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MULTIPLE SCLEROSIS The nurse enters the room of a client diagnosed with acute exacerbation of The nurse writes the client problem of "altered sexual functioning" for a...

MULTIPLE SCLEROSIS The nurse enters the room of a client diagnosed with acute exacerbation of The nurse writes the client problem of "altered sexual functioning" for a multiple sclerosis and finds the client crying. Which statement is the most male client diagnosed with multiple sclerosis (MS). Which intervention Which of the following statements made by a patient diagnosed with therapeutic response for the nurse to make? should be implemented? multiple sclerosis (MS) would alert the healthcare provider that the patient 1. "Why are you crying?The medication will help the disease." 1. Encourage the couple to explore alternative ways of maintaining requires additional instruction about the disease? 2. "You seem upset. I will sit down and we can talk for awhile.” intimacy. Select all that apply. 3. "Multiple sclerosis is a disease that has good times and bad 2. Make an appointment with a psychotherapist to counsel the 1. "A hot bath in the evenings will help relax my muscles and relieve times." couple. pain." 4. "I will have the chaplain come and stay with you for a while." 3. Explain daily exercise will help increase libido and sexual arousal. 2. "I will avoid foods that are high in fiber to prevent problems with 4. Discuss the importance of keeping physically calm during sexual my bowels." The client diagnosed with multiple sclerosis is scheduled for a magnetic intercourse. 3. "It's important for me to inspect my skin daily make sure there resonance imaging (MRI) scan of the head. Which information should the aren't any injuries." nurse teach the client about the test? The nurse is admitting a client diagnosed with multiple sclerosis. Which 4. "Use of stress reduction strategies can decrease the severity of 1. The client will have wires attached to the scalp and lights will clinical manifestation should the nurse assess? my symptoms." flash off and on. Select all that apply. 2. The machine will be loud and the client must not move the head 1. Muscle Weakness. The healthcare provider is teaching a group of patients diagnosed with during the test. 2. Lethargy. multiple sclerosis (MS) about common bladder problems. Which of the 3. The client will drink a contrast medium 30 minutes to one (1) hour 3. Dysmetria. following will the healthcare provider include? before the test. 4. Fatigue. Select all that apply. 4. The test will be repeated at intervals during a five (5)- to six 5. Dysphagia. 1. "Drinking caffeinated beverages can help you empty your bladder (6)-hour period. completely." The nurse should conduct a focused assessment with the client with 2. "MS may cause the bladder to contract and empty more often The 45-year-old client is diagnosed with primary progressive multiple multiple sclerosis for risk of which of the following? than usual." sclerosis and the nurse writes the nursing diagnosis "anticipatory grieving Select all that apply. 3. "You should not attempt to urinate until you feel that your bladder related to progressive loss." Which intervention should be implemented? 1.Dehydration. is full." 1. Consult the physical therapist for assistive devices for mobility. 2.Falls. 4. "Drink 1.5 - 2 liters of water each day so your urine isn't too 2. Determine if the client has a legal power of attorney. 3.Seizures. concentrated." 3. Ask if the client would like to talk to the hospital chaplain. 4.Skin breakdown. 5. "Drinking lots of citrus juices will decrease the amount of bacteria 4. Discuss the client's wishes regarding end-of-life care. 5.Fatigue. in your urinary tract." 6. "Patients with MS are at increased risk of developing urinary tract The home health nurse is caring for the client newly diagnosed with The nurse is teaching a client with bladder dysfunction from multiple infections." multiple sclerosis. Which client issue is of most importance? sclerosis (MS) about bladder training at home. Which instructions should 1. The client refuses to have a gastrostomy feeding. the nurse include in the teaching plan? When assessing a patient diagnosed with multiple sclerosis (MS), which of 2. The client wants to discuss if she should tell her fiancé. Select all that apply. the following would require immediate action by the healthcare provider? 3. The client tells the nurse life is not worth living anymore 1.Restrict fluids to 1,000 mL/24 hours. 1) Fatigue and depression 4. The client needs the flu and pneumonia vaccines. 2.Drink 400 to 500 mL with each meal. 2) Paresthesia and tremor 3.Drink fluids midmorning, midafternoon, and late afternoon. 3) Nystagmus and diplopia The nurse and a licensed practical nurse (LPN) are caring for a group of 4.Attempt to void at least every 2 hours. 4) Dysphagia and congested cough clients. Which nursing task should not be assigned to the LPN? 5.Use intermittent catheterization as needed. 1. Administer a skeletal muscle relaxant to a client diagnosed with The healthcare provider is planning care for a patient diagnosed with low back pain. Which of the following is not a typical clinical manifestation of multiple multiple sclerosis (MS). Which of the following is the priority intervention? 2. Discuss bowel regimen medications with the HCP for the client on sclerosis (MS)? 1) Advise the patient to drink liquids through a straw strict bed rest. 1.Double vision. 2) Monitor the patient's temperature to avoid overheating 3. Draw morning blood work on the client diagnosed with bacterial 2.Sudden bursts of energy. 3) Teach the patient's family how to meet the patient's needs meningitis. 3.Weakness in the extremities. 4) Encourage bed rest in order to conserve strength 4. Teach self-catheterization to the client diagnosed with multiple 4.Muscle tremors. sclerosis. The client newly diagnosed with multiple sclerosis (MS) states, "I don't A client with multiple sclerosis (MS) is receiving baclofen (Lioresal). The understand how I got multiple sclerosis. Is it genetic?" On which statement The male client diagnosed with multiple sclerosis states he has been nurse determines that the drug is effective when it achieves which of the should the nurse base the response? investigating alternative therapies to treat his disease. Which intervention following? 1. Genetics may play a role in susceptibility to MS, but the disease is most appropriate by the nurse? 1.Induces sleep. may be caused by a virus. 1. Encourage the therapy if it is not contraindicated by the medical 2.Stimulates the client's appetite. 2. There is no evidence suggesting there is any chromosomal regimen. 3.Relieves muscular spasticity. involvement in developing MS. 2. Tell the client only the health-care provider should discuss this 4.Reduces the urine bacterial count. 3. Multiple sclerosis is caused by a recessive gene, so both parents with him. had to have the gene for the client to get MS. 3. Ask how his significant other feels about this deviation from the A client has had multiple sclerosis (MS) for 15 years and has received 4. Multiple sclerosis is caused by an autosomal dominant gene on medical regimen. various drug therapies. What is the primary reason why the nurse has the Y chromosome,so only fathers can pass it on. 4. Suggest the client research an investigational therapy instead. found it difficult to evaluate the effectiveness of the drugs that the client has used? The 30-year-old female client is admitted with complaints of numbness, The client diagnosed with an acute exacerbation of multiple sclerosis is 1.The client exhibits intolerance to many drugs. tingling, a crawling sensation affecting the extremities, and double vision placed on high-dose intravenous injections of corticosteroid medication. 