Preview Extract
Chapter 31
1. When interviewing a client suspected of exhibiting signs of Parkinson’s disease, the nurse
shows an understanding of the disease’s etiology when asking:
1. “Do you recall if any of your relatives had difficulty holding on to things with his or her
hands?”
2. ”Did I understand correctly that your memory problems started about 5 years ago?”
3. “Is it painful to flex your chin to your chest?”
4. “Did your muscle weakness first occur in your arms or in your legs?”
Answer: “Do you recall if any of your relatives had difficulty holding on to things with their
hands?”
Rationale:
In Parkinson’s disease (PD), the resulting lack of dopamine production leads to difficulty
with movement, tremor, rigidity, and difficulty maintaining posture. It is thought that the
resulting disease process results from a complex interaction between genetic and
environmental factors. Slow and insidious in onset, and ranging over a course of 3 to 20
years, Alzheimer’s disease progressively degrades cognitive function. The symptoms of
multiple sclerosis include L’Hermite’s sign, or a shocklike pain that results from flexion of
the neck. Amyotrophic lateral sclerosis (ALS) symptoms first present in an arm in roughly
half of the cases, with about 20% of the occurrences affecting a leg.
2. A nurse is providing an informative session to a local civic group. The nurse shows an
understanding of the disorder when describing Alzheimer’s disease (AD) as:
1. A disease process that starts by affecting a person’s memory and progresses toward the loss
of reasoning abilities.
2. A form of dementia that is caused by a lack of a brain chemical.
3. The central nervous system is unpredictably affected, resulting in a loss of communication
and motor skills.
4. The person’s own immune system attacks the cells of the body.
Answer: A disease process that starts by affecting a person’s memory and progresses toward
the loss of reasoning abilities.
Rationale:
The onset of Alzheimer’s disease begins with subtle lapses of memory, which gradually and
progressively develops into a chronic loss of personality, recognition, reasoning, and
independence. Parkinson’s disease is a movement disorder resulting from a dopamine
deficiency; dementia occurs in 15% to 20% of cases. Multiple sclerosis (MS) is a disease of
the central nervous system that is an unpredictable condition that can be relatively benign,
disabling, or devastating, leaving the patient unable to speak, walk, or write. Myasthenia
gravis is an autoimmune reaction that results from a malfunction in the immune system in
which the body produces auto-antibodies that attack specific receptors located on the surface
of muscle cells.
3. The nurse explains to a client who has been diagnosed with myasthenia gravis (MG) that
this condition differs from amyotrophic lateral sclerosis (ALS) in that MG:
Select all that apply.
1. Has an onset for women that commonly occurs between 20 and 40 years of age.
2. Clients experience an increase of symptoms when exposed to sunlight, viral illness, and
emotional stress.
3. Presents with shorter remissions as the disease progresses.
4. Is usually fatal in 3 to 4 years after onset.
5. Produces involuntary twitching of the arms, legs, and tongue muscles.
Answer: 1. Has an onset for women that commonly occurs between 20 and 40 years of age.
2. Clients experience an increase of symptoms when exposed to sunlight, viral illness, and
emotional stress.
3. Presents with shorter remissions as the disease progresses.
Rationale:
Has an onset for women that commonly occurs between 20 and 40 years of age. MG occurs
at any age, although the age of onset is commonly either at 20 to 40 years of age for women
or 60 to 80 years of age for men. Clients experience an increase of symptoms when exposed
to sunlight, viral illness, and emotional stress. Exposure to sunlight, viral illness, surgery,
immunization, emotional stress, menstruation, and physical factors might trigger or worsen
exacerbations. Presents with shorter remissions as the disease progresses. As MG progresses,
symptom-free periods decrease, and muscle weakness fluctuates from mild to severe. Is
usually fatal in 3 to 4 years after onset. Average disease duration in ALS is 3 to 4 years.
Produces involuntary twitching of the arms, legs and tongue muscles. In ALS, symptoms
include fasciculation (involuntary twitching) of the limb and tongue muscles.
4. The nurse is assessing a client with myasthenia gravis (MG). Which of the following
describes a situation that is characteristic of this disease?
Select all that apply.
