NCLEX Questions Test 4 MS, Parkinsons, Myasthenia Gravis, Osteoarthritis

NCLEX Questions Test 4 MS, Parkinsons, Myasthenia Gravis, Osteoarthritis Leave the first rating Students also studied Terms in this set (44) George Brown College Nursing Save Neuro Practice from Saunders 20 terms murkacatPreview

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11 terms RPayne0216Preview Practice Problems unit 4 48 terms mmchale12Preview Saunde 28 terms cint The nurse is teaching a client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. Which client activity suggests that teaching is most effective?

• Taking medications as scheduled
• Eating large, well-balanced meals
• Doing muscle-strengthening exercises
• Doing all chores early in the day while less fatigued
• Taking medications as scheduled

Rationale: Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle- strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress.The nurse is instructing a client with Parkinson's disease about preventing falls. Which client statement reflects a need for further teaching?

• "I can sit down to put on my pants and shoes."
• "I try to exercise every day and rest when I'm tired."
• "My son removed all loose rugs from my bedroom."
• "I don't need to use my walker to get to the bathroom."
• "I don't need to use my walker to get to the bathroom."

Rationale: The client with Parkinson's disease should be instructed regarding

safety measures in the home. The client should use her or his walker as support to get to the bathroom because of bradykinesia. The client should sit down to put on pants and shoes to prevent falling. The client should exercise every day in the morning when energy levels are highest. The client should have all loose rugs in the home removed to prevent falling.Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect?

• Pruritus
• Tachycardia
• Hypertension
• Impaired voluntary movements
• Impaired voluntary movements

Rationale: Dyskinesia and impaired voluntary movements may occur with high

carbidopa-levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia are frequent side effects of the medication.

A client with myasthenia gravis has become increasingly weaker. The primary health care provider prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or an increasing severity of the disease (myasthenic crisis). An injection of edrophonium is administered. Which finding would indicate that the client is in cholinergic crisis?

• No change in the condition
• Complaints of muscle spasms

3.An improvement of the weakness 4.A temporary worsening of the condition 4.A temporary worsening of the condition

Rationale: An edrophonium injection makes the client in cholinergic crisis

temporarily worse. An improvement in the weakness indicates myasthenia crisis.Muscle spasms are not associated with this test.The home health nurse has been discussing interventions to prevent constipation in a client with multiple sclerosis.The nurse determines that the client is using the information most effectively if the client reports which action?

• Drinking a total of 1000 mL/day
• Giving herself an enema every morning before

breakfast

• Taking stool softeners daily and a glycerin suppository

once a week

• Initiating a bowel movement every other day, 45

minutes after the largest meal of the day

• Initiating a bowel movement every other day, 45 minutes after the largest meal

of the day Rationale: To manage constipation, the client should take in a high-fiber diet, bulk formers, and stool softeners. A fluid intake of 2000 mL/day is recommended. The client should initiate a bowel movement on an every-other-day basis and should sit on the toilet or commode. This should be done approximately 45 minutes after the largest meal of the day to take advantage of the gastrocolic reflex. A glycerin suppository, bisacodyl suppository, or digital stimulation may be used to initiate the process. Laxatives and enemas should be avoided whenever possible because they lead to dependence.The clinic nurse is reviewing the record of a client scheduled to be seen in the clinic. The nurse notes that the client is taking selegiline hydrochloride. The nurse suspects that the client has which disorder?

1.Diabetes mellitus c 3.Alzheimer's disease 4.Coronary artery disease 2.Parkinson's disease

Rationale: Selegiline hydrochloride is an antiparkinsonian medication. The

medication increases dopaminergic action, assisting in the reduction of tremor, akinesia, and the rigidity of parkinsonism. This medication is not used to treat diabetes mellitus, Alzheimer's disease, or coronary artery disease.A thymectomy accomplished via a median sternotomy approach is performed in a client with a diagnosis of myasthenia gravis. The nurse creates a postoperative plan of care for the client that should include which intervention?

1.Monitor the chest tube drainage.

2.Restrict visitors for 24 hours postoperatively.

3.Maintain intravenous infusion of lactated Ringer's solution.

4.Avoid administering pain medication to prevent respiratory depression.

1.Monitor the chest tube drainage.Rationale: The thymus has played a role in the development of myasthenia gravis.A thymectomy is the surgical removal of the thymus gland and may be used for management of clients with myasthenia gravis to improve weakness. The procedure is performed through a median sternotomy or a transcervical approach. Postoperatively the client will have a chest tube in the mediastinum.Lactated intravenous solutions usually are avoided because they can increase weakness. Pain medication is administered as needed, but the client is monitored closely for respiratory depression. There is no reason to restrict visitors.

The home care nurse is visiting a client with a diagnosis of Parkinson's disease. The client is taking benztropine mesylate orally daily. The nurse provides information to the spouse regarding the side effects of this medication and should tell the spouse to report which side effect if it occurs?

1.Shuffling gait 2.Inability to urinate 3.Decreased appetite 4.Irregular bowel movements

• Inability to urinate

Rationale: Benztropine mesylate is an anticholinergic, which causes urinary

retention as a side effect. The nurse would instruct the client or spouse about the need to monitor for difficulty with urinating, a distended abdomen, infrequent voiding in small amounts, and overflow incontinence. The remaining options are unrelated to the use of this medication.A client with myasthenia gravis is having difficulty with airway clearance and difficulty with maintaining an effective breathing pattern. The nurse should keep which most important items available at the client's bedside?

