CCI Final Exam
20. A 38-year-old woman has newly diagnosed multiple sclerosis (MS) and asks the nurse what is going
to happen to her. What is the best response by the nurse?
a. "You will have either periods of attacks and remissions or progression of nerve damage over time."
b. "You need to plan for a continuous loss of movement, sensory functions, and mental capabilities."
c. "You will most likely have a steady course of chronic progressive nerve damage that will change your
personality."
d. "It is common for people with MS to have an acute attack of weakness and then not to have any other
symptoms
for years." - Answer-20. a. Most patients with multiple sclerosis (MS) have
remissions and exacerbations of neurologic dysfunction or a relapsing-remitting initial course followed
by progression with or without occasional relapses, minor remissions, and plateaus that progressively
cause loss of motor, sensory, and cerebellar functions. Intellectual function generally remains intact but
patients may experience anger, depression, or euphoria. A few people have chronic progressive
deterioration and some may experience only occasional and mild symptoms for several years after
onset.
21. During assessment of a patient admitted to the hospital with an acute exacerbation of MS, what
should the nurse expect to find?
a. Tremors, dysphasia, and ptosis
b. Bowel and bladder incontinence and loss of memory
,c. Motor impairment, visual disturbances, and paresthesias
d. Excessive involuntary movements, hearing loss, and ataxia - Answer-21. c. Specific neurologic
dysfunction of MS is caused by
destruction of myelin and replacement with glial scar tissue at specific areas in the nervous system.
Motor, sensory, cerebellar, and emotional dysfunctions, including paresthesias as well as patchy
blindness, blurred vision, pain radiating along the dermatome of the nerve, ataxia, and severe fatigue,
are the most common manifestations of MS. Constipation and bladder dysfunctions, short-term memory
loss, sexual dysfunction, anger, and depression or euphoria may also occur. Excessive involuntary
movements and tremors are not seen in MS.
22. The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by
a. spinal x-ray findings.
b. T-cell analysis of the blood.
c. analysis of cerebrospinal fluid.
d. history and clinical manifestations. - Answer-d. There is no specific diagnostic test for MS. A diagnosis
is made primarily by history and clinical manifestations. Certain diagnostic tests may be used to help
establish a diagnosis of MS. Positive findings on MRI include evidence of at least two inflammatory
demyelinating lesions in at least two different locations within the central nervous system (CNS).
Cerebrospinal fluid (CSF) may have increased immunoglobulin G and the presence of oligoclonal
banding. Evoked potential responses are often delayed in persons with MS.
23. Mitoxantrone (Novantrone) is being considered as treatment for a patient with progressive-relapsing
MS. The nurse explains that a disadvantage of this drug compared with other drugs used for MS is what?
a. It must be given subcutaneously every day.
b. It has a lifetime dose limit because of cardiac toxicity.
c. It is an anticholinergic agent that causes urinary incontinence.
d. It is an immunosuppressant agent that increases the risk for infection. - Answer-23. b. Mitoxantrone
(Novantrone) cannot be used for more than 2 to 3 years because it is an antineoplastic drug that causes
cardiac toxicity, leukemia, and infertility. It is a monoclonal antibody given IV monthly when patients
,have inadequate responses to other drugs. It increases the risk of progressive multifocal
leukoencephalopathy.
Priority Decision: A patient with MS has a nursing diagnosis of self-care deficit related to muscle
spasticity and neuromuscular deficits. In providing care for the patient, what is most important for the
nurse to do?
a. Teach the family members how to care adequately for the patient's needs.
b. Encourage the patient to maintain social interactions to prevent social isolation.
c. Promote the use of assistive devices so the patient can participate in self-care activities.
d. Perform all activities of daily living (ADLs) for the patient to conserve the patient's energy. - Answer-
24. c. The main goal in care of the patient with MS is to keep the patient active and maximally functional
and promote self-care as much as possible to maintain independence. Assistive devices encourage
independence while preserving the patient's energy. No care activity that the patient can do for himself
or herself should be performed by others. Involvement of the family in the patient's care and
maintenance of social interactions are also important but are not the priority in care.
25. A patient with newly diagnosed MS has been hospitalized for evaluation and initial treatment of the
disease. Following discharge teaching, the nurse realizes that additional instruction is needed when the
patient says what?
a. "It is important for me to avoid exposure to people with upper respiratory infections."
b. "When I begin to feel better, I should stop taking the prednisone to prevent side effects."
c. "I plan to use vitamin supplements and a high-protein diet to help manage my condition."
d. "I must plan with my family how we are going to manage my care if I become more incapacitated." -
Answer-25. b. Corticosteroids used in treating acute exacerbations of MS should not be abruptly
stopped by the patient because adrenal insufficiency may result and prescribed tapering doses should
be followed. Infections may exacerbate symptoms and should be avoided and high-protein diets with
vitamin supplements are advocated. Long-term planning for increasing disability is also important.
, 33. 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-33. 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.
34. 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-34. 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.
