Wk. 12 - Chronic Neurological Disorders Practice Questions

A client with Parkinson’s disease demonstrates a “pill-rolling tremor.” Which pathophysiologic change is responsible for this symptom?

B. Loss of dopamine-producing neurons in the substantia nigra

Which early, non-motor symptom may appear up to 10 years before a diagnosis of Parkinson’s disease?

B. Hyposmia

A nurse caring for a Parkinson’s patient notes difficulty initiating movement, a masked facial expression, and “freezing.” Which term best describes this cluster of symptoms?

B. Bradykinesia

Which clinical manifestations are characteristic of late-stage Parkinson’s disease? (Select all that apply). A. Postural instability B. Constipation C. Visual hallucinations D. Rest tremor only E. Cognitive impairment

A,B,C,E

The mechanism of action of carbidopa in carbidopa-levodopa (Sinemet) is to:

B. Increase dopamine release from presynaptic neurons

A nurse teaches a client taking carbidopa-levodopa about diet. Which statement indicates the client understands the teaching?

C. “I should take this medication at least 30 minutes before meals.”

Which are expected adverse effects of dopamine agonists (pramipexole, ropinirole)? (Select All That Apply) A. Excessive daytime sleepiness B. Impulsive behaviors C. Leg edema D. Severe hypertension E. Hallucinations

A,B,C,E

Entacapone (Comtan) is most effective when:

B. Administered with carbidopa-levodopa

True/False: MAO-B inhibitors require strict dietary tyramine restrictions similar to MAO-A inhibitors.

False

The nursing priority for a patient with Parkinson’s disease who is in Stage III (Hoehn & Yahr) is:

B. Gait training and assistive device use

Which intervention is MOST appropriate for a patient with PD experiencing “freezing” during ambulation? A. Encourage rapid turns B. Use of auditory or visual cues to step over C. Avoid walking aids D. Instruct the patient to take large steps quickly

B

Which definitions are correctly matched with their neurological term? (Select All That Apply) A. Chorea – involuntary, rapid, jerky movements B. Clonus – rhythmic, involuntary muscle contractions C. Dyskinesia – involuntary writhing movements seen in long-term levodopa use D. Dystonia – sustained muscle contractions causing abnormal postures E. Bradykinesia – quick, repetitive movements

A,B,C,D

A newly diagnosed patient with MS presents with numbness, blurry vision, and fatigue. These symptoms occur due to:

B. Demyelination of CNS neurons

Which findings support the 2017 McDonald Criteria for diagnosing MS? (Select All That Apply) A. MRI lesions in two different CNS locations B. Presence of oligoclonal bands in CSF C. Symptoms lasting longer than 6 months D. Evidence lesions occurred at different times E. EMG showing decreased muscle response

A,B,D

Which medication class slows progression and reduces relapses in MS?

B. Disease-modifying therapies

A primary concern when caring for a patient with MS experiencing fatigue is:

C. Teaching energy conservation strategies

Which interventions are appropriate for MS bladder dysfunction? (Select All That Apply) A. Avoid caffeine and alcohol B. Teach Kegel exercises C. Intermittent catheterization D. Initiate fluid restriction every evening E. Administer oxybutynin for overactive bladder

A,B,C,E

True/False: Clients with MS often experience an increase in relapses during pregnancy.

False

Myasthenia gravis is primarily caused by:

B. Autoimmune destruction of acetylcholine receptors

Which assessment finding is most characteristic of myasthenia gravis?

C. Fluctuating muscle weakness that improves with rest

Which medications may worsen MG symptoms? (Select All That Apply) A. Beta blockers B. Certain anesthetics C. Some antibiotics D. NSAIDs E. Antipsychotics

A,B,C

Pyridostigmine works by:

A . Blocking breakdown of acetylcholine

A patient taking pyridostigmine presents with severe salivation, diarrhea, bradycardia, and muscle weakness. The nurse suspects:

B. Cholinergic crisis

Which medication is the antidote for cholinergic crisis?

B. Atropine

True/False: A myasthenic crisis requires an increase in acetylcholinesterase inhibitor dosage.

True

ALS is best described as:

B. Progressive degeneration of upper and lower motor neurons

Which clinical manifestations are consistent with ALS? (Select All That Apply) A. Fasciculations B. Spasticity C. Sensory loss D. Dysarthria E. Respiratory failure

A,B,D,E

Riluzole prolongs survival in ALS primarily by:

B. Blocking glutamate release

Which nursing intervention is MOST important in late-stage ALS?

B. Monitoring respiratory status

Huntington’s disease is best described as:

C. A toxic accumulation of mutant huntingtin protein

Which symptoms are characteristic of Huntington’s disease? (Select All That Apply) A. Chorea B. Cognitive decline C. Hyperreflexia D. Depression E. Muscle atrophy with flaccidity early in disease

A,C,D

Which medication treats chorea in Huntington’s disease?

B. Tetrabenazine

True/False: Huntington’s disease follows an autosomal dominant inheritance pattern.

True

Which patients are at highest risk for aspiration? (Select All That Apply) A. ALS with dysphagia B. Myasthenia gravis during crisis C. Parkinson’s disease with bradykinesia D. Huntington’s disease with chorea E. MS patient with optic neuritis only

A,B,C,D

A patient with PD on levodopa reports increased hallucinations and compulsive gambling. The nurse should recognize this as a:

A. Expected adverse effect requiring monitoring

A patient taking levodopa experiences worsening rigidity right before the next dose. This is best described as:

B. On/off phenomenon

Appropriate nursing actions for a PD patient experiencing dysphagia include: (Select All That Apply) A. Speech therapy referral B. Thickened liquids C. Encourage large, rapid bites D. Upright position while eating E. Monitoring for weight loss

A,B,D,E

Clonus is best defined as:

B. Rhythmic, involuntary muscle contractions

True/False: Patients in Hoehn & Yahr Stage V are unable to stand or walk and require total care.

True

Which patient should the nurse assess first?

C. MG patient with new onset difficulty breathing