(Osborn) Chapter 31: Learning Outcomes (Number and Title)

[Osborn] chapter 31
Learning Outcomes [Number and Title]

Learning Outcome 1
Distinguish between the neurodegenerative disorders of
Alzheimers disease, Parkinsons disease, multiple sclerosis,
amyotrophic lateral sclerosis, and myasthenia gravis by
describing the etiology and pathophysiology of each disorder.
Learning Outcome 2
Compare and contrast the presenting signs and symptoms of
each of the neurodegenerative disorders discussed in the
chapter.
Learning Outcome 3
Develop a generalized plan of care for each of the
neurodegenerative disorders discussed.
Learning Outcome 4
Develop a comprehensive discharge teaching plan for each of
the neurodegenerative disorders discussed.
Learning Outcome 5
Describe generalized health promotion needs for each
neurodegenerative disorder discussed.
Learning Outcome 6
Explain gerontological implications for each neurodegenerative
disorder discussed.
Learning Outcome 7
Evaluate research implications for nursing practice when caring
for persons with a neurodegenerative disorder.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for
Practice Copyright 2010 by Pearson Education, Inc.
1. When interviewing a client suspected of exhibiting signs of Parkinsons disease, the

nurse shows an understanding of the diseases etiology when asking:
1. Do you recall if any of your relatives had difficulty holding on to things with his or
her hands?
2. Did I understand correctly that your memory problems started about 5 years ago?
3. Is it painful to flex your chin to your chest?
4. Did your muscle weakness first occur in your arms or in your legs?
Correct Answer: Do you recall if any of your relatives had difficulty holding on to things
with their hands?
Rationale: In Parkinsons disease (PD), the resulting lack of dopamine production leads to
difficulty with movement, tremor, rigidity, and difficulty maintaining posture. It is thought
that the resulting disease process results from a complex interaction between genetic and
environmental factors. Slow and insidious in onset, and ranging over a course of 3 to 20
years, Alzheimers disease progressively degrades cognitive function. The symptoms of
multiple sclerosis include LHermites sign, or a shocklike pain that results from flexion of
the neck. Amyotrophic lateral sclerosis (ALS) symptoms first present in an arm in roughly
half of the cases, with about 20% of the occurrences affecting a leg.
Cognitive Level: Analysis
Nursing Process: Planning
Client Need: Physiological Integrity
LO: 1
2. A nurse is providing an informative session to a local civic group. The nurse shows an
understanding of the disorder when describing Alzheimers disease (AD) as:
1. A disease process that starts by affecting a persons memory and progresses toward
the loss of reasoning abilities.
2. A form of dementia that is caused by a lack of a brain chemical.
3. The central nervous system is unpredictably affected, resulting in a loss of
communication and motor skills.
4. The persons own immune system attacks the cells of the body.
Correct Answer: A disease process that starts by affecting a persons memory and
progresses toward the loss of reasoning abilities.
Rationale: The onset of Alzheimers disease begins with subtle lapses of memory, which
gradually and progressively develops into a chronic loss of personality, recognition,
reasoning, and independence. Parkinsons disease is a movement disorder resulting from a
dopamine deficiency; dementia occurs in 15% to 20% of cases. Multiple sclerosis (MS) is a
disease of the central nervous system that is an unpredictable condition that can be
relatively benign, disabling, or devastating, leaving the patient unable to speak, walk, or
write. Myasthenia gravis is an autoimmune reaction that results from a malfunction in the
immune system in which the body produces auto-antibodies that attack specific receptors
located on the surface of muscle cells.
Cognitive Level: Application
Nursing Process: Assessment
LO: 1
3. The nurse explains to a client who has been diagnosed with myasthenia gravis (MG) that