1. Visual problems may be an early symptom.
2. Immunosuppressant therapy may be prescribed.
3. Ptosis may be either unilateral or bilateral.
4. Exercise increases muscle strength.
5. Tremors respond well to anticholinergic drug therapy.
Answer: 1. Visual problems may be an early symptom.
2. Immunosuppressant therapy may be prescribed.
3. Ptosis may be either unilateral or bilateral.
Rationale:
Visual problems may be an early symptom. The manifestations of myasthenia gravis
correspond to the muscles involved. Initially, the eye muscles are affected.
Immunosuppressant therapy may be prescribed. Treatments such as glucocorticoid and
immunosuppressant therapy may result in an increase in muscle strength. Ptosis may be either
unilateral or bilateral. The client experiences either diplopia (double vision) or ptosis
(drooping of the eyelid unilaterally or bilaterally). Exercise increases muscle strength.
Exercise tends to fatigue muscles, while rest will improve function. Tremors respond well to
anticholinergic drug therapy. Anticholinergics are the oldest class of medications used to treat
the tremors experienced in Parkinson’s disease.
5. The client being evaluated for a possible diagnosis of myasthenia gravis (MG) describes
having a diagnostic test that involved an injection that resulted in a 5-minute period of
markedly improved muscle strength. The nurse recognizes the client’s report as describing
a(n):
1. Tensilon test.
2. Computed tomography (CT) scan.
3. Nerve stimulation study.
4. Analysis of antiacetylcholine receptor antibodies.
Answer: Tensilon test.
Rationale:
The Tensilon test produces a 5-minute increase in muscle strength. A computed tomography
(CT) scan would not result in improved muscle strength. The nerve stimulation study and the
analysis of antiacetylcholine receptor antibodies are tests that can be done to help diagnose
MG, but do not require a drug injection.
6. The nurse is assessing a client who is diagnosed with Parkinson’s disease and documents
that he is demonstrating bradykinesia. The nurse bases this on the observation of the client:
1. Having difficulty initiating a walk to the bathroom.
2. Presenting little facial expression.
3. Maintaining his balance by holding on to the furniture.
4. Speaking both slowly and deliberately.
Answer: Having difficulty initiating a walk to the bathroom.
Rationale:
Bradykinesia, one of the more disabling symptoms of PD, refers to slowness of movement.
Parkinson’s disease creates a lack of spontaneous movement that affects starting to move and
actually following through on the movement. Clients with Parkinson’s do talk slowly and
often deliberately, but the term bradykinesia refers to slowness of movement. Postural
instability refers to the balancing difficulties that result from the diminishing of the reflexes
that allow a person to maintain balance. The patient will have difficulty staying balanced and
may even fall when changing positions. Rigid facial muscles lead to hypomimia, or decreased
facial expression, resulting in the characteristic “masked” face of a PD patient.
7. A client is hospitalized with myasthenia gravis and the nursing diagnosis Ineffective
Breathing Pattern related to neuromuscular weakness has been identified. In planning care for
this client, the nurse will identify which of the following interventions as having priority?
1. Airway suctioning as required
2. Provide frequent rest periods
3. Monitor arterial blood gases
4. Assist with ADLs
Answer: Airway suctioning as required
Rationale:
Respiratory failure is a serious complication for the client hospitalized with myasthenia
gravis. Remembering the ABCs, patent airway is the first concern. Assessment of the arterial
blood gases, while important, does not have priority in this situation. Energy conservation
interventions, such as frequent rest periods and assistance with ADLs, while appropriate for
neuromuscular weakness symptoms, do not have priority over maintaining a patent airway.
8. A home health nurse is conducting a nutritional assessment on a client with moderate
Alzheimer’s disease (AD) when it is noted that he has lost 5 pounds over the past month. The
nursing intervention best directed at managing the client’s need for nutrition is to:
1. Provide finger-food snacks several times throughout the day.
2. Recommend referral to a nutritionist who is familiar with AD clients.
3. Suggest menu choices that encourage a mechanical soft diet.
4. Encourage meals that include at least one of the client’s favorite foods.
Answer: Provide finger-food snacks several times throughout the day.
Rationale:
For the client with moderate Alzheimer’s disease, nutrition and hydration problems arise.
