A PACKAGE DEAL FOR NUR 256 MIDTERM AND FINAL EXAM
QUESTIONS WITH DETAILED VERIFIED SOLUTIONS /A+ GRADE
ASSURED
Parkinson's disease - ANSWER: A disorder of the central nervous system caused by a
dopamine deficiency and/or elevated ACTH
4 most common neuromuscular disorders - ANSWER: - Parkinson's disease
- Myasthenia gravis
- Multiple sclerosis
- Guillain barre
What do Parkinson's, Myasthenia gravis, MS, and guillain barre have in common? -
ANSWER: They all have no cure, they are terminal, have periods of remission and
exacerbation, and airway and breathing are always a priority because they are all an
aspiration risk
dopamine and acetylcholine - ANSWER: *Neurotransmitters*
-dopamine is inhibitory (contraindicates the muscle contractions)
-acetylcholine is excitatory (causing muscle contractions)
Parkinson triad - ANSWER: tremor, rigidity, bradykinesia (shuffling gait)
Cause of parkinson's disease - ANSWER: Idiopathic, COULD be genetic or
environmental, unsure what area of the brain it effects
how is parkinsons diagnosed? - ANSWER: MRI or CT with/without contrast
What is the goal for someone with parkinson's disease? - ANSWER: Goal is to
increase QOL or to maintain the highest functioning capacity, allow the person to be
as independent as possible to preserve muscle atrophy
Why is an EMG used in Parkinson's? - ANSWER: To check if person is paralyzed
In parkinson's disease, what causes the rigidity? - ANSWER: Rigidity is due to tired
muscles from all the contractions
In parkinson's disease, what causes the bradykinesia? - ANSWER: Bradykinesia is the
slow movement from being tired
Basal ganglia substantia nigra - ANSWER: parts of the brain that coordinate
movement and posture
area studied for Parkinson's because that is where dopamine is produced
,Symptoms of parkinson's disease - ANSWER: Mask-like face
Drooling
Constipation
Stooped posture
Cogwheel motion (robot like)
Tremors
Why do patients with parkinson drool? - ANSWER: they can't swallow
Interventions for constipation - ANSWER: increase fluid, fiber, and ambulation
Intervention for stooped posture with parkinsons disease - ANSWER: Chin up when
walking to balance center of gravity
Patients with parkinsons should wear ________ shoes, sit in ______ with _______,
and walk on ___________ - ANSWER: wear non-skid shoes, sit in chairs with handle
bars, and walk on firm supported surfaces
Meds used for parkinson's disease - ANSWER: Dopamine replacements (Levodopa-
carbidopa, amantadine, bromocriptine)
Anticholinergics *secondary drugs to increase ACTH* (Atropine sulfate, benztropine
mesylate, trihexyphenidyl, diphenhydramine)
Catechyl-O-methyl inhibitors (Entacapone, tolcapone)
Aspiration risk patients should be given what type of liquids? - ANSWER: Thickened
or pureed liquids
How should a patient with parkinson's swallow their food? - ANSWER: Swallow chin
to chest, physically pushes epiglottis to cover trachea
For parkinson's, medications that affect muscle rigidity should be given at what
time? - ANSWER: before meals so they can take effect to avoid aspiration
Nursing diagnoses for parkinson's disease - ANSWER: - impaired physical mobility
- risk for falls
- ineffective airway clearance
- risk for aspiration
- impaired swallowing
- self care deficit
- disturbed body image
Myasthenia gravis - ANSWER: autoimmune neuromuscular disorder characterized by
generalized muscle weakness
, In myasthenia gravis dopamine levels are ____ but ACTH is ____ - ANSWER:
Dopamine levels are normal but ACTH is low
What kind of face is seen in myasthenia gravis? - ANSWER: Droopy face (ptosis)
Cause of myasthenia gravis - ANSWER: Idiopathic, could be genetics and
environment.
Could be autoimmune, body creates ACTH antibodies
Risk factors for myasthenia gravis - ANSWER: Stress
Infection to exacerbation
Myasthenia crisis - ANSWER: Undermedicated
A positive reaction to the Tensilon test
Cholinergic crisis - ANSWER: Over medication
Give atropine sulfate
Caused by excessive medication ---stop giving Tensilon...will make it worse.
Myasthenic crisis/Cholinergic crisis symptoms - ANSWER: weakness, fatigue, resp.
muscle involvement, dysphagia, diplopia, ptosis, masked facies, slurred speech
What should be set at bedside incase of either a myasthenic crisis or cholinergic
crisis? - ANSWER: Tracheostomy
Cholinesterase inhibitors - ANSWER: Help increase levels of acetylcholine in the
brain.
Ex. pyridostigmine, neostigmine
Management of myasthenia gravis - ANSWER: - Cholinesterase inhibitors
- Steroids
- Immunosuppressants (methotrexate)
- Therapeutic plasma exchange
- IV immune globulin (IVIG)
Multiple sclerosis - ANSWER: A chronic disease of the central nervous system marked
by damage to the myelin sheath.
