requirements related to nausea.

ANS: A

Rigidity and impaired balance with the propulsive gait create a risk for falls. The tremor decreases with voluntary movement, making eating relatively trouble free. Drooling is not a threat for aspiration, and there is no characteristic nausea.

DIF: Cognitive Level: Application REF: 555-556 | Nursing Care Plan 25-1

OBJ: 3 (theory) TOP: Parkinsons Disease: Nursing Diagnoses

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

4. To enhance more erect posture in the patient with Parkinsons disease, the nurse would encourage the patient to practice which activity?

a.

Periodically reach for the ceiling.

b.

Sleep in the prone position.

c.

Walk with a marching step.

d.

Walk guided by an imaginary straight line.

ANS: B

Sleeping in the prone position without a pillow will help to improve erect posture.

DIF: Cognitive Level: Application REF: 555 OBJ: 3 (theory)

TOP: Parkinsons Disease: Improving Posture

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The caregiver of a patient with Parkinsons disease is concerned with the patients recent weight loss. What suggestion by the home health nurse will be most helpful to the caregiver in enhancing the patients nutrition?

a.

Provide six mini-meals throughout the day.

b.

Be sure to include milk and cheese daily in the diet.

c.

Limit the fluid intake in order to increase the appetite.

d.

Prepare larger meals of fibrous foods.

ANS: A

Mini-meals can be eaten before food cools since it takes longer for the patient with Parkinsons to eat. Large meals are overwhelming and may become unappetizing before they can be consumed. Reduced fluid and increased dairy products increase the threat of constipation.

DIF: Cognitive Level: Analysis REF: 557 | Patient Teaching

OBJ: 3 (theory) TOP: Parkinsons Disease: Nutrition

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

6. The nurse encourages the patient with multiple sclerosis (MS) that his disease appears to be the most common type, which is:

a.

secondary progressive.

b.

primary progressive.

c.

relapsing-remitting.

d.

relapsing-progressive.

ANS: C

Relapsing-remitting is the most common type of MS.

DIF: Cognitive Level: Knowledge REF: 557 OBJ: 5 (theory)

TOP: MS: Disease Types KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. The nurse explains that multiple sclerosis (MS) is most likely caused by:

a.

environmental factors and genetic predisposition.

b.

allergic response to antiviral medications.

c.

autoimmune reaction attacking the myelin.

d.

bacterial infection of the myelin.

ANS: A

The actual cause of MS is unknown, but it is believed to be related to environmental factors, such as bacteria, a virus, or a chemical and genetic predisposition.

DIF: Cognitive Level: Comprehension REF: 557 OBJ: 4 (theory)

TOP: MS: Etiology KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. A patient with multiple sclerosis is seen by the home health nurse and complains of severe fatigue. What is the best suggestion by the nurse to help diminish the effects of fatigue?

a.

Relaxing in a warm bath

b.

Performing deep-breathing exercises

c.

Scheduling rest periods during the day

d.

Including daily-dose multivitamins

ANS: C

Scheduling and observing rest periods during the day will reduce fatigue. Heat increases sense of fatigue. Muscular problems are associated with ineffective impulse transmission rather than muscle weakness related to nutritional deficiency.

DIF: Cognitive Level: Application REF: 559 OBJ: 5 (theory)

TOP: MS: Reducing Fatigue KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

9. The nurse is aware that the diagnosis of multiple sclerosis (MS) is based on:

a.

blood tests revealing identifiable MS markers.

b.

lumbar puncture results revealing inflammatory response.

c.

muscle biopsies revealing characteristic lesions.

d.

signs and symptoms assessed and reported by the patient.

ANS: D

Diagnosis is almost completely reliant on signs and symptoms demonstrated by the patient. Other diagnostic tests will likely be performed in order to confirm the diagnosis.

DIF: Cognitive Level: Comprehension REF: 558 OBJ: 4 (theory)

TOP: MS: Diagnosis KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. The nurse anticipates that drug therapy for an acute severe attack of multiple sclerosis (MS) will be:

a.

intravenous methylprednisolone.

b.

intramuscular injections of interferon beta-1b.

c.

massive doses of antibiotics.

d.

muscle relaxants and opioids.

ANS: A

IV methylprednisolone is the standard treatment for the severe acute attack of MS. Interferon is used to prevent attacks.

DIF: Cognitive Level: Comprehension REF: 558 OBJ: 5 (theory)

TOP: MS: Treatment KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

11. The home health nurse caring for a patient with multiple sclerosis (MS) is planning an exercise program with the patient. Which is the best type of exercise for this patient?

a.

Swimming

b.

Progressive walking

c.

Weight training

d.