this condition differs from amyotrophic lateral sclerosis (ALS) in that MG:
Select all that apply.
1. Has an onset for women that commonly occurs between 20 and 40 years of age.
2. Clients experience an increase of symptoms when exposed to sunlight, viral illness,
and emotional stress.
3. Presents with shorter remissions as the disease progresses.
4. Is usually fatal in 3 to 4 years after onset.
5. Produces involuntary twitching of the arms, legs, and tongue muscles.
Correct Answer:
1. Has an onset for women that commonly occurs between 20 and 40 years of age.
2. Clients experience an increase of symptoms when exposed to sunlight, viral illness,
and emotional stress.
3. Presents with shorter remissions as the disease progresses.
Rationale: Has an onset for women that commonly occurs between 20 and 40 years of
age. MG occurs at any age, although the age of onset is commonly either at 20 to 40 years
of age for women or 60 to 80 years of age for men. Clients experience an increase of
symptoms when exposed to sunlight, viral illness, and emotional stress. Exposure to
sunlight, viral illness, surgery, immunization, emotional stress, menstruation, and physical
factors might trigger or worsen exacerbations. Presents with shorter remissions as the
disease progresses. As MG progresses, symptom-free periods decrease, and muscle
weakness fluctuates from mild to severe. Is usually fatal in 3 to 4 years after onset.
Average disease duration in ALS is 3 to 4 years. Produces involuntary twitching of the
arms, legs and tongue muscles. In ALS, symptoms include fasciculation (involuntary
twitching) of the limb and tongue muscles.
LO: 1
4. The nurse is assessing a client with myasthenia gravis (MG). Which of the following
describes a situation that is characteristic of this disease?
1. Visual problems may be an early symptom.
2. Immunosuppressant therapy may be prescribed.
3. Ptosis may be either unilateral or bilateral.
4. Exercise increases muscle strength.
5. Tremors respond well to anticholinergic drug therapy.
Correct Answer:
1. Visual problems may be an early symptom.
2. Immunosuppressant therapy may be prescribed.
3. Ptosis may be either unilateral or bilateral.
Rationale: Visual problems may be an early symptom. The manifestations of myasthenia
gravis correspond to the muscles involved. Initially, the eye muscles are affected.
Immunosuppressant therapy may be prescribed. Treatments such as glucocorticoid and
immunosuppressant therapy may result in an increase in muscle strength. Ptosis may be
either unilateral or bilateral. The client experiences either diplopia (double vision) or
ptosis (drooping of the eyelid unilaterally or bilaterally). Exercise increases muscle
strength. Exercise tends to fatigue muscles, while rest will improve function. Tremors
respond well to anticholinergic drug therapy. Anticholinergics are the oldest class of
medications used to treat the tremors experienced in Parkinsons disease.
LO: 2
5. The client being evaluated for a possible diagnosis of myasthenia gravis (MG) describes
having a diagnostic test that involved an injection that resulted in a 5-minute period of
markedly improved muscle strength. The nurse recognizes the clients report as describing
a(n):
1. Tensilon test.
2. Computed tomography (CT) scan.
3. Nerve stimulation study.
4. Analysis of antiacetylcholine receptor antibodies.
Correct Answer: Tensilon test.
Rationale: The Tensilon test produces a 5-minute increase in muscle strength. A computed
tomography (CT) scan would not result in improved muscle strength. The nerve stimulation
study and the analysis of antiacetylcholine receptor antibodies are tests that can be done to
help diagnose MG, but do not require a drug injection.
LO: 2
6. The nurse is assessing a client who is diagnosed with Parkinsons disease and documents
that he is demonstrating bradykinesia. The nurse bases this on the observation of the client:
1.
2.
3.
4.
Having difficulty initiating a walk to the bathroom.

Presenting little facial expression.
Maintaining his balance by holding on to the furniture.
Speaking both slowly and deliberately.
Correct Answer: Having difficulty initiating a walk to the bathroom.

Rationale: Bradykinesia, one of the more disabling symptoms of PD, refers to slowness of
movement. Parkinsons disease creates a lack of spontaneous movement that affects
starting to move and actually following through on the movement. Clients with Parkinsons
do talk slowly and often deliberately, but the term bradykinesia refers to slowness of
movement. Postural instability refers to the balancing difficulties that result from the
diminishing of the reflexes that allow a person to maintain balance. The patient will have
difficulty staying balanced and may even fall when changing positions. Rigid facial
muscles lead to hypomimia, or decreased facial expression, resulting in the characteristic
masked face of a PD patient.
LO: 2
7. A client is hospitalized with myasthenia gravis and the nursing diagnosis Ineffective
Breathing Pattern related to neuromuscular weakness has been identified. In planning care
for this client, the nurse will identify which of the following interventions as having
priority?
1.
2.
3.
4.
Airway suctioning as required

Provide frequent rest periods
Monitor arterial blood gases
Assist with ADLs
Correct Answer: Airway suctioning as required

Rationale: Respiratory failure is a serious complication for the client hospitalized with
myasthenia gravis. Remembering the ABCs, patent airway is the first concern. Assessment
of the arterial blood gases, while important, does not have priority in this situation. Energy
conservation interventions, such as frequent rest periods and assistance with ADLs, while
appropriate for neuromuscular weakness symptoms, do not have priority over maintaining
a patent airway.
LO: 3
8. A home
health nurse is conducting a nutritional assessment on a client with moderate

Alzheimers disease (AD) when it is noted that he has lost 5 pounds over the past month.
The nursing intervention best directed at managing the clients need for nutrition is to:
1.
2.
3.
4.
Provide finger-food snacks several times throughout the day.

Recommend referral to a nutritionist who is familiar with AD clients.
Suggest menu choices that encourage a mechanical soft diet.
Encourage meals that include at least one of the clients favorite foods.
Correct Answer: Provide finger-food snacks several times throughout the day.
Rationale: For the client with moderate Alzheimers disease, nutrition and hydration
problems arise. Increased confusion, frustration, and wandering are typical of this stage of
AD. Providing the client with opportunities to have snacks throughout the day, and giving
foods that are easy to eat on the go, like fruit slices, protein shakes, or finger foods such
as sandwiches, are ways to offset the nutritional deficits typically seen in clients at this
stage of the disease process. Providing favorite foods is not likely to impact the problem of
altered interest in eating. A nutritionist should be involved if the weight loss continues. A
mechanical soft diet is appropriate only if it is determined that there is a problem with the
clients teeth or chewing/swallowing mechanisms.
Nursing Process: Implementing
LO: 3
9. A 30-year-old
attorney who practices at large corporate law office has recently been
diagnosed with multiple sclerosis (MS). In order to best manage the occurrence of
symptoms, the nurse encourages the client to:
1.
2.
3.
4.
Scale back her caseload to allow for a less stressful work environment.
Take the pemoline (Cylert) she has been prescribed as ordered.
Take time off from work at the first indication of symptom exacerbation.
Consider a career change in order to delay progression of her symptoms.
Correct Answer: Scale back her caseload to allow for a less stressful work environment.
Rationale: Multiple sclerosis (MS) is progressive and will be negatively affected by
working long hours and enduring stressful shifts. It is important for this client to plan a
schedule that is less demanding and move to a work environment that is less stressful for
adapting to life with MS. Pemoline (Cylert) is prescribed for the management of fatigue.
Taking time off after symptoms occur is not a proactive lifestyle change. A career change is
not something a nurse should encourage and will not necessarily delay progression of the
disease.
LO: 3
10. When providing education for a client newly diagnosised with mild Alzheimers
disease (AD) and his family, the nurse identifies which of the following as signs that the
disease is progressing in severity?
1.
2.
3.
4.
5.
Repetitively allows pots of water to boil dry

