1. Nursing Management: Chronic Neurologic Problems
Chapter 59
Nursing Management: Chronic Neurologic Problems

2. 1. turn the patient to the side. 2. start oxygen by mask at 6 L/min.
1. The nurse is called to the patient’s room by the patient’s spouse when the patient experiences a seizure. Upon finding the patient in a clonic reaction, the nurse should
1. turn the patient to the side.
2. start oxygen by mask at 6 L/min.
3. restrain the patient’s arms and legs to prevent injury.
4. record the time sequence of the patient’s movements and responses as they occur.
Answer: 1
Rationale: During the seizure, the nurse should maintain a patent airway, protect the patient’s head, turn the patient to the side, loosen constrictive clothing, and ease the patient to the floor, if seated. The patient should not be restrained, and no objects should be placed in the mouth. After the seizure, the patient may require repositioning to open and maintain the airway, suctioning, and oxygen. When a seizure occurs, the nurse should carefully observe and record details of the event because diagnosis and subsequent treatment often rest solely on the seizure description.

3. 1. slurred speech, visual disturbances, and ataxia.
2. The nurse admits a patient with advanced Parkinson’s disease at the outpatient clinic with a cough and fever. During assessment of the patient, the nurse would expect to find
1. slurred speech, visual disturbances, and ataxia.
2. muscle atrophy, spasticity, and speech difficulties.
3. muscle weakness, double vision, and reports of fatigue.
4. drooling, stooped posture, tremors, and a propulsive gait.
Answer: 4
Rationale: The classic manifestations of Parkinson’s disease (PD) often include tremor, rigidity, and bradykinesia. In the beginning stages, only a mild tremor, a slight limp, or a decreased arm swing may be evident. Later in the disease, the patient may have a shuffling, propulsive gait with arms flexed and loss of postural reflexes. In some patients, a slight change in speech patterns may occur.

4. 1. risk for injury related to limited vision.
3. An appropriate nursing diagnosis for a patient with advanced Parkinson’s disease is
1. risk for injury related to limited vision.
2. risk for aspiration related to impaired swallowing.
3. urge incontinence related to effects of drug therapy.
4. ineffective breathing pattern related to diaphragm fatigue.
Answer: 2
Rationale: As swallowing becomes more difficult (dysphagia), malnutrition or aspiration may result.

5. 1. “I will need to rotate injection sites with each dose I inject.”
4. Interferon β-1b (Betaseron) has been prescribed for a young woman who has been diagnosed with relapsing-remitting multiple sclerosis. The nurse determines that additional teaching about the drug is needed when the patient says,
1. “I will need to rotate injection sites with each dose I inject.”
2. “I should report any depression or suicidal thoughts that develop.”
3. “I should avoid direct sunlight and use sunscreen and protective clothing when out of doors.”
4. “Because this drug is a corticosteroid, I should reduce my sodium intake to prevent edema.”
Answer: 4
Rationale: Interferon β-1b (Betaseron) is an immunomodulator drug (and not a corticosteroid). The drug is given subcutaneously every other day. Patient teaching should include rotate injection sites with each dose; assess for depression, suicidal ideation; wear sunscreen and protective clothing while exposed to sun; know that flu-like symptoms are common following initiation of therapy.