CNRN Neurodegenerative Disorders Nursing 2 — Questions and Answers
Question 1: The Uhthoff phenomenon in multiple sclerosis refers to:
- Sudden severe spasticity triggered by a urinary tract infection
- Temporary worsening of neurological symptoms with increased body temperature (Correct answer)
- Paroxysmal tonic spasms of the limbs during remission
- Monocular vision loss lasting more than 24 hours
Correct answer: Temporary worsening of neurological symptoms with increased body temperature
The Uhthoff phenomenon is the temporary worsening of MS symptoms that occurs with a rise in body temperature, due to impaired conduction in already-demyelinated nerve fibers.
Question 2: A patient with Parkinson's disease is prescribed carbidopa-levodopa. Which nursing teaching point is MOST important?
- Take the medication with a high-protein meal to enhance GI absorption
- Avoid taking the medication within 30–60 minutes of a high-protein meal (Correct answer)
- Take the medication only when tremor symptoms become severe
- Expect complete elimination of all tremors after the first dose
Correct answer: Avoid taking the medication within 30–60 minutes of a high-protein meal
High-protein meals compete with levodopa for intestinal absorption and blood-brain barrier transport via large neutral amino acid carriers, reducing therapeutic efficacy.
Question 3: When assessing a patient with ALS for respiratory compromise, which measurement is MOST critical for determining the need for ventilatory support?
- Oxygen saturation by pulse oximetry
- Forced vital capacity (FVC) (Correct answer)
- Arterial blood pH
- Resting respiratory rate
Correct answer: Forced vital capacity (FVC)
Forced vital capacity (FVC) is the most sensitive early indicator of respiratory muscle weakness in ALS; an FVC below 50% predicted typically prompts discussion of non-invasive ventilatory support.
Question 4: Which symptom is typically the FIRST neurological manifestation of multiple sclerosis?
- Significant cognitive impairment and memory loss
- Optic neuritis causing painful unilateral visual loss (Correct answer)
- Complete paraplegia of both lower extremities
- Intractable focal seizures
Correct answer: Optic neuritis causing painful unilateral visual loss
Optic neuritis, presenting as painful monocular visual loss with color desaturation, is one of the most common initial presentations of MS and often the first demyelinating event.
Question 5: Dementia with Lewy bodies (DLB) is distinguished from Alzheimer's disease primarily by the presence of:
- Memory loss as the predominant early symptom
- Fluctuating cognition with recurrent vivid visual hallucinations and parkinsonism (Correct answer)
- Stepwise cognitive deterioration following ischemic events
- Prominent personality and behavioral changes preceding memory loss
Correct answer: Fluctuating cognition with recurrent vivid visual hallucinations and parkinsonism
DLB is characterized by the triad of fluctuating cognition, vivid recurrent visual hallucinations, and spontaneous parkinsonism — features that distinguish it from Alzheimer's disease.
Question 6: A patient with Parkinson's disease reports difficulty swallowing. Which nursing intervention is MOST appropriate?
- Thicken liquids to nectar consistency and refer to speech-language pathology (Correct answer)
- Encourage the patient to drink thin liquids rapidly to clear the throat
- Position the patient supine during all meals to reduce aspiration risk
- Provide large bites of food to stimulate the swallowing reflex
Correct answer: Thicken liquids to nectar consistency and refer to speech-language pathology
Thickened liquids reduce aspiration risk in Parkinson's-related dysphagia, and speech-language pathology referral provides individualized swallowing assessment and safe diet recommendations.
Question 7: In Guillain-Barré syndrome, which pattern of weakness is MOST characteristic?
- Ascending symmetrical weakness beginning in the legs and progressing upward (Correct answer)
- Descending weakness beginning in the facial and bulbar muscles
- Isolated proximal muscle weakness with distal sparing
- Unilateral hemiparesis corresponding to a focal cerebral lesion
Correct answer: Ascending symmetrical weakness beginning in the legs and progressing upward
Guillain-Barré syndrome classically presents with ascending symmetrical weakness starting in the lower extremities and progressing upward, potentially reaching the respiratory muscles.
CNRN Neurodegenerative Disorders Nursing 2
The Uhthoff phenomenon in multiple sclerosis refers to: