A nurse is teaching a client who has multiple sclerosis and a new prescription for dantrolene

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    Terms in this set (20)

    A nurse is caring for a client who has a new diagnosis of myasthenia gravis. For what manifestation should the nurse monitor?

    Weakness.

    Rationale: Generalized weakness of the diaphragmatic and intercostal muscles may produce respiratory distress or predispose the client to respiratory infections.

    A nurse is teaching a client who has multiple sclerosis and a new prescription for dantrolene. What statement by the client indicates an understanding of the teaching?

    "I need to apply a sunscreen when I go outside."

    Rationale: This medication can cause photosensitivity; therefore, the client should protect her skin by wearing a hat and using sunscreen while in the sunlight.

    A nurse is teaching a client who has multiple sclerosis about a new prescription for baclofen. What instructions should the nurse include in the teaching?

    "Do not take antihistamines with this medication."

    Rationale: The nurse should instruct the client not to take antihistamines while taking baclofen. Antihistamines will intensify the depressant effects of baclofen.

    A nurse is instructing a client's family members about feeding safety for a client who has dysphagia. What instruction should the nurse include?

    Encourage the client to take small bites.

    Rationale: The family members should encourage the client to take small bites and chew food thoroughly in order to prevent choking.

    A nurse is providing teaching to a client who has a new diagnosis of Parkinson's disease. On what medications should the nurse prepare to instruct the client?

    Levodopa/carbidopa.

    Rationale: Levodopa/carbidopa is the cornerstone of Parkinson's treatment. The nurse should prepare to instruct the client on the use of this medication.

    A nurse is caring for a client who has aphasia following a stroke. A family member asks the nurse how she should communicate with the client. What responses by the nurse is appropriate?

    "Incorporate nonverbal cues in the conversation."

    Rationale: Nonverbal cues enhance the client's ability to comprehend and use language.

    A nurse is caring for a client who had a stroke involving the left cerebral hemisphere. The nurse should monitor for what finding?

    Intellectual impairment.

    Rationale: A client who had a stroke involving the left cerebral hemisphere is likely to have deficits that involve language, mathematical skills, and thinking.

    A nurse is providing teaching to the family of a client who has Parkinson's disease. What information should the nurse include in the teaching?

    Provide client supervision.

    Rationale: Because the client's voluntary motor control is affected by the disease, the nurse should recommend that the family provide client supervision to create a safe and respectful environment.

    A nurse is teaching about risk factors of developing a stroke with a group of older adults clients. What non-modifiable risk factors should the nurse include in the teaching?

    Race.

    Rationale: Race is a non-modifiable risk factor, which the client is unable to control.

    A nurse is caring for a client who has right-sided paralysis from a stroke. What interventions should the nurse implement to prevent foot drop?

    Apply a protective boot to the right ankle.

    Rationale: The nurse should apply padded splints or protective boots to the right ankle to keep the foot at a right angle to the leg to prevent foot drop.

    A nurse is preparing to administer PO medication to a client who has myasthenia gravis. What actions should the nurse take prior to administering the client medication?

    Ask the client to take a few sips of water.

    Rationale: Clients who have myasthenia gravis, an autoimmune disorder, have weakness of the muscles of the face and throat, which increases the risk for aspiration. The nurse should check the client's ability to swallow before administering oral medication.

    A nurse in a long-term care facility is caring for an older adult client who had a stroke 4 weeks ago and who is unable to move independently. The nurse should monitor for what complications of immobility?

    A reddened area over the sacrum.

    Rationale: A reddened area over bony prominence is a stage 1 pressure ulcer, a complication of immobility. If the nurse recognizes it at this stage and implements measures to avoid additional pressure, it might not progress to the next stage.

    A nurse is caring for a client who has had a stroke involving the right hemisphere. What alterations in function should the nurse expect?

    Inability to recognize his family members.

    Rationale: The right hemisphere is involved with visual and spatial awareness. A client who is unable to recognize faces would have involvement with the right hemisphere.

    A nurse is teaching a client who taking benztropine to treat Parkinson's disease. The nurse should instruct the client to report what adverse effects?

    Difficulty voiding.

    Rationale: The nurse should instruct the client to report difficulty voiding, which may indicate urinary retention, as an adverse effect of benztropine. Benztropine is an anticholinergic medication that helps decrease the rigidity and tremors of Parkinson's disease.

    A nurse suspects a client who has myasthenia gravis is experiencing a myasthenic crisis. What interventions should the nurse take?

    Prepare the client for mechanical ventilation.

    Rationale: The client who is experiencing a myasthenic crisis is at risk for loss of adequate respiratory function. The nurse should closely monitor the client's respiratory status and prepare for possible mechanical ventilation.

    A nurse is caring for a client who has had a hemorrhagic stroke following a ruptured cerebral aneurysm. What manifestation should the nurse expect?

    Manifestations preceded by a severe headache.

    Rationale: A hemorrhagic stroke is caused by bleeding into the brain tissues, ventricles, or subarachnoid space. It can be caused by hypertension, an aneurysm, or an arteriovenous malformation. A sudden, severe headache is an expected initial manifestation of a hemorrhagic stroke.

    A nurse is at a rehabilitation center is planning care for a client who had a left hemispheric cerebrovascular accident (CVA) 3 weeks ago. What goals should the nurse include in the client's rehabilitation program?

    Establish the ability to communicate effectively.

    Rationale: A CVA is an interruption of the blood supply to any part of the brain, resulting in damaged brain tissue. The left hemisphere is usually dominant for language. Because this client had a left-sided CVA, the nurse should anticipate the client will have some degree of aphasia and will require speech therapy to establish communication.

    A nurse is assessing a client who has Parkinson's disease. What manifestations should the nurse expect?

    Bradykinesia.

    Rationale: The nurse should expect to find bradykinesia or difficulty moving in a client who has Parkinson's disease.

    A nurse is caring for a client who had a stroke involving the right cerebral hemisphere. The nurse should monitor for what finding?

    Poor impulse control.

    Rationale: A client who had a stroke involving the right cerebral hemisphere is likely to have personality changes, which can include impulsiveness, confabulation, and poor judgement.

    A nurse is presenting discharge instructions to a client who has multiple sclerosis (MS). The client reports symptoms of diplopia, dysmetria, and sensory change. What nursing statement is appropriate?

    "Implement a schedule to include periods of rest."

    Rationale: The nurse should assist the client in developing a schedule that include periods of exercise followed by periods of rest to maintain muscle strength and coordination.

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