Isometric exercises

ANS: A

Swimming is less tiring than other forms of exercise.

DIF: Cognitive Level: Comprehension REF: 559 OBJ: 5 (theory)

TOP: MS: Exercise Program KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

12. The nurse is educating the family of a patient in the late stages of amyotrophic lateral sclerosis (ALS). What teaching point is most important for the nurse to include?

a.

The patients ability to move the upper limbs may be affected.

b.

The patients cognitive and mental capacity will most likely remain intact throughout the disease progression.

c.

The patients breathing should not be affected by the disease.

d.

The patients ability to swallow will remain intact.

ANS: B

Whereas the ability to move the upper limbs will likely be affected by the disease, it is important for families to remember that the patients cognitive and mental capacity stays intact as the motor activity rapidly declines. Breathing and swallowing are often significantly affected by ALS.

DIF: Cognitive Level: Application REF: 560 OBJ: 7 (theory)

TOP: ALS: Retention of Mentation KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity

13. The home care nurse is visiting a patient in the late stages of amyotrophic lateral sclerosis (ALS). Which statement by the patient indicates the acceptance of grief from the condition and prognosis?

a.

The patient often cries about his incapacity.

b.

The patient makes jokes about this approaching death.

c.

The patient talks with his family about his desires for his funeral.

d.

The patient begins to sleep for longer periods of time during the day.

ANS: C

Planning with family signals acceptance. Crying, joking, and sleeping are efforts at denial.

DIF: Cognitive Level: Analysis REF: 560 OBJ: 7 (theory)

TOP: ALS: Acceptance of Death KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Psychosocial Integrity

14. The nurse is aware that the signs and symptoms of Guillain-Barr syndrome (GBS) occur following a virus infection at about _____ days postinfection.

a.

2 to 3

b.

7

c.

10 to 21

d.

30

ANS: C

GBS symptoms occur 10 to 21 days after viral infection.

DIF: Cognitive Level: Knowledge REF: 560 OBJ: 6 (theory)

TOP: GBS: Etiology KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

15. The person who has Huntingtons disease asks if his disease will affect children he might have. Which statement by the nurse is most accurate?

a.

No. Huntingtons disease has no genetic link.

b.

Yes. Your children will either have Huntingtons disease or be carriers.

c.

No. Huntingtons disease is caused by an autoimmune response.

d.

Yes. Because of the nature of Huntingtons disease, 50% of your children will have the disease.

ANS: D

Huntingtons disease has an autosomal link and can be passed on to 50% of the children of a person with the disease.

DIF: Cognitive Level: Comprehension REF: 562 OBJ: 7 (theory)

TOP: Huntingtons Disease: Genetic Link

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

16. The nurse is assessing a patient diagnosed with myasthenia gravis. Which symptom would the nurse expect to assess?

a.

Ptosis

b.

Tremors of the hands during voluntary movement

c.

Dizziness on sudden movement of the head

d.

Postural hypotension

ANS: A

Ptosis is a sign of myasthenia gravis.

DIF: Cognitive Level: Knowledge REF: 562 OBJ: 8 (theory)

TOP: Myasthenia Gravis: Early Sign KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. The patient with myasthenia gravis asks the nurse if she will be able to use the computer for her job. Which symptom will most affect the patients ability to use the computer?

a.

Ptosis

b.

Diplopia

c.

Dysphagia

d.

Aphasia

ANS: B

Ptosis, dysphagia, and aphasia are all symptoms associated with myasthenia gravis, but diplopia, or double vision, will cause the patient the most difficulty with using a computer.

DIF: Cognitive Level: Application REF: 562 OBJ: 8 (theory)

TOP: Myasthenia Gravis: Symptoms KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

18. The nurse is planning care for a patient with Parkinsons disease. Which nursing diagnosis is most appropriate for the patient experiencing bradykinesia?

a.

Risk for falls

b.

Impaired swallowing

c.

Acute confusion

d.

Risk for suicide

ANS: A

Bradykinesia is a condition that is associated with Parkinsons disease, characterized by slow movement and speech which produces poor body balance, a characteristic shuffling gait, and difficulty initiating movement. This condition places the patient at risk for falling.

DIF: Cognitive Level: Application REF: 552 OBJ: 3 (theory)

TOP: Parkinsons Disease KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

MULTIPLE RESPONSE

19. The home health nurse assesses the patient with Parkinsons disease who has just been placed on carbidopa-levodopa. What side effects should the nurse be alert for when assessing this patient? (Select all that apply.)

a.

Urinary retention

b.

Rash

c.

Increased diaphoresis

d.

Orthostatic hypotension

e.

Hematuria

ANS: A, B, C, D

Hematuria is not a side effect, although the urine does turn dark.

