Review Practice Exercise 2

Multiple Sclerosis, ALS, and Myasthenia Gravis > Adult Health

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Practice Exercise 2

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Total Questions : 5

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Question 1:

A nurse is caring for a client with Amyotrophic Lateral Sclerosis (ALS) who has developed dysphagia. Which of the following nursing interventions is most appropriate to ensure the client's safety and nutritional intake?

A. Encourage the client to eat a solid, high-fiber diet to maintain bowel regularity. B. Position the client with the head tilted back during meals to facilitate swallowing. C. Consult with a speech-language pathologist to develop a swallowing plan and recommend thickened liquids. D. Provide a straw with all beverages to make drinking easier.

Answer and Explanation

Choice A:

Encourage a solid, high-fiber diet: Solid foods may be difficult to swallow and increase aspiration risk; diet should be modified to match the client’s swallowing ability.

Choice B:

Position with head tilted back: Tilting the head back actually increases the risk of aspiration; safer positions may include chin-tuck, as recommended by an SLP.

Choice C:

Consult with a speech-language pathologist: The SLP provides individualized assessment and interventions, including recommending thickened liquids, altering food textures, and teaching posture or swallowing techniques to improve safety during eating.

Choice D:

Provide a straw with all beverages: Using a straw can worsen aspiration risk in dysphagic patients unless specifically approved by the SLP.

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Question 2:

A patient with advanced ALS is having difficulty swallowing and frequently chokes while eating. The nurse should anticipate which of the following interventions?

A. Initiating a pureed diet. B. Inserting a nasogastric tube for feeding. C. Referring the patient for a percutaneous endoscopic gastrostomy (PEG) tube placement. D. Encouraging the patient to continue eating as long as possible to maintain muscle strength.

Answer and Explanation

Choice A:

Initiating a pureed diet: While a texture-modified diet may be used in early dysphagia, frequent choking indicates a higher aspiration risk requiring more definitive intervention.

Choice B:

Inserting a nasogastric tube for feeding: NG tubes are typically for short-term use and can be uncomfortable, with higher risk of dislodgement; they are not ideal for long-term ALS management.

Choice C:

Referring the patient for a percutaneous endoscopic gastrostomy (PEG) tube placement: PEG placement ensures nutritional support while minimizing aspiration risk. It is preferred for long-term feeding in ALS patients with progressive dysphagia.

Choice D:

Encouraging the patient to continue eating as long as possible to maintain muscle strength: This approach ignores the significant aspiration risk and could lead to pneumonia or respiratory distress.

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Question 3:

The nurse is assessing a patient with a suspected diagnosis of ALS. Which of the following findings would be consistent with the disease? Select all that apply

A. Increased deep tendon reflexes. B. Presence of spasticity. C. Symmetric muscle weakness in all four limbs. D. Intention tremor. E. Preserved eye movement and bladder function.

Answer and Explanation

Choice A:

Increased deep tendon reflexes: Indicates upper motor neuron involvement, a hallmark feature of ALS.

Choice B:

Presence of spasticity: Another sign of upper motor neuron damage, leading to stiffness and resistance to movement.

Choice C:

Symmetric muscle weakness in all four limbs: Weakness in ALS often starts in one limb or region and then spreads; early symmetry is uncommon.

Choice D:

Intention tremor: This is associated with cerebellar disorders such as multiple sclerosis, not ALS.

Choice E:

Preserved eye movement and bladder function: ALS usually spares extraocular muscles and bladder control, differentiating it from other neurological disorders.

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Question 4:

Which of the following statements about Amyotrophic Lateral Sclerosis (ALS) are correct? Select all that apply

A. ALS primarily affects the sensory neurons, leading to a loss of sensation. B. The disease is characterized by the degeneration of both upper and lower motor neurons. C. Early symptoms often include muscle cramps and fasciculations. D. Patients with ALS typically experience a rapid loss of cognitive function. E. The most common cause of death in ALS patients is respiratory failure.

Answer and Explanation

Choice A:

ALS primarily affects the sensory neurons, leading to a loss of sensation: Sensory function is typically intact in ALS, as the disease targets motor neurons.

Choice B:

The disease is characterized by the degeneration of both upper and lower motor neurons: This explains the combination of hyperreflexia, spasticity, and muscle wasting seen in ALS.

Choice C:

Early symptoms often include muscle cramps and fasciculations: These result from irritation of damaged motor neurons and are often among the first signs.

Choice D:

Patients with ALS typically experience a rapid loss of cognitive function: Cognitive decline is not a defining feature of ALS; most patients remain mentally alert.

Choice E:

The most common cause of death in ALS patients is respiratory failure: Progressive weakness of the diaphragm and intercostal muscles leads to inadequate ventilation.

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Question 5:

When planning care for a patient with ALS, what is the most important long-term goal for the nurse to focus on?

A. Helping the patient maintain a positive attitude toward their diagnosis. B. Maximizing the patient's functional abilities and quality of life for as long as possible. C. Preventing the patient from developing aspiration pneumonia. D. Ensuring the patient remains pain-free throughout the disease process.

Answer and Explanation

Choice A:

Helping the patient maintain a positive attitude toward their diagnosis: Emotional support is important, but it is one component of the larger aim to preserve quality of life.

Choice B:

Maximizing the patient's functional abilities and quality of life for as long as possible: This holistic goal guides all aspects of ALS care, from physical therapy to respiratory management and psychosocial support.

Choice C:

Preventing the patient from developing aspiration pneumonia: This is a critical short-term objective, but it is a specific complication-prevention goal, not the overarching long-term focus.

Choice D:

Ensuring the patient remains pain-free throughout the disease process: Pain management is essential for comfort but does not address the full scope of the disease’s impact.

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Practice Exercise 2

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