Gabapentin (along with several other anti-seizure medications) is characterized by:
a. High potential for abuse
b. High potential for teratogenicity
c. High frequency of off-label prescriptions
d. High price - Answer-c. High frequency of off-label prescriptions
20. A 38-year-old woman has newly diagnosed multiple sclerosis (MS) and asks the nurse what is going
to happen to her. What is the best response by the nurse?
a. "You will have either periods of attacks and remissions or progression of nerve damage over time."
b. "You need to plan for a continuous loss of movement, sensory functions, and mental capabilities."
c. "You will most likely have a steady course of chronic progressive nerve damage that will change your
personality."
d. "It is common for people with MS to have an acute attack of weakness and then not to have any other
symptoms
for years." - Answer-20. a. Most patients with multiple sclerosis (MS) have
remissions and exacerbations of neurologic dysfunction or a relapsing-remitting initial course followed
by progression with or without occasional relapses, minor remissions, and plateaus that progressively
cause loss of motor, sensory, and cerebellar functions. Intellectual function generally remains intact but
patients may experience anger, depression, or euphoria. A few people have chronic progressive
deterioration and some may experience only occasional and mild symptoms for several years after
onset.
21. During assessment of a patient admitted to the hospital with an acute exacerbation of MS, what
should the nurse expect to find?
a. Tremors, dysphasia, and ptosis
b. Bowel and bladder incontinence and loss of memory
,c. Motor impairment, visual disturbances, and paresthesias
d. Excessive involuntary movements, hearing loss, and ataxia - Answer-21. c. Specific neurologic
dysfunction of MS is caused by
destruction of myelin and replacement with glial scar tissue at specific areas in the nervous system.
Motor, sensory, cerebellar, and emotional dysfunctions, including paresthesias as well as patchy
blindness, blurred vision, pain radiating along the dermatome of the nerve, ataxia, and severe fatigue,
are the most common manifestations of MS. Constipation and bladder dysfunctions, short-term memory
loss, sexual dysfunction, anger, and depression or euphoria may also occur. Excessive involuntary
movements and tremors are not seen in MS.
22. The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by
a. spinal x-ray findings.
b. T-cell analysis of the blood.
c. analysis of cerebrospinal fluid.
d. history and clinical manifestations. - Answer-d. There is no specific diagnostic test for MS. A diagnosis
is made primarily by history and clinical manifestations. Certain diagnostic tests may be used to help
establish a diagnosis of MS. Positive findings on MRI include evidence of at least two inflammatory
demyelinating lesions in at least two different locations within the central nervous system (CNS).
Cerebrospinal fluid (CSF) may have increased immunoglobulin G and the presence of oligoclonal
banding. Evoked potential responses are often delayed in persons with MS.
23. Mitoxantrone (Novantrone) is being considered as treatment for a patient with progressive-relapsing
MS. The nurse explains that a disadvantage of this drug compared with other drugs used for MS is what?
a. It must be given subcutaneously every day.
b. It has a lifetime dose limit because of cardiac toxicity.
c. It is an anticholinergic agent that causes urinary incontinence.
d. It is an immunosuppressant agent that increases the risk for infection. - Answer-23. b. Mitoxantrone
(Novantrone) cannot be used for more than 2 to 3 years because it is an antineoplastic drug that causes
cardiac toxicity, leukemia, and infertility. It is a monoclonal antibody given IV monthly when patients
,have inadequate responses to other drugs. It increases the risk of progressive multifocal
leukoencephalopathy.
Priority Decision: A patient with MS has a nursing diagnosis of self-care deficit related to muscle
spasticity and neuromuscular deficits. In providing care for the patient, what is most important for the
nurse to do?
a. Teach the family members how to care adequately for the patient's needs.
b. Encourage the patient to maintain social interactions to prevent social isolation.
c. Promote the use of assistive devices so the patient can participate in self-care activities.
d. Perform all activities of daily living (ADLs) for the patient to conserve the patient's energy. - Answer-
24. c. The main goal in care of the patient with MS is to keep the patient active and maximally functional
and promote self-care as much as possible to maintain independence. Assistive devices encourage
independence while preserving the patient's energy. No care activity that the patient can do for himself
or herself should be performed by others. Involvement of the family in the patient's care and
maintenance of social interactions are also important but are not the priority in care.
25. A patient with newly diagnosed MS has been hospitalized for evaluation and initial treatment of the
disease. Following discharge teaching, the nurse realizes that additional instruction is needed when the
patient says what?
a. "It is important for me to avoid exposure to people with upper respiratory infections."
b. "When I begin to feel better, I should stop taking the prednisone to prevent side effects."
c. "I plan to use vitamin supplements and a high-protein diet to help manage my condition."
d. "I must plan with my family how we are going to manage my care if I become more incapacitated." -
Answer-25. b. Corticosteroids used in treating acute exacerbations of MS should not be abruptly
stopped by the patient because adrenal insufficiency may result and prescribed tapering doses should
be followed. Infections may exacerbate symptoms and should be avoided and high-protein diets with
vitamin supplements are advocated. Long-term planning for increasing disability is also important.
, 33. 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-33. 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.
34. 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-34. 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.
Gabapentin (along with several other anti-seizure medications) is characterized by:
a. High potential for abuse
b. High potential for teratogenicity
c. High frequency of off-label prescriptions
d. High price - Answer-c. High frequency of off-label prescriptions
