Which medication overdose may lead to paradoxical intoxication in a patient with parkinsonism

A patient with a diagnosis of Parkinson's disease (PD) has been admitted recently to a long-term care facility. Which action should the health care team take to promote adequate nutrition for this patient?

Provide multivitamins with each meal.

Provide a diet that is low in complex carbohydrates and high in protein.

Provide small, frequent meals throughout the day that are easy to chew and swallow.

Provide the patient with a minced or pureed diet that is high in potassium and low in sodium.

Provide small, frequent meals throughout the day that are easy to chew and swallow.

Which nerve is represented as [CN] V?

Facial nerve

Vagus nerve

Trigeminal nerve

Glossopharyngeal nerve

Trigeminal

A patient was just diagnosed with Huntington's disease. The patient's adult child is upset about the diagnosis. How can the nurse best help the patient's child?

Provide emotional and psychologic support.

Encourage him or her to get diagnostic genetic testing done.

Tell him the cognitive deterioration will be treated with counseling.

Tell him the chorea and psychiatric disorders can be treated with haloperidol (Haldol).

Provide emotional and psychologic support.

Which degenerative neurologic disorder is an example of a genetically transmitted, autosomal dominant disorder?

Multiple sclerosis

Myasthenia gravis

Lou Gehrig's disease

Huntington's disease

Huntington's disease

A patient with an aggressive form of multiple sclerosis is not responding to the drugs teriflunomide and dalfampridine. The patient is then prescribed natalizumab and mitoxantrone. The patient is later diagnosed with progressive multifocal leukoencephalopathy. Which medication in the patient's prescription might be responsible for this complication?

Natalizumab

Mitoxantrone

Teriflunomide

Dalfampridine

Natalizumab

A patient diagnosed with myasthenia gravis reports difficulty in swallowing, chewing, eye movement, and facial mobility. Which drugs are most suitable for the patient? Select all that apply.

Tramadol

Prednisone

Azathioprine

Chlorzoxazone

Pyridostigmine

Prednisone

Azathioprine

Pyridostigmine

What is the major complication associated with myasthenic crisis?

Speech alteration

Difficulty chewing

Impaired facial mobility

Respiratory insufficiency

Respiratory insufficiency

Which measure is a priority for a nurse to include in the plan of care for a patient who has multiple sclerosis?

Referring the patient for genetic counseling

Teaching the patient about medications used during acute exacerbations

Assisting the patient in identifying the factors that precipitate exacerbations

Instructing the patient in the proper technique for self-administration of an enema

Assisting the patient in identifying the factors that precipitate exacerbations

Which degenerative neurologic disorder is characterized by a deficiency of ϒ-aminobutyric acid (GABA) and acetylcholine?

Myasthenia gravis

Parkinson's disease

Lou Gehrig's disease

Huntington's disease

Huntington's disease

Which measure should the nurse initially include in the plan of care for a patient who has difficulty swallowing as a result of Parkinson's disease?

Arranging for someone to feed the patient

Providing the patient with semisolid or soft foods

Encouraging the patient to drink fluids with meals

Placing food in the unaffected side of the patient's mouth

Providing the patient with semisolid or soft foods

Which autoimmune disease is characterized by a decreased number of acetylcholine receptors in the neuromuscular junction?

Multiple sclerosis

Myasthenia gravis

Lou Gehrig's disease

Huntington's disease

Myasthenia gravis

A patient with parkinsonism on a dopamine agonist medication reports severe nausea and vomiting. After receiving the antiemetic, the patient lost consciousness due to a sudden drop in blood pressure. Which antiemetic drug interaction is responsible for the patient's condition?

Ondansetron and amantadine

Ondansetron and apomorphine

Trimethobenzamide and amantadine

Trimethobenzamide and apomorphine

Ondansetron and apomorphine

A patient has been diagnosed with amyotrophic lateral sclerosis (ALS). What nursing intervention is most important to help prevent a common cause of death for patients with ALS?

Reduce fat intake

Reduce the risk of aspiration

Decrease injury related to falls

Decrease pain secondary to muscle weakness

Reduce the risk of aspiration

A patient with multiple sclerosis has an exacerbation of sensory deficits. Which nursing diagnostic statement should be assigned highest priority?

Risk for injury

Acute confusion

Fluid volume deficit

Ineffective thermoregulation

Risk for injury

Which neurologic disorder has paradoxic intoxication as a potential adverse effect of medication therapy?

Multiple sclerosis

Myasthenia gravis

Parkinson's disease

Huntington's disease

Parkinson's disease

Which disease is characterized by a degeneration of dopamine-producing neurons and decreased levels of dopamine?

Multiple sclerosis

Parkinson's disease

Lou Gehrig's disease

Huntington's disease

Parkinson's disease

Which nursing diagnosis is likely to be a priority in the care of a patient with myasthenia gravis (MG)?

Acute confusion

Bowel incontinence

Activity intolerance

Disturbed sleep pattern

Activity intolerance

Which drug overdose may lead to paradoxic intoxication in a patient with parkinsonism?

Levodopa

Biperiden

Trihexyphenidyl

Diphenhydramine

Levodopa

Which type of multiple sclerosis is characterized by a relapsing-remitting initial course followed by disease with or without relapses?

Relapsing-remitting

Primary-progressive

Progressive-relapsing

Secondary-progressive

Secondary-progressive

A patient is diagnosed with multiple sclerosis (MS) and is prescribed interferon. What should the nurse include in medication teaching?

The medication should be taken before meals on an empty stomach.

The medication often causes patients to experience flu-like symptoms.

The medication is given during exacerbation of symptoms to promote remission.

The medication alters carbohydrate metabolism and elevates serum glucose levels.

The medication often causes patients to experience flu-like symptoms.

A patient with Parkinson's disease has lost 35 pounds over two months. A swallowing study shows that the patient is able to swallow and does not aspirate. What suggestion should the nurse discuss with the patient and spouse to improve nutrition?

Allow adequate time for the patient to eat meals.

Administer prescribed carbidopa/levodopa with a protein drink.

Encourage the patient to eat at least every two hours while awake.

Include foods that are chewy so the patient builds up the jaw muscles.

Allow adequate time for the patient to eat meals.

Which type of drug is prescribed to patients with parkinsonism with a condition such as hypomobility?

Ropinirole

Pramiprexole

Apomorphine

Bromocriptine

Apomorphine

Which drug helps to increase the bioavailability of levodopa in the brain by inhibiting the enzyme dopa-decarboxylase?

Carbidopa

Tolcapone

Rasagiline

Entacapone

Carbidopa

The nurse performs a pull test on a patient with suspected Parkinson's disease. The nurse stands behind the patient and gives a tug backward on the shoulder. What would be the patient's reaction if he has Parkinson's disease?

Lose balance and sit down

Lose balance and fall forward

Lose balance and fall backward

Lose balance and become unconscious

Lose balance and fall backward

A patient with a family history of Huntington's disease (HD) who underwent genetic testing has positive results. What can the nurse infer from this finding? Select all that apply.

There is no cure for this disease.

The patient would not be treated completely with the help of drugs.

The patient will develop a progressive, degenerative brain disorder.

The onset of disease usually occurs between 30 and 50 years of age.

The patient will be a carrier of the mutated gene but will not develop the disease.

There is no cure for this disease.

The patient will develop a progressive, degenerative brain disorder.

The onset of disease usually occurs between 30 and 50 years of age.

A patient with a family history of Huntington's disease suffers from a psychiatric disorder and is treated with sertraline and paroxetine. Tetrabenazine is added to the patient's prescription. Which assessment finding supports the addition of tetrabenazine to the prescription?