Claims that the newspaper is not readable anymore
Becomes agitated when old friends come to visit
Develops a ravenous appetite, especially for carbohydrates
Is obsessive about how personal belongings are organized
Correct Answer:
1. Repetitively allows pots of water to boil dry
2. Claims that the newspaper is not readable anymore
3. Becomes agitated when old friends come to visit
Rationale: Repetitively allows pots of water to boil dry. Poor judgment, memory loss,
and difficulty completing familiar tasks are warning signs of progressively worsening AD.
Claims that the newspaper is not readable anymore. Loss of reading skills is a warning
sign of progressively worsening AD. Becomes agitated when old friends come to visit.
Changes in mood or behavior and changes in personality are warning signs of progressively
worsening AD. Develops a ravenous appetite, especially for carbohydrates. An increase
in appetite is not usually associated with Alzheimers. Is obsessive about how personal
belongings are organized. Obsession with organization is not usually associated with
Alzheimers.
Nursing Process: Implementation
LO: 4
11. The nurse caring for a client with Alzheimers disease (AD) is discussing discharge
planning with the family. The client has been showing signs of increasing agitation in the
evenings. The nurse suggests the following intervention to initially manage the clients
behavior:
1.
2.
3.
4.
Taking the client to his room, where soft music is being played on the radio
Administering an oral tranquilizer with dinner
Engaging the client in a distractive activity when agitation occurs
Recommending the client be in bed for the night by 9 p.m.
Correct Answer: Taking the client to his room, where soft music is being played on the
radio
Rationale: Music therapy, massage, art therapy, sound, and dance are all alternative
therapies that have been helpful in the treatment of Alzheimers disease. Increased agitation
in the evenings is part of the sundowners phenomenon and, although common, can be
frustrating to the client as well as the caregivers. A quiet environment with less stimulation
is often helpful. A quiet environment will most likely be more beneficial than engaging in a
distractive activity. Though the use of tranquilizers might become necessary, it would not
be the best initial intervention. Having the client in bed by 9 p.m. will not necessarily have
a positive effect on the agitation.
LO: 4
12. The nurse is preparing a client diagnosed with amyotrophic lateral sclerosis (ALS) for
discharge. The nurse realizes that interventions for the following nursing diagnosis should
be stressed for this client:
1.
2.
3.
4.
Ineffective Breathing Pattern related to neuromuscular dysfunction.

Impaired Urinary Elimination related to spastic or flaccid bladder.
Alteration in Vision acuity related to ocular muscle involvement.
Disturbed Thought Processes related to cognitive decline.
Correct Answer: Ineffective Breathing Pattern related to neuromuscular dysfunction.