2.The client experiences spontaneous remissions from time to time. which has occurred two(2) times in the month. Which question is most Which nursing intervention should be implemented? 3.The client requires multiple drugs simultaneously. important for the nurse to ask the client? 1. Discuss discontinuing the proton pump inhibitor with the HCP. 4.The client endures long periods of exacerbation before the illness 2. Hold the medication until after all cultures have been obtained. responds to a particular drug. 1. "Have you experienced any difficulty with your menstrual cycle?" 3. Monitor the client's serum blood glucose levels frequently 2. "Have you noticed a rash across the bridge of your nose?" 4. Provide supplemental dietary sodium with the client's meals. When the nurse talks with a client with multiple sclerosis who has slurred 3. "Do you get tired easily and sometimes have problems speech, which nursing intervention is contraindicated? swallowing?" 1.Encouraging the client to speak slowly. 4. "Are you taking birth control pills to prevent conception?" 2.Encouraging the client to speak distinctly. 3.Asking the client to repeat indistinguishable words. 4.Asking the client to speak louder when tired.  A young adult client complains of blurred vision and muscle spasms that A 32-year-old client recently diagnosed with multiple sclerosis is a full-time The right hand of a client with multiple sclerosis trembles severely come and go over the past several months. On what information from the aerobics exercise instructor at a local fitness center. Which statements whenever she attempts a voluntary action. She spills her coffee twice at client's history should the nurse focus to help identify this help problem? contain the correct information to give the client when answering her lunch and cannot get her dress fastened securely. Which is the best legal A) Family history of Parkinson disease specific questions about lifestyle? documentation in nurses' notes of the chart for this client assessment? B) Family history of epilepsy Select all that apply. 1."Has an intention tremor of the right hand." C) Is an immigrant from Germany A) "Hyperbaric oxygen treatment is recommended prior to vigorous 2."Right-hand tremor worsens with purposeful acts." D) Has been depressed physical exercise." 3."Needs assistance with dressing and eating due to severe B) "You will tolerate exercise better in an air-conditioned room." trembling and clumsiness." A client with a history of relapsing-remitting multiple sclerosis is expecting C) "Acupuncture may benefit some of your symptoms." 4."Slight shaking of right hand increases to severe tremor when her first child. What would be indicated for this client? D) "Drinking cold water is recommended during exercise.” client tries to button her clothes or drink from a cup. A) Suggest reproductive counseling, as multiple sclerosis can be E) "You will be able to maintain your exercise teaching schedule." genetic. A client with multiple sclerosis (MS) is experiencing bowel incontinence B) Instruct to expect a period of remission after delivery of the baby. A nurse is caring for a client who has multiple sclerosis. Which of the and is starting a bowel retraining program. Which strategy is not C) Instruct to expect an exacerbation of symptoms while pregnant. following findings should the nurse expect? appropriate? D) Discuss pain control during labor, as contractions will be severe. A. Fluctuations in blood pressure 1.Eating a diet high in fiber. B. Loss of cognitive function 2.Setting a regular time for elimination. A client with relapsing-remitting multiple sclerosis tells the nurse that even C. Ineffective cough 3.Using an elevated toilet seat. though the primary symptoms of exacerbation are leg spasms and blurred D. Drooping eye lids 4.Limiting fluid intake to 1,000 mL/day. 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 A nurse is beginning a physical assessment of a client who has a new Which of the following is not a realistic outcome to establish with a client client? diagnosis of multiple sclerosis. Which of the following findings should the who has multiple sclerosis (MS)? The client will develop: A) Fatigue nurse expect? 1.Joint mobility. B) Disturbed Sensory Perception Select all that apply. 2.Muscle strength. C) Impaired Physical Mobility A. Areas of paresthesia 3.Cognition. D) Self-Care Deficit B. Involuntary eye movements 4.Mood elevation. C. Alopecia A client admitted with an exacerbation of multiple sclerosis is D. Increased salivation The nurse is preparing a client with multiple sclerosis (MS) for discharge demonstrating frustration with eating because hand and arm spasms E. Ataxia from the hospital to home. The nurse should tell the client: prevent the proper use of utensils. What should the nurse do to assist this 1."You will need to accept the necessity for a quiet and inactive client? A nurse is teaching a client who has multiple sclerosis and a new lifestyle." A) Consult with Occupational Therapy regarding assistive devices prescription for baclofen. Which of the following statements should the 2."Keep active, use stress reduction strategies, and avoid fatigue." for meals. nurse include in the teaching? 3."Follow good health habits to change the course of the disease." B) Counsel the client to select finger foods for meals. A. "This medication will help you with your tremors." 4."Practice using the mechanical aids that you will need when future C) Plan time to feed the client. B. "This medication will help you with your bladder function." disabilities arise. D) Consult with Physical Therapy regarding hand and arm C."This medication may cause your skin to bruise easily." exercises. D."This medication may cause your skin to appear yellow in color." Which of the following should the nurse include in the discharge plan for a client with multiple sclerosis who has an impaired peripheral sensation? A client with multiple sclerosis is observed transferring from the bed to a Which of the following statements made by a patient diagnosed with Select all that apply. motorized wheelchair and applying splints to the lower extremities before multiple sclerosis (MS) would alert the healthcare provider that the patient 1.Carefully test the temperature of bath water. entering the bathroom to perform morning self-care. What could the nurse requires additional instruction about the disease? 2.Avoid kitchen activities because of the risk of injury. conclude regarding this observation? Select all that apply. 3.Avoid hot water bottles and heating pads. A) The client uses assistive devices to optimize autonomy. A. "Use of stress reduction strategies can decrease the severity of 4.Inspect the skin daily for injury or pressure points. B) The client needs instruction to conduct morning care before my symptoms." 