Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 7th Edition
Chapter 74: Management of Clients with Degenerative Neurologic Disorders
MULTIPLE CHOICE
1. The nurse instructs a group of nursing students that the pathologic changes that occur in the
brain of a person with dementia of Alzheimer’s include
a. damage to the myelin sheath of neurons.
b. abnormal accumulation of proteins.
c. destruction of neurons.
d. increase in production of cerebrospinal fluid (CSF).
ANS: b
The neuritic plaque is a cluster of degenerating nerve terminals, both dendritic and axonal, that
contains amyloid protein.
DIF: Cognitive Level: Knowledge REF: Text Reference: 2162
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
2. A client is assessed as being in stage I of Alzheimer’s disease (AD). The nurse recognizes the
complaint made by the client's family that is most closely related to the diagnosis is
a. “She seems indifferent about things she used to care about.”
b. “She seems to have lost control over her bowels.”
c. “She uses words in the wrong context.”
d. “She has difficulty using simple things, such as her toothbrush or comb.”
ANS: a
A common clinical manifestation of stage I AD would include indifference.
DIF: Cognitive Level: Application REF: Text Reference: 2165
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
3. The nurse would suggest to the family of a client who is in stage II AD and has memory
impairment to
a. obtain an order for restraints.
b. assess orientation hourly.
c. have the client wear an identification badge.
d. place the client in a quiet environment.
ANS: c
In the inpatient setting, nurses should ensure that clients cannot leave the premises without being
noticed; that they wear an identification badge in case they become lost; and that doors and
windows are secured.
Chapter 74: Management of Clients with Degenerative Neurologic Disorders 2
DIF: Cognitive Level: Application REF: Text Reference: 2168
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
4. A client with AD begins to tell the nurse about his early married life. The nurse should
a. encourage the client to talk about recent memories.
b. listen to his stories.
c. orient the client to time and place.
d. distract the client from this activity.
ANS: b
Because clients' long-term memory is retained longer than their short-term memory, allow them
to reminisce.
DIF: Cognitive Level: Analysis REF: Text Reference: 2168
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Psychosocial Integrity
5. The nurse reminds a group of students about the aspects of the pathophysiology of multiple
sclerosis (MS), which is
a. damage occurs primarily to the dendrites.
b. once damaged, myelin cannot regenerate.
c. plaques occur anywhere in the white matter of the central nervous system (CNS).
d. Schwann cells are destroyed.
ANS: c
Although plaques may occur anywhere in the white matter of the CNS, the areas most commonly
involved are the optic nerves, cerebrum, and cervical spinal cord.
DIF: Cognitive Level: Knowledge REF: Text Reference: 2177
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
6. A client who is being evaluated for possible MS is experiencing vision problems. It is
significant for the nurse to ask
a. “Have you ever experienced these vision problems before?”
b. “How long have you had these vision problems?”
c. “Do the problems affect your lifestyle?”
d. “Have you experienced problems with memory?”
ANS: a
As a result of the fluctuation of clinical manifestations, the client may report a history of similar
findings that went away.
DIF: Cognitive Level: Analysis REF: Text Reference: 2179
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
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Chapter 74: Management of Clients with Degenerative Neurologic Disorders 3
7. When teaching the client with MS to intervene for his constipation problem, the nurse should
encourage the client to avoid
a. a high-fiber diet.
b. stool softeners.
c. citrus fruits.
d. laxatives.
ANS: d
A high-fiber diet, bulk formers, and stool softeners are useful for maintaining stool consistency.
Explain that laxatives and enemas should be avoided because they lead to dependence.
DIF: Cognitive Level: Application REF: Text Reference: 2179
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
8. The nurse formulates the following nursing diagnosis for a client with MS: Impaired
Physical Mobility related to muscle weakness. To implement this the nurse would
a. encourage long naps or rest periods.
b. encourage strengthening exercises for affected muscles every 4 hours.
c. perform range-of-motion exercises at least two times daily.
d. perform all the activities of daily living (ADLs) for the client.
ANS: c
Range-of-motion exercises should be performed at least twice daily.
DIF: Cognitive Level: Application REF: Text Reference: 2180
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
9. A client tells the nurse that he is experiencing some leg stiffness when walking and slowness
when performing ADLs. Occasionally he has noted slight tremors in his hands at rest. This
information leads the nurse to suspect
a. Parkinson's disease (PD).
b. myasthenia gravis (MG).
c. amyotrophic lateral sclerosis (ALS).
d. Huntington's disease.
ANS: a
Early in PD the client may notice a slight slowing in the ability to perform ADLs. A general
feeling of stiffness may be noticed, along with mild, diffuse muscular pain. Tremor is a common
early manifestation that usually occurs in one of the upper limbs.
DIF: Cognitive Level: Analysis REF: Text Reference: 2170
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
10. When a client experiences the manifestations of a parkinsonian crisis, the nurse should
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Chapter 74: Management of Clients with Degenerative Neurologic Disorders 4
a. provide the client with fluids high in calcium.
b. place the client in a nonstimulating environment.
c. prepare to administer intravenous fluids that contain potassium.
d. administer oxygen by nasal catheter.