Rationale: ALS affects the neuromuscular function; the client is at risk for respiratory
dysfunction as a result of this disease process. Impaired urinary elimination is a result of a
spastic or flaccid bladder resulting from MS. Visual acuity is impaired in clients diagnosed
with MG. Disturbed thought processes is seen in AD clients.
LO: 4
13. A client newly diagnosed with Parkinsons disease expresses concerns to the nurse
about how she and her family will cope with the disease. The response to the concerns is
based on the knowledge that:
1. Involvement with a support group that focuses on a specific disease process has
been proven to be very helpful.
2. Most clients need to foster a strong family/friend-based support system to
effectively cope with their disease.
3. A period of depression is generally experienced initially by everyone affected by the
disease process.
4. Coping with the disease will come more naturally as the client becomes familiar
with the limitations it creates.
Correct Answer: Involvement with a support group that focuses on a specific disease
process has been proven to be very helpful.
Rationale: Parkinsons support organizations offer understanding and hope for both the
patients and their families. Local and national support groups provide information,
educational programs, and social activities tailored especially for people with PD. While a
strong family/friend support system is important, it does not usually occur without initial
supplementary support. Depression is not necessarily seen in all clients, and realization that
it may occur does not address the clients concerns. Coping may improve as the client
becomes familiar with the disease process, but that realization does not help address the
clients current needs.
LO: 5
14. The nurse is discussing the future with a client recently diagnosed with amyotrophic
lateral sclerosis (ALS). When the client asks about the possibility of continuing to work at
his familys construction business, the nurse responses:
1. Work as long at your job as you feel capable of keeping up with the demands it
makes on you.
2. This is a progressively debilitating disease; you need to think of ways to conserve
your energy, not expend it.
3. Can you do work that is less strenuous?
4. Is there a way that you can switch over to the office side of the business?
Correct Answer: Work as long at your job as you feel capable of keeping up with the
demands it makes on you.
Rationale: People with ALS do maintain careers and interests. They are encouraged to
remain active for as long as possible. While it is important to minimize stress and conserve
energy, it is not necessary to alter ones life dramatically until the symptoms of the disease
demand it.
LO: 5
15. A nurse is encouraging a client diagnosed with multiple sclerosis to engage in a regular
exercise program. This recommendation is based on the knowledge that exercise will help
the client manage:
1.
2.
3.
4.
5.
Fatigue.
Muscle spasticity.
Constipation.
Infection exposure.
Obesity.
Correct Answer:
1. Fatigue.
2. Muscle spasticity.
3. Constipation.
Rationale: Fatigue. Patients should be encouraged to engage in a regular exercise program
because exercise may help manage fatigue. Muscle spasticity. Patients should be
encouraged to engage in a regular exercise program because exercise may help manage
spasticity. Constipation. Patients should be encouraged to engage in a regular exercise
program because exercise may help manage bowel and bladder problems. Infection
exposure. Good nutrition can aid in resistance to infection. Obesity. Obesity is not a
typical manifestation of this disease process.
LO: 5
16. A client diagnosed with Parkinsons disease (PD) 11 years ago is being cared for at
home by his wife. The nurse asks whether the family has considered arranging for in-home
assistive care based primarily on the knowledge that:
1. This type of assistance can help preserve the physical and emotional well-being of
the clients wife.
2. It is becoming more difficult for his wife to adequately meet his physical needs.
3. This type of assistive care is warranted, since PD is both progressive and
degenerative.
4. The client may live for many more years, requiring more intensive care as the
disease progresses.
Correct Answer: This type of assistance can help preserve the physical and emotional wellbeing of the clients wife.
Rationale: People can live with PD for many years. The chronic and progressive nature of
PD can significantly impact older, spousal caregivers. Caregiver stress and burden have
been shown to increase as the disease progresses, and this has significant impact on the
physical and emotional health of the caregiver. There is no indication that the clients needs
are not being met. The decision to enlist assistive home care is not based solely on the
progressive, degenerative nature of a disease. It is true that the client with PD may live for
many years, but that is not the primary reason for suggesting assistive home care.
LO: 6
17. The nurse is preparing an educational program on amyotrophic lateral sclerosis (ALS).
The nurse recognizes that this information is most appropriately presented at a:
1. Mens 50 or older bowling league banquet.
2. Mother-and-daughter softball league season kickoff brunch.
3. Singles over 60 wellness health fair.
4. A teenage mens hockey team annual fund raising event.
Correct Answer: Mens 50 or older bowling league banquet.
Rationale: The onset of ALS typically occurs between 40 and 60 years of age, affecting
men more often than women. While it can affect younger and older people of either gender,
the 50-or-older male group would be the target population of the available options.
LO: 6
18. A client who has been diagnosed with Parkinsons disease (PD) shares with the nurse
that, I feel like no one else knows what Im dealing with. The nurses best response is
based on the knowledge that:
1.
2.
3.
4.
PD is the second most common neurological disorder in people over 65.