Chorea

Anxiety

Depression

Social withdrawal

Chorea

A patient complains of difficulty with eye and eyelid movement, chewing, swallowing, speaking, and breathing. Which findings in the patient's diagnostic results would indicate the presence of myasthenia gravis? Select all that apply.

Alteration of one copy of gene in DNA test

Improved muscle contractibility during the Tensilon test

Presence of three signs of the classic triad: tremor, rigidity, and bradykinesia

Decreased response to repeated stimulation of hand muscles during EMG test

Increased immunoglobulin G levels in the cerebrospinal fluid during CSF analysis test

Improved muscle contractibility during the Tensilon test

Decreased response to repeated stimulation of hand muscles during EMG test

A patient being treated for multiple sclerosis complains of flu-like symptoms and reports feeling depressed. The patient also reports having frequent thoughts of committing suicide. Which drug in the patient's prescription may be responsible for these symptoms?

β-interferon

Natalizumab

Mitoxantrone

Dalfampridine

β-interferon

A patient who has multiple sclerosis has received a prescription for a medication to alleviate the major symptoms of the disease. The nurse expects the medication to be in what drug classification?

Antipsychotics

Muscle relaxant

Antihypertensive

Narcotic analgesic

Muscle relaxant

The registered nurse supervises a student nurse providing care to a patient with Huntington's disease (HD). Which action of the student nurse needs correction?

Providing more fluid diet to the patient

Providing a low-calorie diet not more than 2000 calories/day

Providing palliative care is the only option for collaborative care

Providing comfortable environment by maintaining physical safety

Providing a low-calorie diet not more than 2000 calories/day

A patient with Parkinson's disease is prescribed sinemet. Which side effects of the drug would the nurse monitor for in this patient? Select all that apply.

Dizziness

Dyskinesia

Severe headache

Involuntary eyelid movements

Severe nausea and vomiting

Dyskinesia

Involuntary eyelid movements

Severe nausea and vomiting

Which criterion is included to establish that a patient has Parkinson's disease? Select all that apply.

Decreased serum dopamine levels.

Tumor present in the thymus gland.

Positive response to antiparkinsonian medications.

Magnetic resonance imaging (MRI) shows areas of plaque on cranial nerves.

Presence of two of the three classic features: rigidity, bradykinesia, and tremor.

Positive response to antiparkinsonian medications.

Presence of two of the three classic features: rigidity, bradykinesia, and tremor.

A patient has been found to have amyotrophic lateral sclerosis. What classic symptom of the disorder does the nurse recognize?

Dysuria

Dyspnea

Dysphagia

Dysreflexia

Dysphagia

A patient, whose parent died from Huntington's disease, is discussing the condition and genetic testing with a nurse. Which of the patient's statements needs to be corrected by the nurse?

Currently there is no effective treatment or cure for Huntington's disease.

Offspring of persons with Huntington's disease have a 50% risk to develop it.

Positive genetic testing indicates the patient eventually will develop the disease.

Positive genetic testing indicates at what age the symptoms of the disease will occur.

Positive genetic testing indicates at what age the symptoms of the disease will occur.

The nurse is planning discharge teaching for a patient with myasthenia gravis. What instructions should the nurse include in the plan? Select all that apply.

Plan activities with periods of rest.

Practice hobbies such as playing golf.

Include liquid rather than solid foods in the diet.

Eat a balanced diet that can be easily chewed and swallowed.

Schedule drugs so that the peak effect of the drug is at mealtime.

Plan activities with periods of rest.

Eat a balanced diet that can be easily chewed and swallowed.

Schedule drugs so that the peak effect of the drug is at mealtime.

What nursing interventions would be applied first for the patient with acute exacerbation of multiple sclerosis? Select all that apply.