5.Wear warm clothing when outside in cold temperatures. applying splints to lower extremities. B. "Regular exercise can help reduce fatigue and help improve my C) The client is dependent upon assistive devices. sense of balance." Which intervention should the nurse suggest to help a client with multiple D) The client is reliant upon assistive devices for independent. C. "I will avoid foods that are high in fiber to prevent problems with sclerosis avoid episodes of urinary incontinence? my bowels." 1.Limit fluid intake to 1,000 mL/day. A client with multiple sclerosis is prescribed diazepam (Valium). What D. "It's important for me to inspect my skin daily make sure there 2.Insert an indwelling urinary catheter. assessment finding indicates that the medication is effective for the client? aren't any injuries." 3.Establish a regular voiding schedule. A) Muscle spasticity is reduced. E. "A hot bath in the evenings will help relax my muscles and relieve 4.Administer prophylactic antibiotics, as prescribed. B) Blood glucose level is within normal limits. pain." C) The client states that muscles are weak. A client with multiple sclerosis (MS) lives with her daughter and 3-year-old D) Ophthalmologic examination shows no evidence of cataracts. A patient is prescribed high-dose methylprednisolone for an acute granddaughter. The daughter asks the nurse what she can do at home to exacerbation of multiple sclerosis (MS). Which of these findings, if help her mother. Which of the following measures would be most The nurse is planning care for a client with multiple sclerosis. Which identified in the patient, would indicate the patient is experiencing an beneficial? intervention would address the nursing diagnosis of Fatigue? adverse effect of the medication? 1.Psychotherapy. A) Encourage increased activity. Select all that apply. 2.Regular exercise. B) Schedule physical therapy three times a day. A. Hypokalemia 3.Day care for the granddaughter. C) Plan activities with sufficient rest periods. B. Angioedema 4.Weekly visits by another person with MS. D) Group activities together so care will not be interrupted. C. Hyperglycemia D. Candida infection A client diagnosed with multiple sclerosis has an acute onset of visual E. Epigastric pain changes, fatigue, and leg weakness. The client says that the last time this F. Paralytic ileus happened, recovery occurred in a few weeks. Which classification of multiple sclerosis is the client experiencing? A) Progressive-relapsing B) Secondary-progressive C) Relapsing-remitting D) Primary-progressive A patient diagnosed with multiple sclerosis (MS) is admitted to the medical JM is a 32-year-old male who presents with gait disturbance and loss of SC, a 30-year-old female, was prescribed teriflunomide 7 mg orally daily for unit. When assessing the patient, which of the following will the HCP balance. His magnetic resonance imaging (MRI) shows a high T2 burden of the treatment of her relapsing MS. Which of the following counseling expect to identify? disease with multiple lesions in multiple locations in the brain. Which of points is false? Select all that apply. the following is not a poor prognostic factor for JM? A. Teriflunomide is a pregnancy category X medication and a A. Scanning speech A. Age contraceptive method is recommended. B. Flaccid paralysis B. Gender B. Alopecia, nausea, headache, and paresthesias are common side C. Nystagmus C. Initial presentation of symptoms effects associated with teriflunomide. D. Resting tremors D. MRI presentation C. A cholestyramine washout may be considered if pregnancy is E. Seizures desired. In the case above, JM's physician decides to initiate natalizumab therapy D. Teriflunomide causes secondary leukemia in 1 in 1,400 patients. The healthcare provider is teaching a group of patients diagnosed with 300 mg IV every 4 weeks. Which of the following is not a monitoring Efficacy of the interferons can be attributed to which mechanism of multiple sclerosis (MS) about common bladder problems. Which of the parameter? action? following will the healthcare provider include? A. Liver function tests A. β1-blockade Select all that apply. B. Anti-JCV Antibodies B. α1 - and β1-blockade A. "You should not attempt to urinate until you feel that your bladder C. Tuberculin skin test C. Immune system dysregulation in the CNS is full." D. MRI D. Immune system modulation in the periphery and at the B. "Patients with MS are at increased risk of developing urinary tract blood-brain barrier infections." Which of the following is used in the treatment of an exacerbation C. "Drinking lots of citrus juices will decrease the amount of bacteria (attack/relapse) of MS? Glatiramer acetate (Copaxone) is thought to act by which of the following in your urinary tract." A. Oral Immunoglobulin mechanisms of action? D. "Drink 1.5 - 2 liters of water each day so your urine isn't too B. High-dose IV methylprednisolone A. Decrease matrix metalloproteinases concentrated." C. Low-dose oral prednisone B. Inhibition of the proliferation of reactive T-cells E. "Drinking caffeinated beverages can help you empty your bladder D. Mitoxantrone C. Decreased number of adhesion molecules completely." D. Blockage of the binding of major histocompatibility (MHC) class II F. "MS may cause the bladder to contract and empty more often PJ is a 47-year-old female with RRMS who presents to the clinic with products to myelin basic protein (MBP) than usual." complaints of fatigue. The physician decides to prescribe a medication for the symptomatic treatment of fatigue. Which of the following agents would MB, a 35-year-old female with RRMS, asks you about an MS drug that A student is assisting the healthcare provider with the care of a patient not be appropriate? requires a 6-hour observation period. Which of the following drugs diagnosed with multiple sclerosis (MS). The student correctly identifies A. Methylphenidate 5 mg every morning requires a 6-hour observation monitoring period? which of the following as part of the pathophysiological process of MS? B. Modafinil 200 mg every morning A. Mitoxantrone Select all that apply. C. Amantadine 100 mg twice daily B. Natalizumab A. Axonal loss in the central nervous system D. Dextromethorphan/quinidine 20 mg/10 mg every morning C. Fingolimod B. Deficiency of acetylcholine at the neuromuscular junction D. Interferon-βla C. Scarring and plaque development Which is true about spasticity in MS? D. Hypoxic damage to cerebral tissue A. Spasticity occurs early after a patient is diagnosed with MS CC, a 52-year-old female, is having difficulty walking without stopping E. Myelin regeneration and remission of symptoms B. Increased muscle tone due to spasticity in late stage MS can help every 25 feet (7-8 m) or so to take a break. Which of the following drugs is F. Autoimmune damage to myelin sheath to decrease falls due to weakness the most appropriate choice for CC at this time? C. Fluoxetine is a first-line agent to treat spasticity A. Mitoxantrone Which of these assessment findings should the healthcare provider expect D. Baclofen is useful orally, intrathecally, and IV for spasticity B. Modafinil to identify as an early clinical characteristic of multiple sclerosis (MS)? C. Interferon-βla (Extavia) A. Vision loss When counseling a patient about interferon therapy for MS, you should D. Dalfampridine B. Dementia communicate to the patient which important aspect regarding efficacy? C. Muscle atrophy A. He or she will start to notice a change in symptoms immediately Which agent is contraindicated in pregnancy? D. Clonus B. He or she must freeze the medication A. Glatiramer acetate C. It may take up to 1 