CASE 1:

1. The nurse on a medical unit is providing care for 32-year-old Martha Newman,
who has multiple sclerosis (MS). She was diagnosed aft er she gave birth to a healthy baby
girl 5 years earlier.
Select all that apply:

How is MS diagnosed?
A. History and physical
B. Magnetic resonance imaging (MRI)
C. Bone scan
D. Electroencephalogram (EEG)

2. Select all that apply:

Which of the following are symptoms of MS?
A. Weakness of the limbs
B. Scotomas
C. Dysphagia
D. Headache
E. Vertigo
F. Diplopia
G. Scanning speech
H. Spasticity of muscles

3. What teaching would be utilized to promote safety for a patient with:

Diplopia
Scotomas

4. Multiple-choice question:
Mrs. Newman tells the nurse, “I am interested in having another child, but I am concerned
about how multiple sclerosis would aff ect the pregnancy.” Which statement by the nurse
would be accurate?
A. MS would cause birth defects in the neonate during the fi rst trimester.
B. MS causes placental abruption, which places the neonate at high risk.
C. Pregnancy, labor, and delivery have no eff ect on MS, but symptoms may be exacerbated
during the postpartum period.
D. Pregnancy causes an increase in motor and sensory symptoms in the last trimester,
which could lead to a cesarean section.

5. Select all that apply:

Th e nurse is told that Mrs. Newman has a spastic bladder. Which symptoms would the
nurse expect?
A. Urinary urgency
B. Urinary retention
C. Urinary frequency
D. Incontinence
CASE 2:

1. Th e nurse is completing an admission assessment on Mr. Rodriguez, who states that he

had progressive symptoms of Parkinson’s disease, which began when he was 64.
He is now 70 years old. Th e nurse notes that the patient has the triad of symptoms that
are classic in patients with Parkinson’s disease.

2. Matching:
Match the symptom to the observed manifestation written below.

A. Resistance during passive range of motion

B. Masked face
C. Initial sign
D. Drooling
E. Pill rolling
F. Cogwheel movement
G. Shuffl ing gate

Tremor
Rigidity
Bradykinesia

3. Select all that apply:

Which of the complications listed below are commonly found in a patient with Parkinson’s
disease?
A. Depression
B. Diarrhea
C. Dyskinesias
D. Dysphasia
E. Dementia

4. What is akinesia? ______________________________________

What is the cause of akinesia?____________________________

5. List two interventions that would be appropriate for each symptom that is listed below:
Freeze when walking
1.
2.
Diffi culty standing up from a sitting position
1.
2.
Diffi culty dressing
1.
2.

6. Multiple-choice question:
Th e nurse observes that the patient has decreased mobility of the tongue. Th e nursing
diagnosis would be:
A. Ineff ective airway clearance, related to retained secretions.
B. Impaired nutrition—less than body requirements, related to dysphagia.
 C. Impaired physical mobility, related to bradykinesia.
D. Impaired verbal communication, related to dental problems.

7. List the swallowing sequence technique indicated for a patient with Parkinson's disease
who has dysphasia.
1.
2.
3.rcise

888888
Select all that apply:
8. Which of the following nursing interventions will improve nutritional balance in a patient
with Parkinson’s disease?
A. Drinking fl uids aft er swallowing food.
B. Cutting food into bite-sized pieces.
C. Providing six small meals each day.
D. Increasing time for eating meals.

CASE 3:

1. Mrs. Costa is admitted to the inpatient unit with a myasthenic crisis. She has severe
muscle weakness and is having diffi culty speaking, swallowing, and breathing.

2. Fill in the blanks:

Name the two assessments that would be done first.
1.
2.

3. Multiple-choice question:
Th e nurse is performing a neurological assessment of Mrs. Costa. An expected
Finding would be:
A. Sensory loss
B. Abnormal reflexes
C. Ptosis
D. Muscle atrophy

4. Select all that apply:

An exacerbation of myasthenia gravis can be precipitated by:
A. Emotional stress
B. Extremes of temperature
C. Acetaminophen (Tylenol)
D. Pregnancy
E. Influenza

5. Johanna explains to the family that edrophonium (Tensilon) is a drug used for diagnostic
purposes and that it can also be helpful in evaluating the treatment plan. The patient’s
family agree to the test.
When Tensilon is administered, the patient may have several reactions. Which disease
process matches to the clinical manifestations?

6. Matching:
Match the symptom to the disease
A. Sweating.
 B. Muscle strength improves.
C. Abdominal pain.
D. Excessive salivation.
E. Muscles become weaker.

Myasthenia gravis
Cholinergic crisis
.
7. Name two factors that cause myasthenic crisis.
1.
2.

8. Name one factor that causes cholinergic crisis.

1.

9. What medication should be readily available during the Tensilon test?

Why?

10. Mrs. Costa has severe muscle weakness and is having diffi culty speaking, swallowing,
and breathing. Name two methods that would help the patient to communicate.

11. Th e nurse reviews the care plan and discusses the expected outcomes
with the patient and family. Which expected outcome is the priority?
A. Adapts to impaired physical mobility.
B. Demonstrates eff ective coping mechanisms.
C. Achieves adequate respiratory function.
D. Utilizes alternative communication methods.