DIF: Cognitive Level: Application REF: 553 | Box 25-1

OBJ: 2 (theory) TOP: Parkinsons Disease Treatment: Carbidopa-Levodopa

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

20. The nurse is preparing a care plan for a person with late-stage Parkinsons disease. What complications should the nurse plan interventions to address? (Select all that apply.)

a.

Dysphagia

b.

Hallucinations

c.

Immobility

d.

Insomnia

e.

Urinary incontinence

ANS: A, C, D, E

Hallucinations are not part of the late Parkinsons disease symptoms.

DIF: Cognitive Level: Application REF: 552 OBJ: 3 (theory)

TOP: Parkinsons Disease: Complications

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

21. The nurse outlines nutritional needs for the patient with multiple sclerosis (MS). What interventions should be emphasized for inclusion in the dietary intake? (Select all that apply.)

a.

Intake of at least 1500 mL of fluid daily

b.

Inclusion of high-fiber foods

c.

A high carbohydrate level in the diet

d.

Adding calcium and vitamin D

e.

Ensuring a high fat content

ANS: A, B, D

High levels of carbohydrates and fats are not emphasized in the diet for an MS patient. Fluids and high fiber in the diet will prevent constipation, and calcium and vitamin D will help in preventing osteoporosis.

DIF: Cognitive Level: Application REF: 559 OBJ: 5 (theory)

TOP: MS: Nutrition KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

22. The nurse is caring for a patient with Guillain-Barr syndrome. What will be the focus of nursing care? (Select all that apply.)

a.

Assessment of advancing paralysis

b.

Provision for ventilation support

c.

Maintenance of adequate nutrition

d.

Prevention of complications of immobility

e.

Assessment of hypertension

ANS: A, B, C, D

All of the options except assessment of hypertension are significant considerations in planning the care of a patient with GBS. Hypotension would be a focus.

DIF: Cognitive Level: Comprehension REF: 561-562 OBJ: 6 (theory)

TOP: GBS: Nursing Care KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

23. The student nurse is researching relapsing progressive forms of multiple sclerosis. What characteristics would the student discover as typical of this form of the disease? (Select all that apply.)

a.

Steady worsening

b.

Partial remissions

c.

Clear acute relapses

d.

Temporary minor improvements

e.

Long plateau periods

ANS: A, C

Steady worsening and clear acute relapses are the principle characteristics of relapsing progressive multiple sclerosis.

DIF: Cognitive Level: Comprehension REF: 557-558 OBJ: 2 (clinical)

TOP: Multiple Sclerosis: Relapsing Progressive Type

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. The nurse is caring for a patient with Huntingtons chorea. Which symptoms typically would be seen in the patient with this disease? (Select all that apply.)

a.

Fidgeting

b.

Restlessness

c.

Constant movement

d.

Dementia

e.

Difficulty swallowing

ANS: A, B, C, D

Huntingtons chorea is a degenerative neurologic disorder characterized by abnormal movements (chorea). The disease begins with the patient being fidgety and progresses to constant movement and intellectual decline. Death usually occurs within 15 to 20 years after diagnosis.

DIF: Cognitive Level: Comprehension REF: 562 OBJ: 7 (theory)

TOP: Huntingtons Chorea: Symptoms KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

COMPLETION

25. The triad of Parkinsons disease is __________, __________, and __________.

ANS:

tremor, bradykinesia, rigidity

bradykinesia, rigidity, tremor

tremor, rigidity, bradykinesia

bradykinesia, tremor, rigidity

rigidity, tremor, bradykinesia

rigidity, bradykinesia, tremor

Tremor, bradykinesia, and rigidity are included in the triad of Parkinsons disease.

DIF: Cognitive Level: Comprehension REF: 552 OBJ: 1 (theory)

TOP: Parkinsons Disease: Signs KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

26. Two viruses that are especially associated with the etiology of Guillain-Barr syndrome (GBS) are ___________ and ___________.

ANS:

cytomegalovirus, Epstein-Barr virus

Epstein-Barr virus, cytomegalovirus

Cytomegalovirus and Epstein-Barr virus are especially associated with the development of GBS.

DIF: Cognitive Level: Knowledge REF: 560 OBJ: 6 (theory)

TOP: GBS: Etiology KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

27. The test for the diagnosis of myasthenia gravis in which muscle strength is increased within 1 minute of the injection is the __________ test.

ANS:

Tensilon

An injection of Tensilon will increase muscle strength within 1 minute of injection and is a positive test for the diagnosis of myasthenia gravis.

DIF: Cognitive Level: Knowledge REF: 563 OBJ: 8 (theory)

TOP: Myasthenia Gravis: Diagnosis KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

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