Unit 5 Chapter 15 Path Flashcards
A client works as a data entry worker for a large company and goes to employee health with pain in the wrist/hand. The nurse suspects that it is carpal tunnel syndrome based on which assessment findings? Select all that apply.
A) Describes numbness/tingling in the thumb and first digit
B) States his forearm feels funny (paresthesia)
C) Loss of tendon reflexes on the affected extremity
D) Pain interferes with sleeping
E) Precision grip weakness in the affected hand
A) Describes numbness/tingling in the thumb and first digit
D) Pain interferes with sleeping
E) Precision grip weakness in the affected hand
Rationale:Carpal tunnel syndrome is a mononeuropathy with compression of the median nerve as it travels with the flexor tendons through a canal made by the carpal bones and transverse carpal ligament. Carpal tunnel syndrome is characterized by hand and wrist pain, hand or finger paresthesia, and numbness of the thumb and first 2 1/2 digits of the hand; atrophy of abductor pollicis muscle; pain interferes with sleep; and weakness in precision grip. Guillain-Barré syndrome is characterized by rapidly progressive limb weakness and loss of tendon reflexes.
A client has just been diagnosed with multiple sclerosis (MS). The nurse recognizes that the client’s condition is a result of:
A) Degenerative changes in the musculoskeletal system
B) Degeneration of the lower cell bodies of the lower motor neurons in the gray matter
C) Circulating antibodies attacking the postsynaptic acetylcholine levels
D) An immune-mediated response that is caused by the demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and optic nerve
D) An immune-mediated response that is caused by the demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and optic nerve
Rationale:MS is an immune response against the components of the myelin sheath. There is a progressive demyelinization of the myelin sheath of the white matter of the brain, spinal cord, and the optic nerve. The other options do not describe MS.
The nurse is assessing a client diagnosed with myasthenia gravis (MG). The nurse would expect the assessment to include:
A) Impaired ability to move tongue laterally
B) Loss of hearing on the affected side
C) Inability to move eyes in multiple positions
D) Absent deep tendon reflexes
C) Inability to move eyes in multiple positions
Rationale:Commonly affected are the eye and periorbital muscles, with ptosis (drooping of eyelids) due to eyelid weakness or diplopia (double vision) due to weakness of the extraocular muscles as an initial symptom. The disease may progress from ocular muscle weakness to generalized weakness, including respiratory muscle weakness. Chewing and swallowing may be difficult. Weakness in limb movement usually is more pronounced in the proximal rather than distal parts of the extremity. Speech may be impaired.
Which symptom is unique to amyotrophic lateral sclerosis (ALS) and is not observed in multiple sclerosis (MS)?
A) Optic nerve dysfunction
B) Fatigue
C) Respiratory muscle impairment
D) Dysarthria
C) Respiratory muscle impairment
Rationale:Dysphagia with recurrent aspiration and weakness of the respiratory muscles produce the most significant acute complication of ALS. MS does not typically include respiratory muscle impairment.
After being thrown off the back of a bull, a bull rider can move his arms but has loss of motor function in the lumbar and sacral segments of the spinal cord. This is referred to as:
A) Quadriplegia
B) Anterior cord syndrome
C) Tetraplegia
D) Paraplegia
D) Paraplegia
Rationale:Tetraplegia and quadriplegia are loss of motor or sensory function after damage to neural structures in the cervical segments of the spinal cord. Paraplegia refers to loss of motor or sensory function in thoracic, lumbar, or sacral segments. The arms function as normal. Anterior cord syndrome includes loss of motor function provided by the corticospinal tracts and loss of pain and temperature sensation from damage to the lateral spinothalamic tracts.
When assessing the motor system, which area of the assessment should be the focus for the nurse? Select all that apply.
A) Muscle strength
B) Presence of muscle pain
C) Coordination
D) Body position
E) Presence of involuntary muscle movement
A) Muscle strength
C) Coordination
D) Body position
E) Presence of involuntary muscle movement
Rationale:Assessing the motor system should include assessment of body position, involuntary movements, muscle characteristics (strength, bulk, and tone), spinal reflexes, and coordination. Muscle pain is not included in this assessment of motor function.
An individual experiencing spinal cord damage (SCD) is at high risk for developing deep vein thrombosis (DVT) and pulmonary emboli (PE) due to which pathophysical cause? Select all that apply.
A) Stasis of blood flow
B) Impaired vasomotor tone
C) Hypercoagulation of blood
D) Impaired mobility
E) Impaired pain perception
A) Stasis of blood flow
B) Impaired vasomotor tone
C) Hypercoagulation of blood
D) Impaired mobility
Rationale:People with SCI are at high risk for development of deep vein thrombosis (DVT) and pulmonary embolism. The high risk for DVT in people with acute SCI is due to immobility, decreased vasomotor tone below the level of injury, and hypercoagulability and stasis of blood flow. While a significant factor to the client’s increased risk for injury, poor pain perception would affect the ability to adequately identify such problems but not cause them.
The nurse is teaching a client about appropriate interventions for back pain. Select all that apply.
A) Muscle relaxants
B) Nonsteroidal anti-inflammatory drugs
C) Analgesics
D) Bed rest
E) Aerobic exercise
A) Muscle relaxants
B) Nonsteroidal anti-inflammatory drugs
C) Analgesics
Rationale:Treatment of back pain usually is conservative and consists of analgesic medications, muscle relaxants, and instruction in the correct mechanics for lifting and methods of protecting the back. Pain relief is usually provided using nonsteroidal anti-inflammatory drugs. Bed rest, once the mainstay of conservative therapy, is now understood to be ineffective for acute back pain. Conditioning exercises of the trunk muscles, particularly the back extensors, are often recommended.