It is not usual to feel alone when faced with a stressful situation.
The client will cope better when he realizes his family is supportive.
Depression is a commonly seen reaction to such a diagnosis.
Correct Answer: PD is the second most common neurological disorder in people over 65.
Rationale: People with PD ages 65 and older account for 17% of neurology outpatient
visits. After Alzheimers disease, it is the second most common neurological condition
requiring home health care. The client is feeling isolated because of the diagnosis and will
benefit greatly from knowing that many are dealing with the disease and that mutual
support is available. Knowing that the feeling is common in a stressful situation does not
adequately address the clients needs. The incidence of depression and need for family
support do not address the clients current emotional state.
LO: 6
19. The nurse is conducting an assessment interview with a client when he shares that two
of his uncles have been diagnosed with Alzheimers disease (AD). The nurse recognizes
which of the following assessment data as a potential risk reduction for developing the
disease?
1.
2.
3.
4.
Has taken atorvastatin (Lipitor) daily for the last 5 years

Maintains a regular cardiovascular and weight training exercise program
Body fat percentage is calculated to be 22%
Can remember and repeat the names of five objects after 10 minutes
Correct Answer: Has taken atorvastatin (Lipitor) daily for the last 5 years
Rationale: Several agents are undergoing research as potential treatments or preventive
therapies for AD. Studies have shown a decreased AD prevalence and a risk reduction in
those patients taking statin drugs. While factors in maintaining general health, regular
exercise and an acceptable body fat percentage have not shown a connection to the
prevention of AD. Current short-term memory is not an indicator of future AD.
LO: 7
20. The mother of a client diagnosed with multiple sclerosis (MS) asks the nurse to
Explain what caused my daughter to have this disease. The nurses response is based on
research data that suggest that MS may be a result of:
1.
2.
3.
4.
5.
Genetic predisposition.
Viral infection.
Exposure to environmental pollutants.
Birth trauma.
Nutritional deficiencies.
Correct Answer:
1. Genetic predisposition.
2. Viral infection.
3. Exposure to environmental pollutants.
Rationale: Genetic predisposition. Many researchers hypothesize that MS is not caused by
a single gene, virus, or environmental factor, but is the result of a combination of factors,
including genetic predisposition. Viral infection. Many researchers hypothesize that MS is
not caused by a single gene, virus, or environmental factor, but is the result of a
combination of factors, including viral infection. Exposure to environmental pollutants.
Many researchers hypothesize that MS is not caused by a single gene, virus, or
environmental factor, but is the result of a combination of factors, including exposure to
environmental pollutants. Birth trauma. Birth trauma is not typically associated with
causing MS. Nutritional deficiencies. Nutritional deficiencies are not typically associated
with causing MS.
LO: 7
21. The nurse is discussing physical methods to help manage balance problems for a client
who has been newly diagnosed with Parkinsons disease. Based on current research
findings, the nurse suggests the client look into:
1.
2.
3.
4.
Tai Chi exercise.

Water aerobics class.
Riding a stationary recumbent bike.
Active range of motion exercises.
Correct Answer: Tai Chi exercise.

Rationale: The majority of studies on tai chi show that it may lead to improved balance
and balance awareness, reduced fear of falling, increased strength, increased functional
mobility, greater flexibility, and increased psychological well-being, and conclude that tai
chi may be a viable option for improving balance in patients with mild Parkinsonism. The
other optionswater aerobics, recumbent biking, and active range of motionhave no
proven effect on improving balance.
LO: 7

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[Osborn] chapter 31

Learning Outcomes [Number and Title]

1. When interviewing a client suspected of exhibiting signs of Parkinsons disease, the

Having difficulty initiating a walk to the bathroom.

Correct Answer: Having difficulty initiating a walk to the bathroom.

Airway suctioning as required

Correct Answer: Airway suctioning as required

health nurse is conducting a nutritional assessment on a client with moderate

Provide finger-food snacks several times throughout the day.

Repetitively allows pots of water to boil dry

Ineffective Breathing Pattern related to neuromuscular dysfunction.

Correct Answer: Ineffective Breathing Pattern related to neuromuscular dysfunction.

PD is the second most common neurological disorder in people over 65.

Has taken atorvastatin (Lipitor) daily for the last 5 years

Tai Chi exercise.

Correct Answer: Tai Chi exercise.

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