or 2 years to see a change on the MRI B. Teriflunomide A patient diagnosed with multiple sclerosis (MS) is prescribed baclofen D. The medication works best if a double dose is given C. Mitoxantrone (Gablofen). Which question will the healthcare provider ask when D. Natalizumab evaluating the effectiveness of the medication? Interferon-βla (Rebif) differs from Interferon-βla (Avonex) in what way? A. "Are you feeling stronger and less fatigued today?" A. Rebif is given once per week PW is a 30-year-old female diagnosed with RRMS approximately 10 years B. "Has the stiffness in your muscles decreased?" B. Rebif is given as an intramuscular injection ago, and now wants to switch to a DMT that is given the least frequently. C. "Did you have a bowel movement this morning?" C. Rebif is given three times per week Which of the following DMTs is initially given as an infusion once a year for D. "Have you been able to urinate without difficulty D. Rebif causes tissue necrosis 5 consecutive days? A. Teriflunomide When analyzing the cerebrospinal fluid of a patient diagnosed with SW is a 55-year-old male currently on Interferon-βla (Rebif) 44 mcg B. Fingolimod multiple sclerosis (MS), which of the following results would the healthcare subcutaneously three times per week, warfarin, and amiodarone. In the C. Natalizumab provider anticipate? past 6 months, he has had three exacerbations and multiple new D. Alemtuzumab A. Clear with decreased white blood cells enhancing lesions on MRI. Following discontinuation of Rebif what is the B. Clear with increased proteins best next step in his course of therapy? C. Cloudy with increased turbidity A. Natalizumab D. Pinkish with increased red blood cells B. Glatiramer acetate C. Mitoxantrone At the time of diagnosis, the most common form of multiple sclerosis (MS) D. Fingolimod is? A. Primary-progressive Which of the following is not a side effect seen with interferon therapy B. Relapsing-progressive (Avonex, Betaseron, Extavia, Rebif, or Peginterferon)? C. Relapsing-remitting A. Flu-like symptoms D. Secondary-progressive B. Depression C. Chest tightness and facial flushing D. Skin injection-site reactions MYASTHENIA GRAVIS Karina a client with myasthenia gravis is to receive immunosuppressive The nurse is teaching a client about myasthenia gravis. Which statement, if therapy. The nurse understands that this therapy is effective because it: made by the patient indicates the need for further teaching? The nurse is teaching the female client with myasthenia gravis about the A.Decreases the production of autoantibodies that attack the A) The doctor will take me off of my beta blocker because it could prevention of myasthenic and cholinergic crises. The nurse tells the client acetylcholine receptors. exacerbate my symptoms that this is most effectively done by: B.Stimulates the production of acetylcholine at the neuromuscular B) I should report any signs of infection to my PCP A. Eating large, well-balanced meals junction. C) I can take a ibuprofen to help with pain that may occur with B. Doing all chores early in the day while less fatigued C.Inhibits the breakdown of acetylcholine at the neuromuscular spasms C. Taking medications on time to maintain therapeutic blood levels junction. D) I should avoid taking long walks D. Doing muscle-strengthening exercises D.Promotes the removal of antibodies that impair the transmission of impulses Which of the following would be most likely given as a top nursing Myasthenia gravis is due to ____ receptors being blocked and destroyed diagnosis for a patient experiencing a cholinergic crisis? by antibodies. In making a diagnosis of myasthenia gravis Edrophonium HCI (Tensilon) is A) Impaired Gas Exchange A.Epinephrine used. The nurse knows that this drug will cause a temporary increase in: B) Acute Fatigue B.Acetylcholine A. Muscle strength C) Ineffective airway clearance C.Nicotinic B. Blood pressure D) Altered mental status D.Transient C. Symptoms D. Consciousness Your patient has just been diagnosed with myasthenia gravis. Which of the A client with myasthenia gravis ask the nurse why the disease has following orders should be questioned? occurred. The nurse bases the reply on the knowledge that there is: Myasthenia gravis reflects a deficiency in communication by A) Prednisone PO daily A.A reduced amount of neurotransmitter acetylcholine _______________ because receptors for this neurotransmitter have been B) Eyepatch to be worn every night B.A decreased number of functioning acetylcholine receptor sites destroyed. C) Pyrodostigmine bromide (Mestinon) 4 times daily PO C.A genetic in the production acetylcholine A.Dopamine D) Procaine (Novocain) SQ stat to reduce pain in lower limb D.An inhibition of the enzyme ACHE leaving the end plates folded B.Norepinephrine C.Acetylcholine Which of the following is a side effect of Methylprednisolone The most significant initial nursing observations that need to be made D.GABA (Solu-Medrol)? about a client with myasthenia include: A) Hypovolemia A.Degree of anxiety about her diagnosis You are teaching your patient diagnosed with myasthenia gravis about B) Tinnitus B.Ability to chew and speak distinctly treatments. Which of the following statements, if made by the patient C) Euphoria C.Ability to smile an to close her eyelids indicates the need for further teaching? D) Respiratory Depression D.Respiratory exchange and ability to swallow A) Plasmapheresis is way to reduce symptoms but will need to be done every day Your patient diagnosed with Myasthenia Gravis begins taking Mestinon. A female client has experienced an episode of myasthenic crisis. The B) A thymectomy is a removal of my thymus gland and will show During the first week, the dosage is changed frequently. While the dosage nurse would assess whether the client has precipitating factors such as: some immediate relieving of my symptoms is being adjusted, the nurse's priority intervention is to: A.Getting too little exercise C) Corticosteroids can be used for short periods of time to help A) Administer the medication with food or an 8 oz. glass of water B.Increasing intake of fatty foods improve my symptoms, but it isn't good for long periods of time B) Evaluate the client's muscle strength hourly after medication C.Omitting doses of medication D) I need to take my Mestinon four times a day at the same time C) Take a full set of vital signs every 15 minutes D.Taking excess medication each day. D) Administer the medication exactly on time The nurse is caring for a client admitted with suspected myasthenia gravis. The patient with myasthenia gravis arrives to the clinic and states that he Which statement by the client supports the diagnosis of myasthenia gravis Which finding is usually associated with a diagnosis of myasthenia gravis? is experiencing nausea and diarrhea. His blood pressure is 125/85 HR 70 (MG)? A. Visual disturbances, including diplopia Temp 100.0 R 19 O2 97%. What is the nursing priority? 1. "I have weakness and fatigue in my feet and legs." B. Ascending paralysis and loss of motor function A) Prepare the patient for intubation. He is about to go into a 2. "My eyelids droop, and I see double everything." C. Cogwheel rigidity and loss of coordination myasthenic crisis. 