Assisting the patient with the grieving process

Preventing the complication of pressure ulcers

Preventing the complication of urinary tract infections

Teaching the patient to build a general resistance to illness

Teaching the patient to maintain a good balance between exercise and rest

Preventing the complication of pressure ulcers

Preventing the complication of urinary tract infections

Which measure should the nurse prioritize when providing care for a patient with a diagnosis of multiple sclerosis (MS)?

Vigilant infection control and adherence to standard precautions

Careful monitoring of neurologic assessment and frequent reorientation

Maintenance of a calorie count and hourly assessment of intake and output

Assessment of blood pressure and monitoring for signs of orthostatic hypotension

Vigilant infection control and adherence to standard precautions

A patient is advised to use diazepam for multiple sclerosis. What patient teaching is important for those taking this drug? Select all that apply.

Avoid driving while on the drug.

Do not stop the drug abruptly.

Avoid taking alcohol with the drug.

Monitor blood pressure regularly.

Avoid contact with large crowds.

Avoid driving while on the drug.

Do not stop the drug abruptly.

Avoid taking alcohol with the drug.

What suggestion should the nurse give to the family members of a patient with Parkinson's disease to promote self-care and independence of the patient? Select all that apply.

Use slip-on shoes.

Use rugs on the floor.

Use an elevated toilet seat.

Use buttons and hooks on clothes.

Elevate the legs on an ottoman when sitting.

Use slip-on shoes.

Use an elevated toilet seat.

Elevate the legs on an ottoman when sitting.

The nurse is performing a physical examination on a patient with Parkinson's disease. What manifestations of Parkinson's disease is the nurse likely to find? Select all that apply.

Nystagmus

Drooling of saliva

Patchy blindness

Decreased arm swing

Shuffling, propulsive gait

Drooling of saliva

Decreased arm swing

Shuffling, propulsive gait

A patient with multiple sclerosis has been advised to use dalfampridine to improve walking speed. What questions should the nurse ask the patient before administering the medication? Select all that apply.

Do you have kidney disease?

Does your work involve operating machinery?

Do you have a history of any seizure disorder?

Does any member of the family have diabetes?

Have you been taking any over-the-counter medications?

Do you have kidney disease?

Do you have a history of any seizure disorder?

A patient with Willis-Ekbom disease is admitted to the hospital. What are the signs and symptoms that the nurse is likely to find during data collection and assessment? Select all that apply.

Numbness and tingling in the legs

Discomfort that occurs during activity

Leg pain localized to the calf muscles

Sensation like bugs creeping on the legs

Occurrence of symptoms mostly in the morning

Numbness and tingling in the legs

Leg pain localized to the calf muscles

Sensation like bugs creeping on the legs

A patient with a suspected neurologic disorder has weakness of the limbs, blurred vision, patchy blindness, and bowel and bladder dysfunction. Which clinical findings would support the diagnosis of multiple sclerosis? Select all that apply.

Presence of visual and auditory evoked potential

Presence of IgM antibodies in the cerebrospinal fluid

Presence of increased IgG antibodies in the cerebrospinal fluid

Presence of an altered copy of the HTT gene located on chromosome 4

Presence of inflammation, tissue breakdown, and atropy of the spinal cord in the MRI

Presence of visual and auditory evoked potential

Presence of increased IgG antibodies in the cerebrospinal fluid

Presence of inflammation, tissue breakdown, and atropy of the spinal cord in the MRI

When performing a physical assessment on a patient with amyotrophic lateral sclerosis, which manifestations is the nurse likely to find? Select all that apply.

Limb weakness

Difficulty swallowing

Difficulty articulating words

Twisting movements of the face

Involuntary movements of the body

Limb weakness

Difficulty swallowing

Difficulty articulating words

A patient with myasthenia gravis is admitted to the hospital in respiratory failure and diagnosed with myasthenic crisis. Which of the factors in the patient's current life situation led to the development of this myasthenic crisis? Select all that apply.

Omitted pyridostigmine previous day.

Attended funeral of family member earlier in week.

Took antibiotic prescribed for urinary tract infection.

