1. How would you explain Alzheimer’s disease to the family? 2. The husband asks, “How did she get Alzheimer’s? We don’t know anyone else who has it.” How would you respond? 3. After asking the family to describe M.E.’s behavior, you determine that she is in stage 2 of Alzheimer’s three stages. Describe common signs and symptoms for each stage of the disease. 4. The daughter expresses frustration at the number of tests M.E. had to undergo and the length of time it took for someone to diagnose M.E.’s problem. What tests are likely to be performed, and how is Alzheimer’s disease diagnosed? 5. Describe specific nursing interventions that are part of national patient safety initiatives aimed at minimizing the risk of harm for M.E. 6. Describe the Alzheimer’s-related nursing interventions related to each of the following nursing care problems: chronic confusion, inability to perform self-hygiene, disrupted sleep pattern, impaired verbal communication, and agitation. 7. M.E.’s son asks whether there is any medication that might be prescribed to treat Alzheimer’s disease. How would you respond? 8. What other medications might be used with a patient like M.E.? 1. What is the etiology of GBS? 2. What type of individual is likely to be diagnosed with GBS? 3. What are the clinical manifestations of GBS? 4. Why does life-threatening respiratory dysfunction occur? 5. How is GBS diagnosed, and what tests would you expect to be performed? 6. Is the history of C.B.’s case typical? 7. What is the medical management for GBS? 8. What are the overall goals of nursing care for C.B. at this time? 9. You are concerned about the possibility of disuse syndrome related to C.B.’s paralysis. Describe an outcome of nursing care for C.B., and describe the independent nursing interventions you would implement to meet that outcome. 10. How would C.B.’s nutritional needs be maintained? 11. What evaluative parameters could you use to determine whether C.B.’s nutritional needs were being met? 12. What interventions can you implement to decrease C.B.’s fear and anxiety? 3. What are the clinical manifestations of PD? Place a star next to the symptoms L.C. has mentioned. 4. L.C.’s wife asks you, “How do the doctors know L.C. has Parkinson’s disease? They never did a lot of tests on him.” How is the diagnosis of PD made? 5. L.C.’s wife comments, “I don’t even know which one of his medicines he takes for his Parkinson’s.” What medications are used for PD? 6. L.C. asks, “If I don’t have enough dopamine, then why don’t they give me a dopamine pill?” Why can’t oral dopamine be given as replacement therapy? 7. Levodopa is always given in combination with carbidopa. Why? 8. Why did L.C.’s dyskinetic movements appear to be worse just after taking his carbidopa-levodopa, and what might be done about it? 9. L.C.’s wife asks, “They can do surgery for everything else. Why can’t they do surgery to fix Parkinson’s?” How would you describe the surgical treatments available for patients with PD? 10. Because L.C. is reporting an increase in drooling, you are concerned about the possibility of his having developed a decreased ability to swallow. What further assessment could you perform to determine whether L.C. is at risk for aspirating? 11. What are three nutrition interventions that should be implemented in caring for L.C? 12. Because L.C. is reporting that his gait is more unsteady, there is an increased risk for falls. Which suggestion could you offer to diminish this risk? a. Use a wheelchair to move around. b. Stand erect, and use a cane to ambulate. c. Keep the feet close together while ambulating, and use a walker. d. Consciously think about walking over imaginary lines on the floor. 13. You are giving instructions to L.C. and his wife about maintaining mobility. You determine that they understand the directions if they state that L.C. will: a. sit in soft, deep chairs with supportive pillows. b. perform his daily exercises in the evening. c. rock back and forth to start movement when rising. d. buy clothes with many buttons to maintain finger dexterity. 14. As L.C.’s case manager, identify six things that you would need to assess to determine whether L.C. could be cared for in his home. 1. Outline a plan of care for implementing these orders. 2. The instructions on the tPA vials read to reconstitute with 50 mL of sterile water to make a total of 50 mg/50 mL (1 mg/mL). The hospital protocol is to infuse 0.9 mg/kg over 60 minutes with 10% of the dose given as a bolus over 1 minute. N.T. weighs 143 pounds. What is the amount of the bolus dose, in both milligrams and milliliters, that you will administer in the first minute? What is the amount of the remaining dose that you will need to administer? 