ATI Lewis Chapter 58 Chronic Neurologic
Problems Questions and correct answers
graded+ year 2022/2023
A patient with myasthenia gravis is admitted to the hospital with respiratory insufficiency and severe
weakness. When is a diagnosis of cholinergic crisis made?
a. The patient's respiration is impaired because of muscle weakness.
b. Administration of edrophonium (Tensilon) increases muscle weakness.
c. Administration of edrophonium (Tensilon) results in improved muscle contractility.
d. EMG reveals decreased response to repeated stimulation of muscles. - ANSWER-b.
The reduction of the acetylcholine (ACh) effect in myasthenia gravis (MG) is treated with
anticholinesterase drugs, which prolong the action of ACh at the neuromuscular synapse, but too much
of these drugs will cause a cholinergic crisis with symptoms very similar to those of MG. To determine
whether the patient's manifestations are due to a deficiency of ACh or to too much anticholinesterase
drug, the anticholinesterase drug edrophonium chloride (Tensilon) is administered. If the patient is in
cholinergic crisis, the patient's symptoms will worsen; if the patient is in a myasthenic crisis, the patient
will improve.
During care of a patient in myasthenic crisis, maintenance of what is the nurse's first priority for the
patient?
a. Mobility
b. Nutrition
c. Respiratory function
d. Verbal communication - ANSWER-c.
The patient in myasthenic crisis has severe weakness and fatigability of all skeletal muscles, affecting the
patient's ability to breathe, swallow, talk, and move. However, the priority of nursing care is monitoring
and maintaining adequate ventilation.
,When providing care for a patient with ALS, the nurse recognizes what as one of the most distressing
problems experienced by the patient?
a. Painful spasticity of the face and extremities
b. Retention of cognitive function with total degeneration of motor function
c. Uncontrollable writhing and twisting movements of the face, limbs, and body
d. Knowledge that there is a 50% chance the disease has been passed to any offspring - ANSWER-b.
In ALS there is gradual degeneration of motor neurons with extreme muscle wasting from lack of
stimulation and use. However, cognitive function is not impaired and patients feel trapped in a dying
body. Chorea manifested by writhing, involuntary movements is characteristic of HD. As an autosomal
dominant genetic disease, HD also has a 50% chance of being passed to each offspring.
In providing care for patients with chronic, progressive neurologic disease, what is the major goal of
treatment that the nurse works toward?
a. Meet the patient's personal care needs.
b. Return the patient to normal neurologic function.
c. Maximize neurologic functioning for as long as possible.
d. Prevent the development of additional chronic diseases. - ANSWER-c.
Many chronic neurologic diseases involve progressive deterioration in physical or mental capabilities
and have no cure, with devastating results for patients and families. Health care providers can only
attempt to alleviate physical symptoms, prevent complications, and assist patients in maximizing
function and self-care abilities for as long as possible.
A patient who is having an acute exacerbation of multiple sclerosis has a prescription for
methylprednisolone (Solu-Medrol) 160 mg IV. The label on the vial reads: methylprednisolone 125 mg in
2 mL. How many mL will the nurse administer? - ANSWER-2.56. With a concentration of 125 mg/2
mL, the nurse will need to administer 2.56 mL to obtain 160 mg of methylprednisolone.
When obtaining a health history and physical assessment for a 36-year-old female patient with possible
multiple sclerosis (MS), the nurse should
a. assess for the presence of chest pain.
, b. inquire about urinary tract problems.
c. inspect the skin for rashes or discoloration.
d. ask the patient about any increase in libido. - ANSWER-B.
Urinary tract problems with incontinence or retention are common symptoms of MS. Chest pain and
skin rashes are not symptoms of MS. A decrease in libido is common with MS.
A 31-year-old woman who has multiple sclerosis (MS) asks the nurse about risks associated with
pregnancy. Which response by the nurse is accurate?
a. "MS symptoms may be worse after the pregnancy."
b. "Women with MS frequently have premature labor."
c. "MS is associated with an increased risk for congenital defects."
d. "Symptoms of MS are likely to become worse during pregnancy." - ANSWER-A.
During the postpartum period, women with MS are at greater risk for exacerbation of symptoms. There
is no increased risk for congenital defects in infants born of mothers with MS. Symptoms of MS may
improve during pregnancy. Onset of labor is not affected by MS.
Which action will the nurse plan to take for a 40year-old patient with multiple sclerosis (MS) who has
urinary retention caused by a flaccid bladder?
a. Decrease the patient's evening fluid intake.
b. Teach the patient how to use the Credé method.
c. Suggest the use of adult incontinence briefs for nighttime only.
d. Assist the patient to the commode every 2 hours during the day. - ANSWER-B.
The Credé method can be used to improve bladder emptying. Decreasing fluid intake will not improve
bladder emptying and may increase risk for urinary tract infection (UTI) and dehydration. The use of
incontinence briefs and frequent toileting will not improve bladder emptying.
A 73-year-old patient with Parkinson's disease has a nursing diagnosis of impaired physical mobility
related to bradykinesia. Which action will the nurse include in the plan of care?