3. "I get chest pain and faint after I walk in the hall." D. Progressive weakness that is worse at the day's end B) Perform teaching on medication side effects 4. “I gained 3 pounds this week, and I am spitting up pink frothy C) Assess for signs of infection sputum." Jane, a 20- year old college student is admitted to the hospital with a D) Further assess for other thymectomy complications tentative diagnosis of myasthenia gravis. She is scheduled to have a series Which response to the Tensilon (edrophonium chloride) injection indicates of diagnostic studies for myasthenia gravis, including a Tensilon test. In The patient with myasthenia gravis is complaining about dealing with the client has myasthenia gravis? preparing her for this procedure, the nurse explains that her response to muscle weakness. Which of the following could the nurse do for this 1. The client has no apparent change in the the medication will confirm the diagnosis if Tensilon produces: patient? assessment data. A. Brief exaggeration of symptoms A) Administer antispasmodic medication 2. There is reduced amplitude of electrical stimulation in the muscle. B. Symptomatic improvement of just the ptosis B) Teach the patient to do physical exercise for several hours each 3. The anti-acetylcholine receptor antibodies are present. C. Rapid but brief symptomatic improvement day to help strengthen muscles 4. The client shows a marked improvement of muscle strength. D. Prolonged symptomatic improvement C) Teach the patient it is important to avoid all forms of physical activity whenever possible The nurse is discharging a client diagnosed with MG. Which statement by The initial nursing goal for a client with myasthenia gravis during the D) Help the patient form a plan to take medications on time the client indicates an understanding of the discharge instructions? diagnostic phase of her hospitalization would be to: 1. "I can control the MG with medication, but an adenectomy will A.Facilitate psychologic adjustment The client is experiencing a myasthenic crisis. Which of the following is a cure it." B.Develop a teaching plan priority action of the following ordered actions? 2. "I should take a holiday from my medications every 4 or 5 weeks." C.Maintain the present muscle strength A) Insert NG tube 3. "I must take my medications on time every day, or I could have D.Prepare for the appearance of myasthenic crisis B) Administer Ativan problems." C) Monitor I&O 4. "I should take my steroid medications with food so it won't upset D) Immediately stop anticholinesterase medications my stomach." The client diagnosed with MG is being discharged home. Which The client is being evaluated to rule out myasthenia gravis & being The wife of a client diagnosed with MG is crying and shares with the nurse intervention should the nurse teach the significant other? administered the Tensilon test. Which response to the test indicates the she just doesn't know what to do. Which response is the best action by the 1. Discuss how to perform the Heimlich maneuver. client has MG? nurse? 2. Explain how to perform oral hygiene on a A) The client has no apparent change in the assessment data A) Discuss the Myasthenia foundation w/ client's wife conscious client. B) This is increased amplitude of electrical stimulation in the muscle B) Refer client to a local MG support group 3. Teach how to perform isometric exercises. C) The circulating acetylcholine receptor antibodies are decreased C) Ask the pts. Wife if she would like to talk to a counselor 4. Demonstrate correct hand placement for chest compressions. D) The client shows a marked improvement of muscle strength D) Sit down & allow the wife to ventilate her feelings to the nurse Which referral is appropriate for the client in the late stages of myasthenia Which surgical procdure should the nurse anticipate the client with The client w/ MG is prescribed the cholinesterase inhibitor neostigmine gravis? myasthenia gravis undergoing to help prevent the s/s of the disease (Prostigmin). Which data indicate the med is effective? 1. The infection control nurse. process? A) Client is able to feed self independently 2. The occupational health nurse. A) There is no surgical option B) The client is able to blink the eyes w/out tearing 3. A vocational guidance counselor. B) A transsphenoidal hypophysectomy C) The client denies and nasue/ vomit when eating 4. The speech therapist. C) A thymectomy D)The client denies any pain when performing ROM D) An adrenalectomy The male client with MG is undergoing plasmapheresis at the bedside. Myasthenia Gravis occurs when antibodies attack the Which assessment data would warrant immediate intervention by the The client diagnosed w/ myasthenia gravis is being discharged home. ___________receptors at the neuromuscular junction leading nurse? Which intervention has priority when teaching the client's significant to___________ 1. The client complains of being lightheaded and dizzy. others? A. Metabotropic; muscle weakness 2. The client can smile and clamp his teeth together. A) discuss ways to help prevent choking episodes B. nicotinic acetylcholing; muscle weakness 3. The client states that his leg cramps have gone away. B) Explain how to care for a client on a ventilator C. Dopaminergic adrenergic; muscle contraction 4. The client has a small hematoma at the vascular access site. C) Teach how to perform passive ROM exercises D. Nicotinic adrenergic; muscle contraction D) Demonstrate how to care for the client's feeding tube Which statement by the 20-year-old female client diagnosed with MG You're educating a patient about the pathophysiology of myasthenia indicates the client understands the discharge teaching? Which collab health care team member should the nurse refer the client to Gravis. While explaining the involvement of the thymus gland, the patient 1. "I can have children, but I will have to see my neurologist during in the late stages of MG? asks you where the thymus gland is located. You state it is located? my pregnancy." A) Occupational therapist A. Behind the thyroid glad. 2. "I have a new job at a children's day care center to help with B) recreational Therapist B. Within the adrenal glands. expenses." C) Vocational therapist C. Behind the sternum in between the lungs. 3. "I should not take a bath because I could pass out and drown D) Speech Therapist D. Anterior to the hypothalamus while in the tub." 4. "I will drink at least 1000 mL of water or other liquid every day." The client w/ MG is undergoing plasmapheresis at the bedside. Which A patient with myasthenia Gravis will be eating lunch at 1200. It is now assessment data warrant immediate intervention? 1000 and the patient is scheduled to take Pyridostigmine. At what time The client diagnosed with MG is admitted to the emergency department A) Client's BP is 94/60 and AP is 112 should you administer this medication so the patient will have the with a sudden exacerbation of motor weakness. Which assessment data B) Negative Chvosteks & Trousseaus maximum benefit of this medication? indicate the client is experiencing a myasthenic crisis? C) Serum potassium 3.5 A. As soon as possible. 1. The serum assay of circulating acetylcholine receptor antibodies D) Echymosis at vascular site access B. 1 hour after the patient has eaten (at 1300) is increased. C. 1 hour before the patient eats (at 1100) 2. The client's symptoms improve when administering on a Which statement by the female client diagnosed w/ MG indicates the client D. At 1200 right before the patient eats. cholinesterase inhibitor. needs more discharge teaching? 