Increased confusion, frustration, and wandering are typical of this stage of AD. Providing the
client with opportunities to have snacks throughout the day, and giving foods that are easy to
eat “on the go,” like fruit slices, protein shakes, or finger foods such as sandwiches, are ways
to offset the nutritional deficits typically seen in clients at this stage of the disease process.
Providing favorite foods is not likely to impact the problem of altered interest in eating. A
nutritionist should be involved if the weight loss continues. A mechanical soft diet is
appropriate only if it is determined that there is a problem with the client’s teeth or
chewing/swallowing mechanisms.
9. A 30-year-old attorney who practices at large corporate law office has recently been
diagnosed with multiple sclerosis (MS). In order to best manage the occurrence of symptoms,
the nurse encourages the client to:
1. Scale back her caseload to allow for a less stressful work environment.
2. Take the pemoline (Cylert) she has been prescribed as ordered.
3. Take time off from work at the first indication of symptom exacerbation.
4. Consider a career change in order to delay progression of her symptoms.
Answer: Scale back her caseload to allow for a less stressful work environment.
Rationale:
Multiple sclerosis (MS) is progressive and will be negatively affected by working long hours
and enduring stressful shifts. It is important for this client to plan a schedule that is less
demanding and move to a work environment that is less stressful for adapting to life with
MS. Pemoline (Cylert) is prescribed for the management of fatigue. Taking time off after
symptoms occur is not a proactive lifestyle change. A career change is not something a nurse
should encourage and will not necessarily delay progression of the disease.
10. When providing education for a client newly diagnosised with mild Alzheimer’s disease
(AD) and his family, the nurse identifies which of the following as signs that the disease is
progressing in severity?
Select all that apply.
1. Repetitively allows pots of water to boil dry
2. Claims that the newspaper is not readable anymore
3. Becomes agitated when old friends come to visit
4. Develops a ravenous appetite, especially for carbohydrates
5. Is obsessive about how personal belongings are organized
Answer: 1. Repetitively allows pots of water to boil dry
2. Claims that the newspaper is not readable anymore
3. Becomes agitated when old friends come to visit
Rationale:
Repetitively allows pots of water to boil dry. Poor judgment, memory loss, and difficulty
completing familiar tasks are warning signs of progressively worsening AD. Claims that the
newspaper is not readable anymore. Loss of reading skills is a warning sign of progressively
worsening AD. Becomes agitated when old friends come to visit. Changes in mood or
behavior and changes in personality are warning signs of progressively worsening AD.
Develops a ravenous appetite, especially for carbohydrates. An increase in appetite is not
usually associated with Alzheimer’s. Is obsessive about how personal belongings are
organized. Obsession with organization is not usually associated with Alzheimer’s.
11. The nurse caring for a client with Alzheimer’s disease (AD) is discussing discharge
planning with the family. The client has been showing signs of increasing agitation in the
evenings. The nurse suggests the following intervention to initially manage the client’s
behavior:
1. Taking the client to his room, where soft music is being played on the radio
2. Administering an oral tranquilizer with dinner
3. Engaging the client in a distractive activity when agitation occurs
4. Recommending the client be in bed for the night by 9 p.m.
Answer: Taking the client to his room, where soft music is being played on the radio
Rationale:
Music therapy, massage, art therapy, sound, and dance are all alternative therapies that have
been helpful in the treatment of Alzheimer’s disease. Increased agitation in the evenings is
part of the “sundowner’s” phenomenon and, although common, can be frustrating to the
client as well as the caregivers. A quiet environment with less stimulation is often helpful. A
quiet environment will most likely be more beneficial than engaging in a distractive activity.
Though the use of tranquilizers might become necessary, it would not be the best initial
intervention. Having the client in bed by 9 p.m. will not necessarily have a positive effect on
the agitation.
12. The nurse is preparing a client diagnosed with amyotrophic lateral sclerosis (ALS) for
discharge. The nurse realizes that interventions for the following nursing diagnosis should be
stressed for this client:
1. Ineffective Breathing Pattern related to neuromuscular dysfunction.
2. Impaired Urinary Elimination related to spastic or flaccid bladder.
3. Alteration in Vision acuity related to ocular muscle involvement.
4. Disturbed Thought Processes related to cognitive decline.
Answer: Ineffective Breathing Pattern related to neuromuscular dysfunction.