1.Oxygen and metered-dose inhaler 2.Ambu bag and suction equipment 3.Pulse oximeter and cardiac monitor 4.Incentive spirometer and cough pillow 2.Ambu bag and suction equipment

Rationale: The client with myasthenia gravis may experience episodes of

respiratory distress if excessively fatigued or with development of myasthenic or cholinergic crisis. For this reason, an Ambu bag, intubation tray, and suction equipment should be available at the bedside.The home health nurse is visiting a client with myasthenia gravis and is discussing methods to minimize the risk of aspiration during meals related to decreased muscle strength. Which suggestions should the nurse give to the client? Select all that apply.

• Chew food thoroughly.
• Cut food into very small pieces.
• Sit straight up in the chair while eating.
• Lift the head while swallowing liquids.
• Swallow when the chin is tipped slightly downward to

the chest.

• Chew food thoroughly.
• Cut food into very small pieces.
• Sit straight up in the chair while eating.
• Swallow when the chin is tipped slightly downward to the chest.

Rationale: The client avoids swallowing any type of food or drink with the head

lifted upward, which could actually cause aspiration by opening the glottis. The client should be advised to sit upright while eating, not to talk with food in the mouth (talking requires opening the glottis), cut food into very small pieces, chew thoroughly, and tip the chin downward to swallow.The nurse has instructed a client with myasthenia gravis about strategies for self-management at home. The nurse determines a need for further teaching if the client makes which statement?

• "Here's the MedicAlert bracelet I obtained."
• "I should take my medications an hour before

mealtime." 3."Going to the beach will be a nice, relaxing form of activity." 4."I've made arrangements to get a portable resuscitation bag and home suction equipment."

• "Going to the beach will be a nice, relaxing form of activity."

Rationale: Most ongoing treatment for myasthenia gravis is done in outpatient

settings, and the client must be aware of the lifestyle changes needed to maintain independence. The client should carry medical identification about the presence of the condition. Taking medications an hour before mealtime gives greater muscle strength for chewing and is indicated. The client should have portable suction equipment and a portable resuscitation bag available in case of respiratory distress. The client should avoid situations and other factors, including stress, infection, heat, surgery, and alcohol, that could worsen the symptoms.

A client is admitted with an exacerbation of multiple sclerosis. The nurse is assessing the client for possible precipitating risk factors. Which factor, if reported by the client, should the nurse identify as being unrelated to the exacerbation?

• Annual influenza vaccination
• Ingestion of increased fruits and vegetables
• An established routine of walking 2 miles each evening
• A recent period of extreme outside ambient

temperatures

• Ingestion of increased fruits and vegetables

Rationale: The onset or exacerbation of multiple sclerosis can be preceded by a

number of different factors, including physical stress (e.g., vaccination, excessive exercise), emotional stress, fatigue, infection, physical injury, pregnancy, extremes in environmental temperature, and high humidity. No methods of primary prevention are known. Intake of fruits and vegetables is a healthy and an unrelated item.A client with multiple sclerosis is experiencing muscle weakness, spasticity, and an ataxic gait. On the basis of this information, the nurse should include which client problem in the plan of care?

• Inability to care for self
• Interruption in skin integrity
• Interruption in physical mobility

4.Inability to perform daily activities

• Interruption in physical mobility

Rationale: Multiple sclerosis is a chronic, nonprogressive, noncontagious

degenerative disease of the central nervous system characterized by demyelination of the neurons. Interruption in physical mobility is most appropriate for the client with multiple sclerosis experiencing muscle weakness, spasticity, and ataxic gait. The remaining options are not related to the data in the question The nurse is planning care for the client with a neurogenic bladder caused by multiple sclerosis. The nurse plans for fluid administration of at least 2000 mL/day. Which plan would be mosthelpful to this client?

1.400 to 500 mL with each meal and 500 to 600 mL in the evening before bedtime 2.400 to 500 mL with each meal and additional fluids in the morning but not after midday 3.400 to 500 mL with each meal, with all extra fluid concentrated in the afternoon and evening 4.400 to 500 mL with each meal and 200 to 250 mL at midmorning, midafternoon, and late afternoon 4.400 to 500 mL with each meal and 200 to 250 mL at midmorning, midafternoon, and late afternoon

Rationale: Spacing fluid intake over the day helps the client with a neurogenic

bladder to establish regular times for successful voiding. Omitting intake after the evening meal minimizes incontinence or the need to empty the bladder during the night.The nurse has provided instructions to a client with a diagnosis of myasthenia gravis about home care measures. Which client statement indicates the need for further teaching?

• "I will rest each afternoon after my walk."
• "I should cough and deep breathe many times during

the day."

• "I can change the time of my medication on the

mornings when I feel strong."

• "If I get abdominal cramps and diarrhea, I should call

my health care provider."

• "I can change the time of my medication on the mornings when I feel strong."

Rationale: The client with myasthenia gravis and the family should be taught

information about the disease and its treatment. They should be aware of the side and adverse effects of anticholinesterase medications and corticosteroids and should be taught that timing of anticholinesterase medication is critical. It is important to instruct the client to administer the medication on time to maintain a chemical balance at the neuromuscular junction. If it is not given on time, the client may become too weak to even swallow. Resting after a walk, coughing and deep breathing many times during the day, and calling the primary health care provider when experiencing abdominal cramps and diarrhea indicate a correct understanding of home care instructions to maintain health with this neurological degenerative disease.