Multiple sclerosis causes what kind of paralysis? - ANSWER: Descending paralysis
1st sign of multiple sclerosis - ANSWER: nystagmus
last sign of multiple sclerosis - ANSWER: legs
QUESTIONS WITH DETAILED VERIFIED SOLUTIONS /A+ GRADE
ASSURED
Parkinson's disease - ANSWER: A disorder of the central nervous system caused by a
dopamine deficiency and/or elevated ACTH
4 most common neuromuscular disorders - ANSWER: - Parkinson's disease
- Myasthenia gravis
- Multiple sclerosis
- Guillain barre
What do Parkinson's, Myasthenia gravis, MS, and guillain barre have in common? -
ANSWER: They all have no cure, they are terminal, have periods of remission and
exacerbation, and airway and breathing are always a priority because they are all an
aspiration risk
dopamine and acetylcholine - ANSWER: *Neurotransmitters*
-dopamine is inhibitory (contraindicates the muscle contractions)
-acetylcholine is excitatory (causing muscle contractions)
Parkinson triad - ANSWER: tremor, rigidity, bradykinesia (shuffling gait)
Cause of parkinson's disease - ANSWER: Idiopathic, COULD be genetic or
environmental, unsure what area of the brain it effects
how is parkinsons diagnosed? - ANSWER: MRI or CT with/without contrast
What is the goal for someone with parkinson's disease? - ANSWER: Goal is to
increase QOL or to maintain the highest functioning capacity, allow the person to be
as independent as possible to preserve muscle atrophy
Why is an EMG used in Parkinson's? - ANSWER: To check if person is paralyzed
In parkinson's disease, what causes the rigidity? - ANSWER: Rigidity is due to tired
muscles from all the contractions
In parkinson's disease, what causes the bradykinesia? - ANSWER: Bradykinesia is the
slow movement from being tired
Basal ganglia substantia nigra - ANSWER: parts of the brain that coordinate
movement and posture
area studied for Parkinson's because that is where dopamine is produced
,Symptoms of parkinson's disease - ANSWER: Mask-like face
Drooling
Constipation
Stooped posture
Cogwheel motion (robot like)
Tremors
Why do patients with parkinson drool? - ANSWER: they can't swallow
Interventions for constipation - ANSWER: increase fluid, fiber, and ambulation
Intervention for stooped posture with parkinsons disease - ANSWER: Chin up when
walking to balance center of gravity
Patients with parkinsons should wear ________ shoes, sit in ______ with _______,
and walk on ___________ - ANSWER: wear non-skid shoes, sit in chairs with handle
bars, and walk on firm supported surfaces
Meds used for parkinson's disease - ANSWER: Dopamine replacements (Levodopa-
carbidopa, amantadine, bromocriptine)
Anticholinergics *secondary drugs to increase ACTH* (Atropine sulfate, benztropine
mesylate, trihexyphenidyl, diphenhydramine)
Catechyl-O-methyl inhibitors (Entacapone, tolcapone)
Aspiration risk patients should be given what type of liquids? - ANSWER: Thickened
or pureed liquids
How should a patient with parkinson's swallow their food? - ANSWER: Swallow chin
to chest, physically pushes epiglottis to cover trachea
For parkinson's, medications that affect muscle rigidity should be given at what
time? - ANSWER: before meals so they can take effect to avoid aspiration
Nursing diagnoses for parkinson's disease - ANSWER: - impaired physical mobility
- risk for falls
- ineffective airway clearance
- risk for aspiration
- impaired swallowing
- self care deficit
- disturbed body image
Myasthenia gravis - ANSWER: autoimmune neuromuscular disorder characterized by
generalized muscle weakness
, In myasthenia gravis dopamine levels are ____ but ACTH is ____ - ANSWER:
Dopamine levels are normal but ACTH is low
What kind of face is seen in myasthenia gravis? - ANSWER: Droopy face (ptosis)
Cause of myasthenia gravis - ANSWER: Idiopathic, could be genetics and
environment.
Could be autoimmune, body creates ACTH antibodies
Risk factors for myasthenia gravis - ANSWER: Stress
Infection to exacerbation
Myasthenia crisis - ANSWER: Undermedicated
A positive reaction to the Tensilon test
Cholinergic crisis - ANSWER: Over medication
Give atropine sulfate
Caused by excessive medication ---stop giving Tensilon...will make it worse.
Myasthenic crisis/Cholinergic crisis symptoms - ANSWER: weakness, fatigue, resp.
muscle involvement, dysphagia, diplopia, ptosis, masked facies, slurred speech
What should be set at bedside incase of either a myasthenic crisis or cholinergic
crisis? - ANSWER: Tracheostomy
Cholinesterase inhibitors - ANSWER: Help increase levels of acetylcholine in the
brain.
Ex. pyridostigmine, neostigmine
Management of myasthenia gravis - ANSWER: - Cholinesterase inhibitors
- Steroids
- Immunosuppressants (methotrexate)
- Therapeutic plasma exchange
- IV immune globulin (IVIG)
Multiple sclerosis - ANSWER: A chronic disease of the central nervous system marked
by damage to the myelin sheath.
Multiple sclerosis causes what kind of paralysis? - ANSWER: Descending paralysis
1st sign of multiple sclerosis - ANSWER: nystagmus
last sign of multiple sclerosis - ANSWER: legs