Rationale:
ALS affects the neuromuscular function; the client is at risk for respiratory dysfunction as a
result of this disease process. Impaired urinary elimination is a result of a spastic or flaccid
bladder resulting from MS. Visual acuity is impaired in clients diagnosed with MG. Disturbed
thought processes is seen in AD clients.
13. A client newly diagnosed with Parkinson’s disease expresses concerns to the nurse about
how she and her family will cope with the disease. The response to the concerns is based on
the knowledge that:
1. Involvement with a support group that focuses on a specific disease process has been
proven to be very helpful.
2. Most clients need to foster a strong family/friend-based support system to effectively cope
with their disease.
3. A period of depression is generally experienced initially by everyone affected by the
disease process.
4. Coping with the disease will come more naturally as the client becomes familiar with the
limitations it creates.
Answer: Involvement with a support group that focuses on a specific disease process has
been proven to be very helpful.
Rationale:
Parkinson’s support organizations offer understanding and hope for both the patients and their
families. Local and national support groups provide information, educational programs, and
social activities tailored especially for people with PD. While a strong family/friend support
system is important, it does not usually occur without initial supplementary support.
Depression is not necessarily seen in all clients, and realization that it may occur does not
address the client’s concerns. Coping may improve as the client becomes familiar with the
disease process, but that realization does not help address the client’s current needs.
14. The nurse is discussing the future with a client recently diagnosed with amyotrophic
lateral sclerosis (ALS). When the client asks about the possibility of continuing to work at his
family’s construction business, the nurse responses:
1. “Work as long at your job as you feel capable of keeping up with the demands it makes on
you.”
2. “This is a progressively debilitating disease; you need to think of ways to conserve your
energy, not expend it.”
3. “Can you do work that is less strenuous?”
4. “Is there a way that you can switch over to the office side of the business?”
Answer: “Work as long at your job as you feel capable of keeping up with the demands it
makes on you.”
Rationale:
People with ALS do maintain careers and interests. They are encouraged to remain active for
as long as possible. While it is important to minimize stress and conserve energy, it is not
necessary to alter one’s life dramatically until the symptoms of the disease demand it.
15. A nurse is encouraging a client diagnosed with multiple sclerosis to engage in a regular
exercise program. This recommendation is based on the knowledge that exercise will help the
client manage:
Select all that apply.
1. Fatigue.
2. Muscle spasticity.
3. Constipation.
4. Infection exposure.
5. Obesity.
Answer: 1. Fatigue.
2. Muscle spasticity.
3. Constipation.
Rationale:
Fatigue. Patients should be encouraged to engage in a regular exercise program because
exercise may help manage fatigue. Muscle spasticity. Patients should be encouraged to
engage in a regular exercise program because exercise may help manage spasticity.
Constipation. Patients should be encouraged to engage in a regular exercise program because
exercise may help manage bowel and bladder problems. Infection exposure. Good nutrition
can aid in resistance to infection. Obesity. Obesity is not a typical manifestation of this
disease process.
16. A client diagnosed with Parkinson’s disease (PD) 11 years ago is being cared for at home
by his wife. The nurse asks whether the family has considered arranging for in-home assistive
care based primarily on the knowledge that:
1. This type of assistance can help preserve the physical and emotional well-being of the
client’s wife.
2. It is becoming more difficult for his wife to adequately meet his physical needs.
3. This type of assistive care is warranted, since PD is both progressive and degenerative.
4. The client may live for many more years, requiring more intensive care as the disease
progresses.
Answer: This type of assistance can help preserve the physical and emotional well-being of
the client’s wife.
Rationale:
People can live with PD for many years. The chronic and progressive nature of PD can
significantly impact older, spousal caregivers. Caregiver stress and burden have been shown
to increase as the disease progresses, and this has significant impact on the physical and
emotional health of the caregiver. There is no indication that the client’s needs are not being
met. The decision to enlist assistive home care is not based solely on the progressive,
degenerative nature of a disease. It is true that the client with PD may live for many years, but
that is not the primary reason for suggesting assistive home care.