Problems Questions and correct answers
graded+ year 2022/2023
A patient with myasthenia gravis is admitted to the hospital with respiratory insufficiency and severe
weakness. When is a diagnosis of cholinergic crisis made?
a. The patient's respiration is impaired because of muscle weakness.
b. Administration of edrophonium (Tensilon) increases muscle weakness.
c. Administration of edrophonium (Tensilon) results in improved muscle contractility.
d. EMG reveals decreased response to repeated stimulation of muscles. - ANSWER-b.
The reduction of the acetylcholine (ACh) effect in myasthenia gravis (MG) is treated with
anticholinesterase drugs, which prolong the action of ACh at the neuromuscular synapse, but too much
of these drugs will cause a cholinergic crisis with symptoms very similar to those of MG. To determine
whether the patient's manifestations are due to a deficiency of ACh or to too much anticholinesterase
drug, the anticholinesterase drug edrophonium chloride (Tensilon) is administered. If the patient is in
cholinergic crisis, the patient's symptoms will worsen; if the patient is in a myasthenic crisis, the patient
will improve.
During care of a patient in myasthenic crisis, maintenance of what is the nurse's first priority for the
patient?
a. Mobility
b. Nutrition
c. Respiratory function
d. Verbal communication - ANSWER-c.
The patient in myasthenic crisis has severe weakness and fatigability of all skeletal muscles, affecting the
patient's ability to breathe, swallow, talk, and move. However, the priority of nursing care is monitoring
and maintaining adequate ventilation.
,When providing care for a patient with ALS, the nurse recognizes what as one of the most distressing
problems experienced by the patient?
a. Painful spasticity of the face and extremities
b. Retention of cognitive function with total degeneration of motor function
c. Uncontrollable writhing and twisting movements of the face, limbs, and body
d. Knowledge that there is a 50% chance the disease has been passed to any offspring - ANSWER-b.
In ALS there is gradual degeneration of motor neurons with extreme muscle wasting from lack of
stimulation and use. However, cognitive function is not impaired and patients feel trapped in a dying
body. Chorea manifested by writhing, involuntary movements is characteristic of HD. As an autosomal
dominant genetic disease, HD also has a 50% chance of being passed to each offspring.
In providing care for patients with chronic, progressive neurologic disease, what is the major goal of
treatment that the nurse works toward?
a. Meet the patient's personal care needs.
b. Return the patient to normal neurologic function.
c. Maximize neurologic functioning for as long as possible.
d. Prevent the development of additional chronic diseases. - ANSWER-c.
Many chronic neurologic diseases involve progressive deterioration in physical or mental capabilities
and have no cure, with devastating results for patients and families. Health care providers can only
attempt to alleviate physical symptoms, prevent complications, and assist patients in maximizing
function and self-care abilities for as long as possible.
A patient who is having an acute exacerbation of multiple sclerosis has a prescription for
methylprednisolone (Solu-Medrol) 160 mg IV. The label on the vial reads: methylprednisolone 125 mg in
2 mL. How many mL will the nurse administer? - ANSWER-2.56. With a concentration of 125 mg/2
mL, the nurse will need to administer 2.56 mL to obtain 160 mg of methylprednisolone.
When obtaining a health history and physical assessment for a 36-year-old female patient with possible
multiple sclerosis (MS), the nurse should
a. assess for the presence of chest pain.
, b. inquire about urinary tract problems.
c. inspect the skin for rashes or discoloration.
d. ask the patient about any increase in libido. - ANSWER-B.
Urinary tract problems with incontinence or retention are common symptoms of MS. Chest pain and
skin rashes are not symptoms of MS. A decrease in libido is common with MS.
A 31-year-old woman who has multiple sclerosis (MS) asks the nurse about risks associated with
pregnancy. Which response by the nurse is accurate?
a. "MS symptoms may be worse after the pregnancy."
b. "Women with MS frequently have premature labor."
c. "MS is associated with an increased risk for congenital defects."
d. "Symptoms of MS are likely to become worse during pregnancy." - ANSWER-A.
During the postpartum period, women with MS are at greater risk for exacerbation of symptoms. There
is no increased risk for congenital defects in infants born of mothers with MS. Symptoms of MS may
improve during pregnancy. Onset of labor is not affected by MS.
Which action will the nurse plan to take for a 40year-old patient with multiple sclerosis (MS) who has
urinary retention caused by a flaccid bladder?
a. Decrease the patient's evening fluid intake.
b. Teach the patient how to use the Credé method.
c. Suggest the use of adult incontinence briefs for nighttime only.
d. Assist the patient to the commode every 2 hours during the day. - ANSWER-B.
The Credé method can be used to improve bladder emptying. Decreasing fluid intake will not improve
bladder emptying and may increase risk for urinary tract infection (UTI) and dehydration. The use of
incontinence briefs and frequent toileting will not improve bladder emptying.
A 73-year-old patient with Parkinson's disease has a nursing diagnosis of impaired physical mobility
related to bradykinesia. Which action will the nurse include in the plan of care?
