NCLEX Questions Parkinson Disease...

NUR200 - M2 - Multiple Sclerosis - NCLEX and ATI ScienceMedicineNursing Gabriela_Castro Save NCLEX Questions Parkinson Disease...20 terms SMathews926Preview Amyotrophic Lateral Sclerosis NCLE...12 terms Courtney_Cooper7 Preview Guillain-Barré Syndrome NCLEX Re...12 terms SMathews926Preview Nclex R 11 terms RPa 1) A client diagnosed with multiple sclerosis has an acute onset of visual changes, fatigue, and leg weakness. The client says that the last time this happened, recovery occurred in a few weeks. Which classification of multiple sclerosis is the client experiencing?

• Progressive-relapsing
• Secondary-progressive
• Relapsing-remitting
• Primary-progressive

Answer: C

Explanation: A) There are four classifications of multiple sclerosis. The client has an exacerbation of symptoms and has a history of full recovery.This is classified as relapsing-remitting and is the most common type. Primary-progressive is a steady worsening of the disease with occasional minor recovery. Secondary-progressive begins as relapsing-remitting but the disease becomes worse between exacerbations. Progressive- relapsing is rare, with the disease progressing from the onset with periods of exacerbation.

Page Ref: 877

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of multiple sclerosis.

2) A young adult client complains of blurred vision and muscle spasms that come and go over the past several months. On what information from the client's history should the nurse focus to help identify this help problem?

• Family history of Parkinson disease
• Family history of epilepsy
• Is an immigrant from Germany
• Has been depressed

Answer: C

Explanation: A) Multiple sclerosis is primarily a disease of people of northern European ancestry. The onset of multiple sclerosis is usually between the ages of 20 and 50, with the peak at age 30. Family history of epilepsy, Parkinson disease, and depression are important items of the client's history but do not support a diagnosis of MS.

Page Ref: 877

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 2. Identify risk factors and prevention methods associated with multiple sclerosis.3) A client with a history of relapsing-remitting multiple sclerosis is expecting her first child. What would be indicated for this client?

• Suggest reproductive counseling, as multiple sclerosis can be genetic.
• Instruct to expect a period of remission after delivery of the baby.
• Instruct to expect an exacerbation of symptoms while pregnant.
• Discuss pain control during labor, as contractions will be severe.

Answer: A

Explanation: A) A definite genetic factor has not been established; however, studies suggest that genetic factors make some individuals more susceptible to the disorder than others. Reproductive counseling would be recommended for this client. Pregnancy often brings about remission of multiple sclerosis, but with a slightly increased relapse rate postpartum. The strength of uterine contractions in a client with multiple sclerosis is not severe, and because clients often have lessened sensation, labor may be almost painless.

Page Ref: 876-877

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with multiple sclerosis.4) A client with relapsing-remitting multiple sclerosis tells the nurse that even though the primary symptoms of exacerbation are leg spasms and blurred vision, the hardest part is trying to get through the day because of being so tired. Which diagnosis should the nurse identify as a priority for this client?

• Fatigue
• Disturbed Sensory Perception
• Impaired Physical Mobility
• Self-Care Deficit

Answer: A

Explanation: A) The client states that the worst part of the disease exacerbation is being tired even though leg spasms and blurred vision are present. The nurse should identify the diagnosis of Fatigue as being a priority for this client. The diagnoses of Impaired Physical Mobility because of the leg spasms and Disturbed Sensory Perception because of the blurred vision are additional nursing diagnoses applicable for this client, but they are not the priority based on the client's statement. The client may or may not have a Self-Care Deficit.

Page Ref: 883

Cognitive Level: Applying

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome: 4. Formulate priority nursing diagnoses appropriate for an individual with multiple sclerosis.

5) A client admitted with an exacerbation of multiple sclerosis is demonstrating frustration with eating because hand and arm spasms prevent the proper use of utensils. What should the nurse do to assist this client?

• Consult with Occupational Therapy regarding assistive devices for meals.
• Counsel the client to select finger foods for meals.
• Plan time to feed the client.
• Consult with Physical Therapy regarding hand and arm exercises.

