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The nurse is caring for a patient who is diagnosed with early Huntington's disease (HD). Which of the following information should the nurse include in the teaching plan for the patient, partner, and children?
- A. Use of levodopa-carbidopa to help reduce HD symptoms
- B. Need to take prophylactic antibiotics to decrease the risk for pneumonia.
- C. Lifestyle changes such as increased exercise that delay disease progression.
- D. Availability of genetic testing to determine the HD risk for the patient's children.
Correct Answer: D
Rationale: Genetic testing is available to determine whether an asymptomatic individual has the HD gene. The patient and family should be informed of the benefits and problems associated with genetic testing. Sinemet will increase symptoms of HD given that HD involves an increase in dopamine. Antibiotic therapy will not reduce the risk for aspiration. There are no effective treatments or lifestyle changes that delay the progression of symptoms in HD.
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The nurse is caring for a patient with a history of cluster headache who awakens during the night with a severe stabbing headache. Which of the following actions should the nurse take first?
- A. Start the prescribed PRN oxygen at 8 L/minute.
- B. Put a moist hot pack on the patient's neck.
- C. Give the prescribed PRN acetaminophen.
- D. Notify the patient's health care provider immediately.
Correct Answer: A
Rationale: Acute treatment for cluster headache is administration of 100% oxygen at 8-12 L/min for 15 minutes. If the patient obtains relief with the oxygen, there is no immediate need to notify the health care provider. Cluster headaches last only 60-90 minutes, so oral pain medications have minimal effect. Hot packs are helpful for tension headaches but are not as likely to reduce pain associated with a cluster headache.
The nurse is caring for a patient with myasthenia gravis who has had a thymectomy and receives the usual dose of pyridostigmine. An hour later, the patient has nausea and severe abdominal cramps. Which of the following actions should the nurse take first?
- A. Auscultate the patient's bowel sounds.
- B. Notify the patient's health care provider.
- C. Administer the prescribed PRN antiemetic drug.
- D. Give the scheduled dose of prednisone.
Correct Answer: B
Rationale: The patient's history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed. The other actions will be appropriate if the patient is not experiencing a cholinergic crisis.
A female patient who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which of the following responses by the nurse is accurate?
- A. MS symptoms may be worse after the pregnancy.
- B. Women with MS frequently have premature labour.
- C. Symptoms of MS are likely to become worse during pregnancy.
- D. MS is associated with a slightly increased risk for congenital defects.
Correct Answer: A
Rationale: 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 labour is not affected by MS.
The nurse is assessing a patient with myasthenia gravis. Which of the following parameters is most important for the nurse to assess?
- A. Check pupillary size.
- B. Monitor grip strength.
- C. Observe respiratory effort.
- D. Assess level of consciousness.
Correct Answer: C
Rationale: Because respiratory insufficiency may be life-threatening, it will be most important to monitor respiratory function. The other data also will be assessed but are not as critical.
The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS) who is hospitalized with pneumonia. Which of the following actions should the nurse take?
- A. Assist with active range of motion
- B. Observe for agitation and paranoia
- C. Give muscle relaxants as needed to reduce spasticity
- D. Use simple words and phrases to explain procedures.
Correct Answer: A
Rationale: ALS causes progressive muscle weakness. Patients should be guided to use moderate-intensity, endurance-type exercises for the trunk and limbs, since this may help reduce ALS spasticity. When hospitalized with other health concerns, it is important to complete ROM to maintain strength. Psychotic symptoms such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient's ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations.