A nurse is caring for a client who has multiple sclerosis and reports a tightening feeling around their torso. Which of the following conditions should the nurse recognize this finding indicates?

Lhermitte's sign

Trigeminal neuralgia

MS hug

Paroxysmal spasms

Answer and Explanation

The Correct Answer is C

A. Lhermitte's sign:

Lhermitte's sign is a neurological symptom characterized by a sensation of electric shock-like pain that radiates down the spine and into the limbs, typically triggered by flexing the neck forward. It is often described as shooting or stabbing pain and is commonly associated with lesions or damage to the cervical spinal cord. Lhermitte's sign is not associated with a tightening sensation around the torso but rather with shooting pain down the spine and limbs.

B. Trigeminal neuralgia:

Trigeminal neuralgia is a neurological condition characterized by severe, shooting pain along the trigeminal nerve, which supplies sensation to the face. The pain is typically triggered by activities such as chewing, speaking, or touching the face. Trigeminal neuralgia causes sudden, intense, electric shock-like pain in the face, particularly in the areas supplied by the trigeminal nerve (e.g., cheek, jaw, forehead). It is not associated with a tightening sensation around the torso.

C. MS hug:

The "MS hug" is a symptom experienced by some individuals with multiple sclerosis, characterized by a sensation of tightness, pressure, or squeezing around the chest, abdomen, or torso. It can feel like a band tightening around the body and may be described as a constricting or girdling sensation. The MS hug is caused by spasms or tightening of the muscles surrounding the rib cage or the intercostal muscles due to damage to the nerves that control muscle function in MS.

D. Paroxysmal spasms:

Paroxysmal spasms refer to sudden, involuntary muscle contractions or spasms that occur intermittently. These spasms can affect various parts of the body and are commonly associated with conditions like multiple sclerosis. However, they typically present as brief, sudden contractions rather than a persistent tightening sensation around the torso.

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Correct Answer is A

Explanation

A. Orthostatic hypotension:

Orthostatic hypotension, a sudden drop in blood pressure when standing up, is a potential adverse effect of levodopa therapy. This can lead to dizziness and increase the risk of falls, thus supporting the nursing diagnosis Risk for Injury.

B. Nausea and vomiting:

Nausea and vomiting are common side effects of levodopa therapy. While they can cause discomfort and dehydration, they are less directly related to the risk of physical injury compared to orthostatic hypotension.

C. Anorexia and depression:

Anorexia (loss of appetite) and depression can occur as adverse effects of levodopa therapy. While they can affect the patient's overall well-being and quality of life, they are not directly associated with an increased risk of physical injury.

D. Tachycardia and palpitations:

Tachycardia (rapid heart rate) and palpitations are less common adverse effects of levodopa therapy. While they may indicate cardiovascular issues, they are not typically associated with a direct risk of physical injury.

A. Bradycardia, hypertension, and widening pulse pressure B. Widening pulse pressure, headache, and seizure C. Hypertension, tachycardia, and headache D. Hypotension, tachycardia, and narrowing pulse pressure

Correct Answer is A

Explanation

A. Bradycardia, hypertension, and widening pulse pressure

This combination of symptoms is characteristic of Cushing's triad. Bradycardia (slow heart rate), hypertension (elevated blood pressure), and widening pulse pressure (difference between systolic and diastolic blood pressure) are indicative of increased ICP, specifically resulting in the compression of brain structures that regulate vital functions.

B. Widening pulse pressure, headache, and seizure

While headache and seizure may occur in patients with increased ICP, widening pulse pressure alone is not sufficient to meet the criteria of Cushing's triad. The presence of bradycardia and hypertension, along with widening pulse pressure, is more indicative of Cushing's triad.

C. Hypertension, tachycardia, and headache

Hypertension and headache may occur in patients with increased ICP, but the absence of bradycardia and widening pulse pressure makes this option less characteristic of Cushing's triad.

D. Hypotension, tachycardia, and narrowing pulse pressure

Hypotension (low blood pressure) and narrowing pulse pressure are not typically associated with Cushing's triad. Tachycardia (rapid heart rate) may occur in response to increased ICP, but it is usually accompanied by bradycardia rather than hypotension.

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A nurse is caring for a client who has multiple sclerosis and reports a tightening feeling around their torso. Which of the following conditions should the nurse recognize this finding indicates?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which adverse effects associated with levodopa therapy would support the nursing diagnosis Risk for Injury?

Correct Answer is A

Explanation

Which three symptoms are characteristic of Cushing triad associated with increased ICP?

Correct Answer is A

Explanation

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