Answer: A

Explanation: A) Since the ability to feed oneself is essential to positive self-concept and self-esteem, the nurse should consult with Occupational Therapy for devices that the client can use to maintain independence at meal times. The nurse should not counsel the client to select finger foods for meals, or feed the client. This would not support the client's self-concept and self-esteem needs. Physical Therapy might be consulted for hand splints, but hand and arm exercises might not be beneficial for this client.

Page Ref: 883

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Nursing Process: Implementation

Learning Outcome: 6. Plan evidence-based care for an individual with multiple sclerosis and his or her family in collaboration with other members of the healthcare team.6) A client with multiple sclerosis is observed transferring from the bed to a motorized wheelchair and applying splints to the lower extremities before entering the bathroom to perform morning self-care. What could the nurse conclude regarding this observation?

• The client uses assistive devices to optimize autonomy.
• The client needs instruction to conduct morning care before applying splints to lower extremities.
• The client is dependent upon assistive devices.
• The client is reliant upon assistive devices for independent.

Answer: A

Explanation: A) The nurse observed the client independently transfer from the bed to a motorized wheelchair, apply splints, and enter the bathroom to perform morning self-care. This is evidence that the client uses assistive devices to optimize autonomy. The statement "Client is reliant upon assistive devices for independence" indicates that the client is not autonomous. The statement "Client is dependent upon assistive devices" also indicates the client is not autonomous. The statement "Client needs instruction to conduct morning care before applying splints to lower extremities" does not take into consideration the client's preference, which might be to apply the splints before doing self-care.

Page Ref: 883

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome: 7. Evaluate expected outcomes for an individual with multiple sclerosis.

7) A client with multiple sclerosis is prescribed diazepam (Valium). What assessment finding indicates that the medication is effective for the client?

• Muscle spasticity is reduced.
• Blood glucose level is within normal limits.
• The client states that muscles are weak.
• Ophthalmologic examination shows no evidence of cataracts.

Answer: A

Explanation: A) Diazepam (Valium) is a muscle relaxant commonly used for clients with multiple sclerosis. Diazepam (Valium) does not cause muscle weakness. Evidence of medication effectiveness would be an observed reduction in muscle spasticity. Glucose intolerance would be assessed if the client were prescribed an adrenal corticosteroid. Cataract development is also a side effect of adrenal corticosteroids.

Page Ref: 881

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with multiple sclerosis.8) The nurse is planning care for a client with multiple sclerosis. Which intervention would address the nursing diagnosis of Fatigue?

• Encourage increased activity.
• Schedule physical therapy three times a day.
• Plan activities with sufficient rest periods.
• Group activities together so care will not be interrupted.

Answer: C

Explanation: A) Interventions to address the client's diagnosis of Fatigue include assessing the level of fatigue, arranging activities to include rest periods, and assisting the client to set priorities regarding activities. Activities should not be grouped together. Increased activity will not help the client with fatigue. Physical therapy three times a day may be too aggressive for this client.

Page Ref: 883

Cognitive Level: Applying

Client Need: Physiological Integrity

Nursing Process: Planning

Learning Outcome: 6. Plan evidence-based care for an individual with multiple sclerosis and his or her family in collaboration with other members of the healthcare team.9) The nurse is presenting a talk for the monthly Nursing Case Study education group at her facility. Which client would be a good choice for a case study on multiple sclerosis (MS)?

• Brazilian with chronic parasitic infestation
• Italian with colonized methicillin resistant staphylococcus aureus (MRSA)
• Northern Canadian who has smoked for 25 years
• African-American man in his 20s with a vitamin D deficiency

Answer: C

Explanation: A) The client with the greatest risk lives the farthest from the equator and smokes. Smokers are at increased risk of MS. Brazilians and Italians live close to the equator, which lowers the risk of MS. Chronic parasitic infestation lowers the immune response, which lowers the risk of MS. African-Americans and men are at lower risk of developing MS. It is theorized that vitamin D deficiency may increase risk of MS because it is seen less in locales near the equator.

Page Ref: 877

Cognitive Level: Evaluating

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing Process: Assessment

Learning Outcome: 2. Identify risk factors and prevention methods associated with multiple sclerosis.