3. The client's blood pressure, pulse, and respirations improve after A) I will not have a menstrual cycle bcs. Of the disease The neurologist is conducting a Tensilon test (Edrophonium) at the intravenous (IV) fluid. B) I should avoid people who have respiratory infections bedside of a patient who is experiencing unexplained muscle weakness, 4. The Tensilon test does not show improvement in the client's C) I should not take a hot back or swim in cold water double vision, difficulty breathing, and ptosis. Which findings after the muscle strength. D) I will drink at least 2,500 ml of h20 a day administration of Edrophonium would represent the patient has myasthenia Gravis? The male client diagnosed with MG is prescribed the cholinesterase inhibitor The client w/ MG is admitted to the emergency room with a sudden A. the patient experiences worsening of the muscle weakness neostigmine (Prostigmin). Which data indicate the medication is not effective? l exacerbation of motor weakness. Which assessment data indicate the B. The patient experiences wheezing along with facial flushing. 1. The client is able to perform activities of daily living (ADLs) client is experiencing cholinergic crisis? C. The patient reports a tingling sensation in the eyelids and sudden independently. A) The serum assay of circulation ACH receptor antibodies is ringing in the ears. 2. The client states that his vision is clear. increased D. The patient experiences improved muscle strength. 3. The client cannot speak or look upward at the ceiling. B) The client's symptoms improve when administering 4. The client is smiling and laughing with the nurse. cholinesterase inhibitor You're preparing to help the neurologist with conducting a Tensilon test. C) Clients BP, pulse, and RR improve after IV fluid Which antidote will you have on hand in case of an emergency? The client is diagnosed with MG. Which intervention should the nurse implement D) The tensilon test does not show improvement in the client's A. Atropine when administering the anticholinesterase pyridostigmine (Mestinon)? muscle strength B. Protamine sulfate 1. Assess for excess salivation and abdominal cramps. C. Narcan 2. Administer the medication before the client has eaten. The client diagnosed w/ MG is admitted w/ an acute exacerbation. Which D. Leucovorin 3. Break the capsule and sprinkle the medication on the food. interventions should the nurse implement? 4. Assess the client's potassium level prior to administering SELECT ALL APPLY. Which patient below is MOST at risk for developing a cholinergic crisis? medication. A) Assist the pt. to turn and cough every 2 hrs A. A patient with myasthenia Gravis is who is not receiving sufficient B) Place client in high/ semi fowlers amounts of their anticholinesterase medication. Which ocular or facial signs/ symptoms should the nurse expect to assess C) assess client's pulse ox reading every shift B. A patient with myasthenia Gravis who reports not taking the for the client diagnosed with myasthenia gravis? D) Plan meals to promote medication effectiveness medications Pyridostigmine for 2 weeks. A) Weakness & Fatigue E) Monitor client's serum anticholinesterase levels C. A patient with myasthenia Gravis who is experiencing a B) Ptosis & diplopia respiratory infection and recently had left hip surgery. C) Breathlessness & dyspnea D. A patient with myasthenia gravis who reports taking too much of D) Weight loss & Dehydration their anticholinesterase medication. Which meal option would be the most appropriate for a patient with myasthenia gravis? A. Roasted potatoes and cubed steak. B. Hamburger with baked fries. C. Clam chowder with mashed potatoes. D. Fresh veggie try with sliced cheese cubes. Select all the signs and symptoms below that can present in myasthenia gravis: A. Respiratory failure. B. Increased salivation. C. Diplopia D. Ptosis E. Slurred speech. F. Restlessness G. Mask-like appearance of looking sleepy H. Difficulty swallowing You're providing teaching to a group of patients with myasthenia gravis. Which of the following is not a treatment option for this condition? A. Plasmapheresis. B. Cholinesterase medications C. Thymectomy. D. Corticosteroids. You're a home health nurse providing care to a patient with myasthenia gravis. Today you plan on helping the patient with bathing and exercising. When would be the best time to visit the patient to help with these tasks? A. Mid-Afternoon. B. Morning. C. Evening. D. Before bedtime Which is the hallmark symptom of MG? Fatigue Somnolence Muscle pain Fatigable muscle weakness PARKINSON’S DISEASE A 72-year-old patient with moderate-severe PD was placed on Nurse Peterson is reviewing her notes on various neurological conditions carbidopa/levodopa 25/100 mg three times a day by his primary care to prepare for an upcoming training session. She focuses on a chronic, Parkinson disease (PD) is characterized by a nigrostriatal deficiency of: physician. He is complaining of nausea and stomach upset since starting degenerative, progressive disease of the central nervous system, notable A. Acetylcholine the medication. The best recommendation is to: for small patches of demyelination in the brain and spinal cord. Which B. Dopamine A. Increase the carbidopa/levodopa dose by 50%. disease is Nurse Peterson studying? C. Norepinephrine B. Discontinue the medication and switch to rasagiline. A. Huntington’s disease D. Serotonin C. Discontinue the medication and switch to a ropinirole. B. Parkinson’s disease D. Recommend taking carbidopa/levodopa with a nonprotein snack. C. Creutzfeldt-Jakob’s disease The clinical diagnosis of parkinsonism is based on the presence of D. Multiple sclerosis bradykinesia and at least one of three other features: muscular rigidity, A 71-year-old patient has had PD for 8 years and is currently taking resting tremor, and: pramipexole 1.5 mg three times a day and carbidopa/levodopa 25/100 mg Nurse Hernandez is conducting an assessment of a client with Parkinson’s A. Dystonia four times a day. His wife claims that he is complaining of seeing spiders disease. During the evaluation, she identifies bradykinesia when she B. Nystagmus and bugs running across the floor and imaginary children in their house. observes the client displaying: C. Postural instability The first thing to do is: A. Sudden, involuntary muscle contraction. D. Seizures A. Increase the pramipexole dose. B. Inability to move the limbs. B. Reduce the pramipexole dose. C. Tremor that occurs with purposeful movement. Which of the following is the most effective drug for PD? C. Increase the carbidopa/levodopa dose. D. A noticeable reduction in voluntary movements. A. Amantadine D. Reduce the carbidopa/levodopa dose. B. Carbidopa/levodopa Before initiating levodopa for a client with Parkinson’s disease, Nurse C. Pramipexole A 65-year-old patient with PD is experiencing moderate dyskinesias that Allen ensures she is well-informed about the medication and its D. Rasagiline are bothersome. The patient is on carbidopa/levodopa 25/100 mg two implications. What crucial information should Nurse Allen be aware of tablets at 7 AM and one tablet at 11 AM, 2 PM, 5 PM, 8 PM, and 11 PM. regarding levodopa? An 80-year-old with newly diagnosed PD and a history of memory Which of the following is most appropriate: A. Levodopa's absorption can be insufficient if it is administered problems and confusion is best treated with: A. Add amantadine. alongside meals. A. Amantadine B. Add