Diagnosed with urinary tract infection previous week.

Continued taking prescribed corticosteroid every other day.

Omitted pyridostigmine previous day.

Attended funeral of family member earlier in week.

Took antibiotic prescribed for urinary tract infection.

Diagnosed with urinary tract infection previous week.

A patient with myasthenia gravis is concerned whether he or she will need a thymectomy. For which patients is thymectomy performed? Select all that apply.

Patients with thymoma

Patients with cholinergic crisis

Patients with a positive Tensilon test

Patients with purely ocular myasthenia gravis

Patients between the ages of puberty and about 65 years

Patients with thymoma

Patients with purely ocular myasthenia gravis

Patients between the ages of puberty and about 65 years

The nurse is caring for a patient with Parkinson's disease. What adjustments should the nurse make in the dietary habits of the patient to prevent malnutrition and constipation? Select all that apply.

Cut food into bite-size pieces.

Serve hot foods on a warmed plate.

Include whole grains and fruits in the diet.

Include plenty of food items high in protein.

Provide three large meals rather than six small meals.

Cut food into bite-size pieces.

Serve hot foods on a warmed plate.

Include whole grains and fruits in the diet.

When establishing a diagnosis of multiple sclerosis (MS), about what diagnostic studies should the nurse teach the patient? Select all that apply.

EEG

Carotid duplex scan

Evoked response testing

Cerebrospinal fluid analysis

Computed tomography (CT) scan

Evoked response testing

Cerebrospinal fluid analysis

Computed tomography (CT) scan

A patient with Parkinson's disease is unresponsive to drug therapy and is being considered for surgery. After the physician discusses surgical options, about which options does the nurse anticipate educating the patient? Select all that apply.

Ablation

Thymectomy

Transplantation

Deep brain stimulation

Dorsal-column electrical stimulation

Ablation

Transplantation

Deep brain stimulation

A patient is advised to use teriflunomide for multiple sclerosis. What nursing interventions are important for this patient? Select all that apply.

Monitor liver function tests.

Monitor blood pressure levels.

Instruct the patient to avoid driving.

Ask the patient to restrict salt intake.

Instruct the patient to avoid pregnancy.

Monitor liver function tests.

Instruct the patient to avoid pregnancy.

The nurse is caring for a patient with multiple sclerosis in remission. What information should the nurse include when teaching the patient about advantages of exercise for multiple sclerosis? Select all that apply.

Decreases spasticity

Increases coordination

Helps to regain bladder control

Delays the demyelination process

Retrains unaffected muscles to substitute for impaired ones

Decreases spasticity

Increases coordination

Retrains unaffected muscles to substitute for impaired ones

A patient with multiple sclerosis is under treatment with β-interferon. What patient teaching would be appropriate for this patient? Select all that apply.

Do not drink grape juice.

Monitor vital signs regularly.

Rotate injection sites with each dose.

Know that flu-like symptoms are common.

Wear sunscreen while exposed to sunlight.

Rotate injection sites with each dose.

Know that flu-like symptoms are common.

Wear sunscreen while exposed to sunlight.

The nurse is caring for a patient with a spastic bladder secondary to multiple sclerosis. What manifestations of spastic bladder should the nurse expect to find in the patient? Select all that apply.

Bladder contractions are unchecked.

The patient experiences urinary retention.

The bladder has a small capacity for urine.

The patient experiences incontinence and dribbling.

There is no sensation of urge to void or no desire to void.

Bladder contractions are unchecked.

The bladder has a small capacity for urine.

The patient experiences incontinence and dribbling.

When performing a physical assessment of a patient with myasthenia gravis, what clinical manifestations is the nurse likely to find? Select all that apply.

Muscle atrophy

Abnormal reflexes

Impaired facial mobility

Difficulty in swallowing food

Voice fading after a long conversation

Impaired facial mobility

Difficulty in swallowing food

Voice fading after a long conversation