Amyotrophic Lateral Sclerosis NCLEX

97. Which diagnostic test is used to confirm the diagnosis of ALS?

1. Electromyogram (EMG).

2. Muscle biopsy.

3. Serum creatine kinase (CK).

4. Pulmonary function test.

2. Biopsy confirms changes consistent

with atrophy and loss of muscle fiber,

both characteristic of ALS.

98. The client is diagnosed with ALS. Which client problem would be most

appropriate for this client?

1. Disuse syndrome.

2. Altered body image.

3. Fluid and electrolyte imbalance.

4. Alteration in pain.

1. Disuse syndrome is associated with

complications of bedrest. Clients with

ALS cannot move and reposition

themselves, and they frequently have

altered nutritional and hydration

status.

99. The client is being evaluated to rule out ALS. Which signs/symptoms would the

nurse note to confirm the diagnosis?

1. Muscle atrophy and flaccidity.

2. Fatigue and malnutrition.

3. Slurred speech and dysphagia.

4. Weakness and paralysis.

4. ALS results from the degeneration and

demyelination of motor neurons in the

spinal cord, which results in paralysis

and weakness of the muscles.

100. The client diagnosed with ALS asks the nurse, "I know this disease is going to kill

me. What will happen to me in the end?" Which statement by the nurse would be

most appropriate?

1. "You are afraid of how you will die?"

2. "Most people with ALS die of respiratory failure."

3. "Don't talk like that. You have to stay positive."

4. "ALS is not a killer. You can live a long life."

2. About 50% of clients die within two

(2) to five (5) years from respiratory

failure, aspiration pneumonia, or

another infectious process.

101. The client with ALS is admitted to the medical unit with shortness of breath,

dyspnea, and respiratory complications. Which intervention should the nurse implement first?

1. Elevate the head of the bed 30 degrees.

2. Administer oxygen via nasal cannula.

3. Assess the client's lung sounds.

4. Obtain a pulse oximeter reading.

2. Oxygen should be given immediately

to help alleviate the difficulty

breathing. Remember that

oxygenation is priority.

102. The client is to receive a 100-mL intravenous antibiotic over 30 minutes via an

intravenous pump. At what rate should the nurse set the IV pump? ___________

200 mL/hr.

103. The nurse is caring for the following clients on a medical unit. Which client should

the nurse assess first?

1. The client with ALS who is refusing to turn every two (2) hours.

2. The client with abdominal pain who is complaining of nausea.

3. The client with pneumonia who has a pulse oximeter reading of 90%.

4. The client who is complaining about not receiving any pain medication.

3. A pulse oximeter reading of less than 93% indicates that the client is experiencing hypoxemia, which is a life-threatening emergency. This

client should be assessed first.

104. The client is diagnosed with ALS. As the disease progresses, which intervention

should the nurse implement?

1. Discuss the need to be placed in a long-term care facility.

2. Explain how to care for a sigmoid colostomy.

3. Assist the client to prepare an advance directive.

4. Teach the client how to use a motorized wheelchair.

3. A client with ALS usually dies within

five (5) years. Therefore, the

nurse should offer the client the

opportunity to determine how he/she

wants to die.

105. The client is in the terminal stage of ALS. Which intervention should the nurse

implement?

1. Perform passive ROM every two (2) hours.

2. Maintain a negative nitrogen balance.

3. Encourage a low-protein, soft-mechanical diet.

4. Turn the client and have him cough and deep breathe every shift.

1. Contractures can develop within a

week because extensor muscles are

weaker than flexor muscles. If the

client cannot perform ROM exercises,

then the nurse must do it for

him—passive ROM.

106. The son of a client diagnosed with ALS asks the nurse, "Is there any chance that I

could get this disease?" Which statement by the nurse would be most appropriate?

1. "It must be scary to think you might get this disease."

2. "No, this disease is not genetic or contagious."

3. "ALS does have a genetic factor and runs in families."

4. "If you are exposed to the same virus, you may get the disease."

3. There is a genetic factor with ALS

that is linked to a chromosome 21

defect.

107. The client with end-stage ALS requires a gastrostomy tube feeding. Which finding

would require the nurse to hold a bolus tube feeding?

1. A residual of 125 mL.

2. The abdomen is soft.

3. Three episodes of diarrhea.

4. The potassium level is 3.4 mEq/L.

1. A residual (aspirated gastric contents)

of greater than 50 to 100 mL indicates

that the tube feeding is not being

digested and that the feeding should

be held.

108. The client diagnosed with ALS is prescribed an antiglutamate, riluzole (Rilutek).

Which instruction should the nurse discuss with the client?

1. Take the medication with food.

2. Do not eat green, leafy vegetables.

3. Use SPF 30 when going out in the sun.

4. Report any febrile illness.

4. The medication can cause blood

dyscrasias. Therefore, the client is

monitored for liver function, blood

count, blood chemistries, and alkaline

phosphatase. The client should report

any febrile illness. This is the first

medication developed to treat ALS.