Chapter 58: Chronic Neurologic Problems Lewis: Medical-Surgical Nursing, 10th Edition(MS, Parkinsons, ALS, Myasthenia Gravis)

When obtaining a health history and physical assessment for a 36-yr-old female patient with possible multiple sclerosis (MS), the nurse should

a. assess for the presence of chest pain.

b. inquire about urinary tract problems.

c. inspect the skin for rashes or discoloration.

d. ask the patient about any increase in libido.

b. inquire about urinary tract problems.

Urinary tract problems with incontinence or retention are common symptoms of MS.

A woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate?

a. "MS symptoms may be worse after the pregnancy."

b. "Women with MS frequently have premature labor."

c. "MS is associated with an increased risk for congenital defects."

d. "Symptoms of MS are likely to become worse during pregnancy."

a. "MS symptoms may be worse after the pregnancy."

During the postpartum period, women with MS are at greater risk for exacerbation of symptoms.

There is no increased risk for congenital defects in infants born of mothers with MS. Symptoms of MS may improve during pregnancy. Onset of labor is not affected by MS.

A 33-yr-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching?

a. Recommendation to drink at least 4 L of fluid daily

b. Need to avoid driving or operating heavy machinery

c. How to draw up and administer injections of the medication

d. Use of contraceptive methods other than oral contraceptives

c. How to draw up and administer injections of the medication

Copaxone is administered by self-injection

Which information about a 60-yr-old patient with multiple sclerosis indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)?

a. The patient walks a mile each day for exercise.

b. The patient complains of pain with neck flexion.

c. The patient has an increased serum creatinine level.

d. The patient has the relapsing-remitting form of MS.

c. The patient has an increased serum creatinine level.

Dalfampridine should not be given to patients with impaired renal function.

The other information will not impact whether the dalfampridine should be administered.

Which action will the nurse plan to take for a patient with multiple sclerosis who has urinary retention caused by a flaccid bladder?

a. Encourage a decreased evening intake of fluid.

b. Teach the patient how to use the Credé method.

c. Suggest the use of adult incontinence briefs for nighttime only.

d. Assist the patient to the commode every 2 hours during the day.

b. Teach the patient how to use the Credé method.

The Credé method can be used to improve bladder emptying

A patient with Parkinson's disease has bradykinesia. Which action will the nurse include in the plan of care?

a. Instruct the patient in activities that can be done while lying or sitting.

b. Suggest that the patient rock from side to side to initiate leg movement.

c. Have the patient take small steps in a straight line directly in front of the feet.

d. Teach the patient to keep the feet in contact with the floor and slide them forward.

b. Suggest that the patient rock from side to side to initiate leg movement.

Rocking the body from side to side stimulates balance and improves mobility.

A 62-yr-old patient who has Parkinson's disease is taking bromocriptine (Parlodel). Which information obtained by the nurse may indicate a need for a decrease in the dosage?

a. The patient has a chronic dry cough.

b. The patient has four loose stools in a day.

c. The patient develops a deep vein thrombosis.

d. The patient's blood pressure is 92/52 mm Hg.

d. The patient's blood pressure is 92/52 mm Hg.

Hypotension is an adverse effect of bromocriptine, and the nurse should check with the health care provider before giving the medication.

The nurse advises a patient with myasthenia gravis (MG) to

a. perform physically demanding activities early in the day.

b. anticipate the need for weekly plasmapheresis treatments.

c. do frequent weight-bearing exercise to prevent muscle atrophy.

d. protect the extremities from injury due to poor sensory perception.

a. perform physically demanding activities early in the day.

Muscles are generally strongest in the morning, and activities involving muscle activity should be scheduled then.

A patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care?

a. Observe for agitation and paranoia.

b. Assist with active range of motion (ROM).

c. Give muscle relaxants as needed to reduce spasms.

d. Use simple words and phrases to explain procedures.

b. Assist with active range of motion (ROM).

ALS causes progressive muscle weakness, but assisting the patient to perform active ROM will help maintain strength as long as possible.

When a 74-yr-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling-type tremor, the nurse will anticipate teaching the patient about

a. oral corticosteroids.

b. antiparkinsonian drugs.

c. magnetic resonance imaging (MRI).

d. electroencephalogram (EEG) testing.

b. antiparkinsonian drugs.

The clinical diagnosis of Parkinson's is made when tremor, rigidity, and akinesia, and postural instability are present.

A patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which information indicates a need for change in the medication or dosage?

a. Shuffling gait

c. Cogwheel rigidity of limbs

b. Tremor at rest

d. Uncontrolled head movement

d. Uncontrolled head movement

Dyskinesia is an adverse effect of the Sinemet, indicating a need for a change in medication or decrease in dose. The other findings are typical with Parkinson's disease.

Which nursing diagnosis is of highest priority for a patient with Parkinson's disease who is unable to move the facial muscles?

a. Activity intolerance

b. Self-care deficit: toileting

c. Ineffective self-health management

d. Imbalanced nutrition: less than body requirements

d. Imbalanced nutrition: less than body requirements

The data about the patient indicate that poor nutrition will be a concern because of decreased swallowing.

Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis?

a. Pupil size

c. Respiratory effort

b. Grip strength

d. Level of consciousness

c. Respiratory effort

Because respiratory insufficiency may be life threatening, it will be most important to monitor respiratory function.

After a thymectomy, a patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first?

a. Auscultate the patient's bowel sounds.

b. Notify the patient's health care provider.

c. Administer the prescribed PRN antiemetic drug.

d. Give the scheduled dose of prednisone (Deltasone).

b. Notify the patient's health care provider.

The patient's history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed.

After change-of-shift report, which patient should the nurse assess first?

a. Patient with myasthenia gravis who is reporting increased muscle weakness

b. Patient with a bilateral headache described as "like a band around my head"

c. Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin)

d. Patient with Parkinson's disease who has developed cogwheel rigidity of the arms

a. Patient with myasthenia gravis who is reporting increased muscle weakness

Because increased muscle weakness may indicate the onset of a myasthenic crisis, the nurse should assess this patient first.

A patient with Parkinson's disease is admitted to the hospital for treatment of pneumonia. Which nursing interventions will be included in the plan of care (select all that apply)?

a. Provide an elevated toilet seat.

b. Cut patient's food into small pieces.

c. Serve high-protein foods at each meal.

d. Place an armchair at the patient's bedside.

e. Observe for sudden exacerbation of symptoms.

a, b, d

a. Provide an elevated toilet seat.

b. Cut patient's food into small pieces.

d. Place an armchair at the patient's bedside.

Because the patient with Parkinson's disease has difficulty chewing, food should be cut into small pieces. An armchair should be used when the patient is seated so that the patient can use the arms to assist with getting up from the chair. An elevated toilet seat will facilitate getting on and off the toilet. High-protein foods will decrease the effectiveness of L-dopa. Parkinson's disease is a steadily progressive disease without acute exacerbations.

The nurse observes a 74-yr-old man with Parkinson's disease rocking side to side while sitting in the chair. Which action by the nurse is most appropriate?

Provide the patient with diversional activities.

Document the activity in the patient's health record.

Take the patient's blood pressure sitting and standing.

Ask if the patient is feeling either anxious or depressed.

Document the activity in the patient's health record.

Patients with Parkinson's disease are instructed to rock from side to side to stimulate balance mechanisms and decrease akinesia.

The nurse is caring for a group of patients on a medical unit. After receiving report, which patient should the nurse see first?

A 42-yr-old patient with multiple sclerosis who was admitted with sepsis

A 72-yr-old patient with Parkinson's disease who has aspiration pneumonia

A 38-yr-old patient with myasthenia gravis who declined prescribed medications

A 45-yr-old patient with amyotrophic lateral sclerosis who refuses enteral feedings

A 38-yr-old patient with myasthenia gravis who declined prescribed medications

Patients with myasthenia gravis who discontinue pyridostigmine (Mestinon) will experience myasthenic crisis. Myasthenia crisis results in severe muscle weakness and can lead to a respiratory arrest.

A 50-yr-old male patient has been diagnosed with amyotrophic lateral sclerosis (ALS). What strategy will prevent a common cause of death for patients with ALS?

Reduce fat intake.

Reduce the risk of aspiration.

Decrease injury related to falls.

Decrease pain secondary to muscle weakness.

Reduce the risk of aspiration.

Reducing the risk of aspiration can help prevent respiratory infections that are a common cause of death from deteriorating muscle function.

Which nursing diagnosis is a priority in the care of a patient with myasthenia gravis (MG)?

Acute confusion

Bowel incontinence

Activity intolerance

Disturbed sleep pattern

Activity intolerance

Which care measure is a priority for a patient with multiple sclerosis (MS)?

Vigilant infection control and adherence to standard precautions

Careful monitoring of neurologic assessment and frequent reorientation

Maintenance of a calorie count and hourly assessment of intake and output

Assessment of blood pressure and monitoring for signs of orthostatic hypotension

Vigilant infection control and adherence to standard precautions

Infection control is a priority in the care of patients with MS because infection is the most common cause of an exacerbation of the disease

When establishing a diagnosis of multiple sclerosis (MS), which diagnostic tests will the nurse expect (select all that apply.)?

Select all that apply.

a. EEG

b. ECG

c. CT scan

d. Carotid duplex scan

e. Evoked response testing

f. Cerebrospinal fluid analysis

c, e, f

c. CT scan

e. Evoked response testing

f. Cerebrospinal fluid analysis

A male patient with a diagnosis of Parkinson's disease (PD) is admitted to a long-term care facility. Which action should the health care team take to promote adequate nutrition for this patient?

Provide multivitamins with each meal.

Provide a diet that is low in complex carbohydrates and high in protein.

Provide small, frequent meals throughout the day that are easy to chew and swallow.

Provide the patient with a minced or pureed diet that is high in potassium and low in sodium.

Provide small, frequent meals throughout the day that are easy to chew and swallow.

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