Select the laboratory blood test that would be a used to suggest a diagnosis of muscular dystrophy (MD).
A) Rheumatoid factor
B) Amylase levels
C) Creatine kinase
D) Serum glucose
C) Creatine kinase
Rationale:Serum levels of the enzyme creatine kinase (CK), which leaks out of damaged muscle fibers, suggest the presence of the disease. A muscle biopsy, which shows a mixture of muscle cell degeneration and regeneration and reveals fat and scar tissue replacement, may be done to confirm the diagnosis.
Following his annual influenza vaccination, a client begins to feel achy, like he has developed the flu. An hour later, the client is rushed to the emergency department and diagnosed of Guillain-Barré syndrome based on which assessment findings? Select all that apply.
A) Lack of any physical pain
B) Flaccid paralysis of limbs
C) Rapid deterioration of respiratory status
D) BP 90/62
E) Pale, cool, dry skin
B) Flaccid paralysis of limbs
C) Rapid deterioration of respiratory status
D) BP 90/62
Rationale:Guillain-Barré syndrome usually is a medical emergency. There may be a rapid development of ventilatory failure and autonomic disturbances that threaten circulatory function. The disorder is characterized by progressive ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis. Paralysis may progress to involve the respiratory muscles. Autonomic nervous system involvement that causes postural hypotension, dysrhythmias, facial flushing, abnormalities of sweating, and urinary retention is common. Pain is another common feature of Guillain-Barré syndrome
A recently injured (3 months ago) client with a spinal cord injury at T4 to T5 is experiencing a complication. He looks extremely ill. The nurse recognizes this as autonomic dysreflexia (autonomic hyperreflexia). His BP is 210/108; skin very pale; gooseflesh noted on arms. The priority nursing intervention would be to:
A) assess calves of legs for redness, warmth, or edema.
B) scan his bladder to make sure it is empty.
C) check the jugular vein for distention.
D) check the mouth/throat for pustules and redness.
B) scan his bladder to make sure it is empty.
Rationale:Autonomic hyperreflexia, an acute episode of exaggerated sympathetic reflex responses that occur in persons with injuries at T6 and above, in which central nervous system (CNS) control of spinal reflexes is lost, does not occur until spinal shock has resolved and autonomic reflexes return. Autonomic dysreflexia is characterized by vasospasm, hypertension ranging from mild to severe, skin pallor, and gooseflesh associated with the piloerector response. In many cases, the dysreflexic response results from a full bladder. There is no indication the client has right-sided heart failure (jugular vein distention); has a DVT (calf redness, warmth, or edema); or has strep throat (pustules and red throat/tonsils).
Regarding the pathophysiology of Parkinson disease, which statement is true?
A) Acetylcholine levels rise and inhibit voluntary movement.
B) Failure of the cerebral cortex interferes with the use of acetylcholine.
C) The dopamine receptors increase from an alteration in neuronal basal ganglia.
D) Degeneration of the nigrostriatal dopamine neurons occurs.
D) Degeneration of the nigrostriatal dopamine neurons occurs.
Rationale:The primary brain abnormality found in all persons diagnosed with Parkinson disease is degeneration of the nigrostriatal dopamine neurons. Acetylcholine has no bearing on Parkinson development. There is a decrease in dopamine rather than an increase.
Which complication of spinal cord injury is the most preventable in a paraplegic client?
A) Autonomic dysreflexia
B) Deep vein thrombosis
C) Skin breakdown
D) Muscle atrophy
C) Skin breakdown
Rationale:The lack of sensory warning mechanisms and voluntary motor ability below the level of injury, coupled with circulatory changes, places the person with spinal cord injury at major risk for disruption of skin integrity. Significant factors associated with disruption of skin integrity are pressure, shearing forces, and localized trauma and irritation. Relieving pressure, allowing adequate circulation to the skin, and inspecting the skin are primary ways of maintaining skin integrity. Of all the complications after spinal cord injury, skin breakdown is the most preventable.
Coordinated muscular movement requires proper functioning of four areas of the nervous system. Which system controls posture and balance?
A) The motor system
B) The vestibular system
C) The cerebellar system
D) The sensory system
B) The vestibular system
Rationale:The vestibular system is responsible for coordinated posture and balance, the cerebellar system for rhythmic movement and steady posture, the sensory system for position sense, and the motor system for muscle strength.
A client is devastated to receive a diagnosis of amyotrophic lateral sclerosis (ALS). The symptomatology of this disease is a result of its effects on upper and lower motor neurons. The health care provider caring for this client will focus on which priority intervention for this client?
A) Ability to empty bladder completely, thereby preventing autonomic dysreflexia
B) Ability to turn from side to side, thereby preventing skin breakdown
C) Assessment of lower extremities to prevent deep vein thrombosis
D) Respiratory ventilation assessment and prevention of aspiration pneumonia
D) Respiratory ventilation assessment and prevention of aspiration pneumonia
Rationale:Amyotrophic lateral sclerosis is a mixed upper motor neuron (UMN) and lower motor neuron (LMN) disorder. In the more advanced stages of ALS, muscles of the palate, pharynx, tongue, neck, and shoulders become involved, causing impairment of chewing, swallowing (dysphagia), and speech. Dysphagia with recurrent aspiration and weakness of the respiratory muscles produces the most significant acute complications of the disease. Airway/breathing is always the priority over bladder emptying, skin breakdown, and assessing for DVT.