entacapone. B. Levodopa has the potential to induce side effects such as B. Carbidopa/levodopa C. Add rasagiline. orthostatic hypotension. C. Trihexyphenidyl D. Add pramipexole. C. Levodopa can lead to an initial feeling of euphoria, which is then D. Ropinirole followed by a phase of depression. A 63-year-old patient with PD has done well on rasagiline 1 mg once a day D. Levodopa administration requires consistent monitoring through The mechanism of action for entacapone is: and ropinirole 4 mg three times a day for several years. In the past, higher weekly laboratory tests. A. COMT inhibition doses of ropinirole resulted in excessive drowsiness. He now needs more B. MAO-B inhibition symptom relief. The best recommendation would be to: Nurse Ramirez is providing guidance to Mr. Johnson, a client with C. D2-receptor inhibition A. Add carbidopa/levodopa. Parkinson’s disease, on how to prevent spinal curvatures commonly D. Dopa-decarboxylase inhibition B. Add entacapone. associated with the condition. In her instructions on preventing spinal C. Add pramipexole. flexion, what should Nurse Ramirez recommend to Mr. Johnson? Which of the following will not worsen PD symptoms? D. Consider DBS surgery. A. Rest in a supine position with his head elevated. A. Haloperidol B. Occasionally lie in a prone position without using a neck pillow. B. Metoclopramide Which of the following is not a side effect of dopamine agonists? C. Sleep on either side but maintain a straight back. C. Prochlorperazine A. Drowsiness D. Only sleep in the dorsal recumbent position. D. Rasagiline B. Nausea C. Impulse control disorder Nurse Johnson is working with Mr. Parker, who is struggling with a resting A patient with PD is taking carbidopa/levodopa 25/100 mg three times a D. Livedo reticularis tremor in his right hand due to Parkinson's disease. Understanding how day, and reports that he tends to slow down 2 hours before his next this symptom can be disruptive, Nurse Johnson offers a practical carbidopa/levodopa dose. This patient is most likely experiencing: A 74-year-old patient has had PD for 8 years and is currently taking suggestion to help manage the tremor. What advice should Nurse Johnson A. Delayed onset response carbidopa/levodopa 25/100 mg one and a half tablets five times a day. His give to Mr. Parker? B. Dyskinesia medical history is also significant for pancytopenia. He is experiencing A. Engage in deep breathing exercises. C. Freezing troublesome hallucinations. Previous attempts to lower his B. Grasp an object in his hand. D. Wearing off carbidopa/levodopa dose were not tolerated due to significant worsening C. Immerse in a warm bath. of motor symptoms. The best recommendation is to add: D. Use diazepam when necessary. A 70-year-old patient taking carbidopa/levodopa 25/100 mg three times a A. Chlorpromazine day for PD is experiencing end-of-dose wearing off. The best next step is B. Clozapine Nurse Cooper is preparing a teaching plan for a client who has started to: C. Haloperidol taking levodopa for Parkinson’s disease. She plans to educate the client A. Add tolcapone. D. Quetiapine about common side effects associated with this medication. Which side B. Consider surgery. effect should Nurse Cooper include in her teaching plan? C. Add trihexyphenidyl. In response to the 66-year-old woman with Parkinson's Disease who is A. Postural hypotension D. Increase carbidopa/levodopa to four times daily. experiencing difficulty walking, the charge nurse could offer a supportive B. Development of a peptic ulcer and appropriate suggestion to aid in her mobility. The nurse might say: C. Experiencing significant weight loss A 63-year-old patient taking carbidopa/levodopa 25/100 mg four times a A. "Using a cane might provide you with the additional support you D. Occurrence of pancytopenia day for PD is experiencing end-of-dose wearing off. The best need while walking." recommendation is to: B. "If walking becomes too challenging, it's important not to push During an assessment, Nurse Johnson observes Brudzinski's sign and A. Add tolcapone. yourself too hard." Kernig’s sign in a patient. She recognizes these as two classic indicators B. Add entacapone. C. "I can arrange for a wheelchair to help ensure your safety and associated with a specific medical condition. Which disorder is Nurse C. Consider deep-brain stimulation (DBS). comfort." Johnson likely considering based on these signs? D. Change carbidopa/levodopa to three times a day. D. "Focus on walking at a steady, comfortable pace to maintain your A. Parkinson’s disease mobility." B. Cerebrovascular accident (CVA) C. Seizure disorder D. Meningitis Nurse Williams is conducting a seminar on dementia for the staff at the In the care plan for Mr. Thompson, a 78-year-old man with Parkinson’s 1. As the nurse you know that Parkinson’s Disease tends to affect the senior care facility. She emphasizes the importance of understanding the disease, Nurse Edwards is identifying tasks that can be safely delegated to _____________ of the midbrain, which leads to the depletion of the most prevalent causes of dementia in the elderly population. Which a nursing assistant (NA). Considering the responsibilities and scope of neurotransmitter ________________. condition does Nurse Williams identify as the most common cause of practice for a nursing assistant, which of the following tasks is most A. red nucleus, acetylcholine dementia among elderly individuals? appropriate for Nurse Edwards to delegate? B. leminisci, norepinephrine A. Amyotrophic lateral sclerosis A. Checking for orthostatic changes in pulse and blood pressure. C. substantia nigra, dopamine B. Alzheimer’s disease B. Monitoring for improvement in tremor after levodopa (L-dopa) is D. tectum nigra, dopamine C. Multiple sclerosis given. D. Parkinson’s disease C. Adjusting the dosage of levodopa (L-dopa) based on the patient’s 2. True or False: Parkinson’s Disease most commonly affects patients in response. young adulthood, and there is currently no cure for the disease. Nurse Thompson is reviewing the neurological assessment of Mr. D. Monitoring for abnormal involuntary jerky movements of FALSE Johnson, a 70-year-old patient who exhibits tremors and slow movements. extremities. She recalls that these symptoms are often linked to a specific neurological 3. You’re caring for a patient with Parkinson’s Disease that has tremors. disorder characterized by reduced dopamine levels due to the loss of Nurse Taylor is about to conduct an initial assessment on Mrs. Bennett, a Select the option that is INCORRECT about tremors experienced in this pigmented neurons in the substantia nigra region of the basal ganglia. 