ANS: b
Occasionally, clients with PD experience a parkinsonian crisis as a result of emotional trauma or
sudden or inadvertent withdrawal of antiparkinson medication. Severe exacerbation of tremor,
rigidity, and bradykinesia, accompanied by acute anxiety, sweating, tachycardia, and hyperpnea
occur. The client should be placed in a quiet room with subdued lighting.
DIF: Cognitive Level: Application REF: Text Reference: 2173
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
11. To assist the client with Parkinson’s disease to reduce tremor, the nurse suggests that the
client
a. tightly hold change in the pocket.
b. clasp arms about self and squeeze.
c. sleep on the nontremorous side.
d. visualize stilling the tremor.
ANS: a
Clasping change tightly in the pocket, using both hands to complete tasks, and sleeping on the
tremorous side will help lessen the tremor.
DIF: Cognitive Level: Application
REF: Text Reference: 2174, Client Education Guide - Parkinson's Disease;
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
12. A nurse is performing an assessment on a client who is suspected of having MG. The
complaint made by the client that reflects a manifestation commonly seen in clients with this
disease is
a. “I have a great deal of difficulty getting up after I rest for a while.”
b. “When I have a cold, I usually have a strong cough with it.”
c. “By the end of the day, my eyelids usually are drooping.”
d. “I perspire more then I ever have in the past.”
ANS: c
The primary feature of MG is increasing weakness with sustained muscle contraction. After a
period of rest the muscles regain their strength. Muscle weakness is greatest after exertion or at
the end of the day. Ocular manifestations are most common, with ptosis or diplopia occurring in
a majority of clients.
DIF: Cognitive Level: Application REF: Text Reference: 2183
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
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Chapter 74: Management of Clients with Degenerative Neurologic Disorders 5
13. A client with MG began to experience a sudden worsening of her condition with difficulty in
breathing. The nurse explains that this complication of MG is usually initially treated with
a. rest.
b. a bolus dose of atropine.
c. an increase in the anticholinesterase dosage.
d. corticosteroids.
ANS: c
With myasthenic crisis, if an increase in the dosage of the anticholinesterase drug does not
improve the weakness, endotracheal intubation and mechanical ventilation may be required.
DIF: Cognitive Level: Comprehension REF: Text Reference: 2183
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
14. A client with advanced ALS is admitted to the hospital. Because of manifestations that are
common in clients with ALS, the nurse should
a. provide the client with small, frequent feedings.
b. orient the client to his or her surroundings at frequent intervals.
c. attempt to institute bowel-training activities.
d. obtain an order for intermittent catheterization.
ANS: a
The course of the disease is relentlessly progressive. Cognition, as well as bowel and bladder
sphincters, remains intact. Encourage small, frequent, high-nutrient feedings.
DIF: Cognitive Level: Application REF: Text Reference: 2185
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
15. The nurse cautions clients with ALS and their families to be aware that
a. intellectual loss occurs only in the late stages of the disease.
b. medical therapy can be effective in some individuals.
c. communication problems will eventually occur.
d. this disease has remissions and exacerbations.
ANS: c
In some cases, weakness begins in the brain stem, causing problems with speech and
swallowing.
DIF: Cognitive Level: Application REF: Text Reference: 2186
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Psychosocial Integrity
16. The nurse explains that pathology of Huntington's disease involves
a. destruction of white matter in the brain.
b. an excess of the neurotransmitter dopamine.
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Chapter 74: Management of Clients with Degenerative Neurologic Disorders 6
c. a decrease in the neurotransmitter norepinephrine.
d. formation of neurofibrillary tangles.
ANS: b
The degeneration of the caudate nucleus leads to a reduction in several neurotransmitters,
including gamma-aminobutyric acid, acetylcholine, substance P, and met-enkephalin, and their
synthetic enzymes. This change leaves relatively higher concentrations of the other
neurotransmitters, dopamine and norepinephrine.
DIF: Cognitive Level: Knowledge REF: Text Reference: 2176
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
17. In order to deal with the most common problem of Huntington's disease, the nurse should
institute
a. a diet that includes foods that are easy to swallow.
b. seizure precautions.
c. an exercise regimen.
d. communication signals.
ANS: a
One of the most common and dangerous middle- to late-stage problems is dysphagia.
DIF: Cognitive Level: Analysis REF: Text Reference: 2176
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
18. When a client is admitted to the hospital with Guillain-Barré syndrome (GBS), the most
important assessment the nurse should make is for
a. seizure activity.
b. decreasing alertness.
c. respiratory difficulty.
d. urinary retention.
ANS: c
The two most dangerous features of GBS are respiratory muscle weakness and autonomic
neuropathy involving both the sympathetic and parasympathetic systems.
DIF: Cognitive Level: Application REF: Text Reference: 2182
TOP: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
19. The nurse warns that the early manifestation of AD that is assessed by family members and
co-workers before the client is aware is
a. inadequate personal hygiene.
b. memory deficit.
c. incontinence.
d. “nodding off” frequently.
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Chapter 74: Management of Clients with Degenerative Neurologic Disorders 7
ANS: b
Family members and co-workers will notice memory deficit in the individual with early
Alzheimer’s before the victim is aware.
DIF: Cognitive Level: Application REF: Text Reference: 2165
TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
Elsevier items and derived items © 2005 by Elsevier Inc.