The nurse is reviewing the record for a client seen in the health care clinic and notes that the health care provider has documented a diagnosis of amyotrophic lateral sclerosis (ALS). Which initial clinical manifestation of this disorder should the nurse expect to see documented in the record?

mild clumsiness

altered mental status

muscle wasting

diminished gag reflex

Answer and Explanation

The Correct Answer is A

A. Mild clumsiness, such as difficulty with fine motor tasks (e.g., buttoning a shirt or writing), is often an early sign of ALS, reflecting initial weakness and muscle dysfunction.
B. ALS typically does not affect mental status in the early stages; cognitive functions remain intact in most patients.
C. Muscle wasting occurs as the disease progresses, but it is not usually the first sign.
D. A diminished gag reflex may develop later in the disease as bulbar involvement increases, but it is not an initial manifestation.

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Correct Answer is B

Explanation

A.Postural hypotension is more commonly associated with autonomic dysfunction (e.g., in Parkinson’s disease or dehydration) and is not a hallmark sign of myasthenia gravis.

B.Diplopia (double vision) is a classic symptom of myasthenia gravis. The disease causes weakness of voluntary muscles, especially those that control eye and eyelid movement, leading to visual disturbances.

C.Dizziness with sudden head movement is often linked to vestibular dysfunction (e.g., benign paroxysmal positional vertigo), not myasthenia gravis.

D.Hand tremors during voluntary movement are more suggestive of cerebellar disorders or essential tremor, not myasthenia gravis, which primarily causes muscle weakness without tremors.

A. Sleeping with two pillows under the head B. Taking a warm tub bath the evening before bed C. Applying moist heat packs upon awakening D. Wearing splints at night to prevent extension contractures

Correct Answer is C

Explanation

A. Sleeping with two pillows under the head may not specifically relieve joint stiffness or discomfort.
B. Taking a warm bath the evening before may help relax muscles but does not directly address morning stiffness.
C. Applying moist heat in the morning helps relax stiff joints and muscles, reducing discomfort common with rheumatoid arthritis.
D. Wearing splints at night is more useful for preventing flexion contractures rather than relieving morning discomfort.

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The nurse is reviewing the record for a client seen in the health care clinic and notes that the health care provider has documented a diagnosis of amyotrophic lateral sclerosis (ALS). Which initial clinical manifestation of this disorder should the nurse expect to see documented in the record?

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