62-year-old woman admitted with Parkinson’s Disease. As part of her disease: Which disease does Nurse Thompson recognize as associated with these preparation, Nurse Taylor reviews the etiology of Parkinson's disease, A. The tremors are most likely to occur with purposeful movements. findings? especially considering its typical onset between 50-60 years of age. What B. A common term used to describe the tremors in the hands and A. Multiple sclerosis. should Nurse Taylor understand as the primary cause of Parkinson’s fingers is called “pill-rolling”. B. Huntington’s disease. Disease? C. Tremors are one of the most common signs and symptoms in C. Creutzfeldt-Jakob’s disease. A. The natural death of brain cells due to aging. Parkinson’s Disease. D. Parkinson’s disease. B. Genetic or hereditary factors. D. Tremors in this disease can occur in the hands, fingers, arms, C. Exposure to injurious chemical substances. legs and even the lips and tongue. Nurse Parker is overseeing the care of a patient with Parkinson’s disease D. Dysfunction of dopamine-producing cells in the brain. who has been consistently taking carbidopa/levodopa (Sinemet) for a year. 4. While assessing a patient with Parkinson’s Disease, you note the She is attentively monitoring for any potential adverse reactions Nurse Gray is tasked with caring for Mr. Thompson, a client with patient’s arms slightly jerk as you passively move them toward the associated with this specific medication. Which adverse reaction should Parkinson’s disease, and is focused on enhancing his nutritional intake patient’s body. This is known as: Nurse Parker be particularly vigilant about in monitoring this patient? and ensuring safe swallowing. Considering the unique needs of Mr. A. Lead Pipe Rigidity A. The occurrence of dyskinesia. Thompson, what interventions should Nurse Gray prioritize to facilitate B. Cogwheel Rigidity B. The emergence of respiratory depression. effective swallowing and proper nutrition? C. Pronate Rigidity C. The onset of glaucoma. A. Ensuring the client sits in an upright position while eating. D. Flexor Rigidity D. The development of a rash or other signs of an allergic reaction. B. Providing liquids during meals. C. Personally feeding the client. 5. A patient with Parkinson’s Disease has slow movements that affects Nurse Anderson is preparing to conduct an initial assessment of Mrs. D. Encouraging the intake of solid foods. their swallowing, facial expressions, and ability to coordinate movements. Green, a 63-year-old woman admitted with Parkinson’s Disease. She As the nurse you will document the patient has: collaborates with the dietician to tailor Mrs. Green's diet, especially Nurse Carter observes that Mr. Adams, a 73-year-old patient in her care, A. Akinesia considering her medication, levodopa. Nurse Anderson discusses with the has a distinctive shuffling walk as he moves down the hallway. B. “Freeze up” tremors dietician about which type of food should be limited or avoided for a Recognizing this unique pattern, Nurse Carter reflects on which C. Bradykinesia patient taking levodopa. What type of food should they focus on? neurological condition is typically associated with such a gait. Which D. Pill-rolling A. Food rich in Vitamin B6. disease should Nurse Carter associate with a shuffling gait? B. Food rich in Thiamine. A. Raynaud’s disease 6. You’re providing free education to a local community group about the C. Food rich in Vitamin E. B. Multiple sclerosis signs and symptoms of Parkinson’s Disease. Select all the signs and D. Food rich in Vitamin C. C. Myasthenia gravis symptoms a patient could experience with this disease: D. Parkinson’s disease A. Increased Salivation Nurse Davis is about to perform an initial assessment on Mrs. Allen, a B. Loss of smell 64-year-old woman admitted with advanced Parkinson’s Disease. Nurse Nurse Thompson is overseeing the care of a patient with Parkinson’s C. Constipation Davis is aware that certain characteristics are indicative of this stage of the disease, diagnosed with Impaired Physical Mobility due to neuromuscular D. Tremors with purposeful movement disease. Which of the following does Nurse Davis recognize as a issues. She notices various activities performed by a nursing assistant E. Shuffling of gait characteristic of a patient with advanced Parkinson’s disease? (NA) and needs to decide if any require her immediate intervention. Which F. Freezing of extremities A. Disturbed vision. action by the NA should prompt Nurse Thompson to intervene? G. Euphoria B. Mask-like facial expression. A. Placing the patient in a chair without using a transfer belt. H. Coordination issues C. Muscle atrophy. B. Assisting the patient in ambulating with a gait belt. D. Forgetfulness. C. Helping the patient with feeding using adaptive utensils. 7. You’re providing diet education to a patient with Parkinson’s Disease. D. Encouraging the patient to perform active range of motion Which statement below demonstrates the patient understood your Nurse Martinez is preparing to conduct an initial assessment of Mrs. Smith, exercises. teaching? a 66-year-old woman admitted with Parkinson’s Disease. As part of her Select all that apply: preparation, Nurse Martinez reviews the patient's medication, specifically Nurse Harris is providing lifestyle and safety advice to Mr. Baker, a patient A. “I will limit foods high in fiber like fruits and vegetables in my diet.” levodopa. She considers the primary action of this medication in the with Parkinson's disease. She wants to ensure that Mr. Baker avoids B. “I will be sure to drink 2 Liter of fluid per day.” management of Parkinson’s Disease. What should Nurse Martinez identify activities that might exacerbate his symptoms or pose a risk to his health. C. “It is very common for me to experience diarrhea with this as the main effect of levodopa? Which of the following should Nurse Harris advise Mr. Baker to avoid? disease.” A. It decreases the availability of acetylcholine. A. Participating in seated yoga classes. D. “I will avoid taking Carbidopa/Levodopa with a protein rich meal.” B. It activates dopaminergic receptors in the basal ganglia. B. Walking on uneven terrain alone. C. It increases the availability of dopamine. C. Eating a balanced diet rich in fiber. 8. A patient with Parkinson Disease is experiencing weight loss due to difficulty D. It releases dopamine and other catecholamines from neurological D. Engaging in mild stretching exercises. chewing and swallowing. Which meal option below is the best for this patient? storage sites. A. Scrambled eggs with a side of cottage cheese B. Grilled cheese with apple slices C. Baked chicken with bacon slices D. Tacos with refried beans 9. As the home health nurse you are helping a patient with Parkinson’s Disease get dressed. What item gathered by the patient to wear should NOT be worn? A. Velcro pants B. Pull over sweatshirt C. Non-slip socks D. Rubber sole shoes 10. A spouse of a husband who has Parkinson’s Disease explains to you that her husband experiences episodes while walking where he freezes and can’t move. She asks what can be done to help with these types of episodes to prevent injury. Select all the options that are correct: A. Have the husband try to change direction of movement by moving in the opposite direction when the freeze ups occur. B. Use a cane with a laser point while walking. C. Have the husband try to push through the freeze ups. D. Encourage the husband to consciously lift the legs while walking (as with marching). 11. A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is incorrect about this medication: A. It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication. B. Body fluids can turn a dark color and stain clothes C. This medication is most commonly prescribed with a vitamin B6 supplement. D. Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain. 12. You’re patient with Parkinson’s Disease has been taking Carbidopa/Levodopa for several years. The patient reports that his signs and symptoms actually become worse before the next dose of medication is due. As the nurse, you know what medication can be prescribed with this medication to help decrease this for happening? A. Antic