17. The nurse is preparing an educational program on amyotrophic lateral sclerosis (ALS).
The nurse recognizes that this information is most appropriately presented at a:
1. Men’s “50 or older” bowling league banquet.
2. Mother-and-daughter softball league season kickoff brunch.
3. “Singles over 60” wellness health fair.
4. A teenage men’s hockey team annual fund raising event.
Answer: Men’s “50 or older” bowling league banquet.
Rationale:
The onset of ALS typically occurs between 40 and 60 years of age, affecting men more often
than women. While it can affect younger and older people of either gender, the 50-or-older
male group would be the target population of the available options.
18. A client who has been diagnosed with Parkinson’s disease (PD) shares with the nurse that,
“I feel like no one else knows what I’m dealing with.” The nurse’s best response is based on
the knowledge that:
1. PD is the second most common neurological disorder in people over 65.
2. It is not usual to feel alone when faced with a stressful situation.
3. The client will cope better when he realizes his family is supportive.
4. Depression is a commonly seen reaction to such a diagnosis.
Answer: PD is the second most common neurological disorder in people over 65.
Rationale:
People with PD ages 65 and older account for 17% of neurology outpatient visits. After
Alzheimer’s disease, it is the second most common neurological condition requiring home
health care. The client is feeling isolated because of the diagnosis and will benefit greatly
from knowing that many are dealing with the disease and that mutual support is available.
Knowing that the feeling is common in a stressful situation does not adequately address the
client’s needs. The incidence of depression and need for family support do not address the
client’s current emotional state.
19. The nurse is conducting an assessment interview with a client when he shares that two of
his uncles have been diagnosed with Alzheimer’s disease (AD). The nurse recognizes which
of the following assessment data as a potential risk reduction for developing the disease?
1. Has taken atorvastatin (Lipitor) daily for the last 5 years
2. Maintains a regular cardiovascular and weight training exercise program
3. Body fat percentage is calculated to be 22%
4. Can remember and repeat the names of five objects after 10 minutes
Answer: Has taken atorvastatin (Lipitor) daily for the last 5 years
Rationale:
Several agents are undergoing research as potential treatments or preventive therapies for AD.
Studies have shown a decreased AD prevalence and a risk reduction in those patients taking
statin drugs. While factors in maintaining general health, regular exercise and an acceptable
body fat percentage have not shown a connection to the prevention of AD. Current short-term
memory is not an indicator of future AD.
20. The mother of a client diagnosed with multiple sclerosis (MS) asks the nurse to “Explain
what caused my daughter to have this disease.” The nurse’s response is based on research
data that suggest that MS may be a result of:
Select all that apply.
1. Genetic predisposition.
2. Viral infection.
3. Exposure to environmental pollutants.
4. Birth trauma.
5. Nutritional deficiencies.
Answer: 1. Genetic predisposition.
2. Viral infection.
3. Exposure to environmental pollutants.
Rationale:
Genetic predisposition. Many researchers hypothesize that MS is not caused by a single gene,
virus, or environmental factor, but is the result of a combination of factors, including genetic
predisposition. Viral infection. Many researchers hypothesize that MS is not caused by a
single gene, virus, or environmental factor, but is the result of a combination of factors,
including viral infection. Exposure to environmental pollutants. Many researchers
hypothesize that MS is not caused by a single gene, virus, or environmental factor, but is the
result of a combination of factors, including exposure to environmental pollutants. Birth
trauma. Birth trauma is not typically associated with causing MS. Nutritional deficiencies.
Nutritional deficiencies are not typically associated with causing MS.
21. The nurse is discussing physical methods to help manage balance problems for a client
who has been newly diagnosed with Parkinson’s disease. Based on current research findings,
the nurse suggests the client look into:
1. T’ai Chi exercise.
2. Water aerobics class.
3. Riding a stationary recumbent bike.
4. Active range of motion exercises.
Answer: T’ai Chi exercise.
Rationale:
The majority of studies on t’ai chi show that it may lead to improved balance and balance
awareness, reduced fear of falling, increased strength, increased functional mobility, greater
flexibility, and increased psychological well-being, and conclude that t’ai chi may be a viable
option for improving balance in patients with mild Parkinsonism. The other options—water
aerobics, recumbent biking, and active range of motion—have no proven effect on improving
balance.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