3. What are the three types of cerebrovascular accidents (CVAs)? 4. What role do diagnostic tests play in evaluating N.T. for a suspected CVA? 5. Explain how the type of stroke is an important factor in planning N.T.’s care. 6. Contraindications for beginning fibrinolytic therapy include: (Select all that apply.) a. Currently on Coumadin with an INR of 2.4 b. Major surgery in the last 14 days d. Platelet count of less than 100,000 e. Blood glucose of less than 50 mg/dL f. History of myocardial infarction 1 year ago 7. What is the purpose of monitoring the CPK isoenzyme levels? 8. If N.T.’s deficits are temporary, how long might it take before they are completely reversed? 9. While assessing N.T., you note the following findings. Which one is unrelated to the CVA? 10. Your co-worker states, “I always heard that atrial fibrillation is a precursor to stroke.” Explain whether this statement is true or false. 11. Why was N.T. placed on clopidogrel (Plavix) post-CVA? 12. Because N.T. had a thrombolytic infusion, how many hours should you wait before beginning administration of any anticoagulant or antiplatelet medications? 13. N.T. is not on hormone replacement therapy post-CVA. Why would this medication be discontinued? 14. Is there any benefit from continuing simvastatin (Zocor) after her CVA? 15. As you walk into the nurses’ station, the charge nurse is talking to N.T.’s physician, who ordered a modified barium swallow study and referral for a speech-language pathologist (SLP), occupational therapist (OT), and registered dietitian (RD). Give the rationale for these orders. 16. N.T.’s BP should be well controlled. What BP level should be considered normal for her, based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure? 1. How would you explain ALS to T.H.? 4. T.H. has many questions. He asks you, “How long can I expect to live?” How should you respond? 5. T.H. asks, “Will I slowly lose my mind?” 6. T.H. then asks, “Are there any treatments for this?” 7. T.H. thinks a moment, then says “How is the doctor even sure this is what I have?” 8. Because ALS affects so many body systems, you will be coordinating efforts with a speech, occupational, respiratory, and physical therapist, as well as a dietitian and psychologist. Define the role that each of the following professionals will play in T.H.’s treatment. 9. You hold a family meeting to recruit adequate help for the caregiver, in this case, T.H.’s spouse. Why is this important? 10. T.H. asks you, “How will the end probably come for me?” What should you tell him? 11. T.H. wants to know whether he has to be put on a “breathing machine.” What factors will you take into consideration when deciding what to tell him? 1. You note that the nursing assistive personnel has just entered these vital signs into J.B.’s record. What is your priority action at this time? 2. What treatment do you anticipate for J.B.? 3. J.B.’s wife asks you, “What may have caused my husband to get worse, and why does he keep having these episodes?” What explanation should you give her? 4. You are visiting with J.B.’s wife, who tells you she doesn’t have a lot of information about MG and she would like to know more about it so that she will feel more comfortable talking to her husband. What should you tell her? 5. J.B.’s wife asks you to explain what to expect in terms of symptoms as her husband’s illness progresses. What should you tell her? 6. J.B.’s wife asks, “How do they know that my husband has MG?” What should you tell her about how MG is diagnosed? 7. J.B.’s wife asks, “What are some options for treatment of MG?” How will you explain the different treatments? 8. List four factors that could predispose J.B. to an exacerbation of his illness. 9. J.B.’s wife asks what the physicians and nurses watch for while her husband is in the hospital. How will you explain these activities? 10. J.B.’s wife wants to know when he will be able to go home. How will you respond? 11. J.B.’s wife asks you what information she will need before taking her husband home. What will you teach her? 12. J.B.’s wife asks you, “What is the difference between a cholinergic crisis and myasthenic crisis?” What explanation should you give her? 13. You teach J.B. and his wife that the most effective means of preventing myasthenic and cholinergic crises is by: a. eating three large, well-balanced meals. b. doing muscle-strengthening exercises twice a day. c. doing all of their errands early in the day.
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