Chapter 46: PrepU - Nursing Management: Patients With Neurologic Disorders

A nurse is assessing a newly admitted client with meningitis. Which of the following findings in this client is most likely? 1- Negative Kernig's sign 2- Positive Brudzinski's sign 3- Increased intake 4- Hyper-alertness

2

A patient with epilepsy is having a seizure. Which of the following should the nurse do after the seizure? 1- Keep the patient to one side. 2- Place a cooling blanket beneath the patient. 3- Help the patient sit up. 4- Pry the patient's mouth open to allow a patent airway.

1

The critical care nurse is caring for a client with bacterial meningitis. The client has developed cerebral vasculitis and increased ICP. What neurologic sequelae might this client develop? 1- Damage to the optic nerve 2- Damage to the vagal nerve 3- Damage to the olfactory nerve 4- Damage to the facial nerve

1

A patient with Parkinson's disease is undergoing a swallowing assessment because she is experiencing difficulties when swallowing. What consistency is most appropriate for this patient, to reduce the risk of aspiration? 1- Solid food with thin liquids 2- Pureed food with water 3- Semisolid food with thick liquids 4- Thin liquids only

3

A client has been brought to the ED with altered LOC, high fever, and a purpura rash on the lower extremities. The family states the client was reporting neck stiffness earlier in the day. What action should the nurse do first? 1- Initiate isolation precautions. 2- Ensure the family receives prophylaxis antibiotic treatment. 3- Administer prescribed antibiotics. 4- Apply a cooling blanket.

1

The nurse is caring for a client diagnosed with Guillain-Barre syndrome. His spouse asks about recovery rates. The nurse can correctly relate which of the following? 1- Approximately 60% to 75% of clients recover completely. 2- Only a very small percentage (5% to 8%) of clients recover completely. 3- Usually 100% of clients recover completely. 4- No one with Guillain-Barre syndrome recovers completely.

1

A client with a traumatic brain injury is showing early signs of increasing intracranial pressure (ICP). While planning care for this client, what would be the priority expected outcome? 1- Attains desired fluid balance 2- Displays no signs or symptoms of infection 3- Maintains a patent airway 4- Demonstrates optimal cerebral tissue perfusion

3

Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of demyelination in the brain and spinal cord? 1- Parkinson disease 2- Huntington disease 3- Creutzfeldt-Jakob disease 4- Multiple sclerosis

4

At what rate (in drops per minute) should a nurse start an IV infusion if the order is for 1 g of vancomycin (Vancocin) to be given in 180 ml of dextrose 5% in water over 60 minutes? The tubing delivers 15 drops/ml. Enter the correct number only.

45

A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease? 1- Ambenonium (Mytelase) 2- Pyridostigmine (Mestinon) 3- Edrophonium (Tensilon) 4- Carbachol (Carboptic)

3

Myasthenia gravis occurs when antibodies attack which receptor sites? 1- Serotonin 2- Dopamine 3- Acetylcholine 4- GABA

3

A client with Parkinson's disease asks the nurse what their treatment is supposed to do since the disease is progressive. What would be the nurse's best response? 1- "Treatment aims at keeping you independent as long as possible." 2- "Treatment really doesn't matter; the disease is going to progress anyway." 3- "Treatment for Parkinson's is only palliative; it keeps you comfortable." 4- "Treatment aims at keeping you emotionally healthy by making you think you are doing something to fight this disease."

1

A patient is exhibiting bradykinesia, rigidity, and tremors related to Parkinson's disease. The nurse understands that these symptoms are directly related to what decreased neurotransmitter level? 1- Acetylcholine 2- Dopamine 3- Serotonin 4- Phenylalanine

2

Cerebral edema peaks at which time point after intracranial surgery? 1- 12 hours 2- 24 hours 3- 48 hours 4- 72 hours

2

The diagnosis of multiple sclerosis is based on which test? 1- CSF electrophoresis 2- Magnetic resonance imaging 3- Evoked potential studies 4- Neuropsychological testing

2

A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order: 1- electromyography (EMG). 2- Doppler scanning. 3- Doppler ultrasonography. 4- quantitative spectral phonoangiography.

1

A nurse is caring for a client with a history of severe migraines. The client has a medical history that includes asthma, gastroesophageal reflux disease, and three pregnancies. Which medication does the nurse anticipate the physician will order for the client's migraines? 1- Verapamil (Calan) 2- Metoprolol (Lopressor) 3- Amiodarone (Cordarone) 4- Captopril (Coreg)

1

A patient with generalized seizure disorder has just had a seizure. The nurse would assess for what characteristic associated with the postictal state? 1- Epileptic cry 2- Confusion 3- Urinary incontinence 4- Body rigidity

2

The nurse is educating a patient with a seizure disorder. What nutritional approach for seizure management would be beneficial for this patient? 1- Low in fat 2- Restricts protein to 10% of daily caloric intake 3- High in protein and low in carbohydrate 4- At least 50% carbohydrate

3

A client with Guillain-Barre syndrome cannot swallow and has a paralytic ileus; the nurse is administering parenteral nutrition intraveneously. The nurse is careful to assess which of the following related to intake of nutrients? 1- Gag reflex and bowel sounds 2- Condition of skin 3- Respiratory status 4- Urinary output and capillary refill

1

A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by: 1- a positive edrophonium (Tensilon) test. 2- Kernig's sign. 3- a positive sweat chloride test. 4- Brudzinski's sign.

1

The nurse is talking with the mother of a client who is diagnosed with a traumatic brain injury. The mother states that she has never seen the client lash out when frustrated or throw things across the room. Which instruction, made by the nurse, is most correct? 1- "The client may be experiencing a change in affect due to the brain injury." 2- "The client has demonstrated this behavior before and is now anticipated." 3- "The client has underlying aggression problems, which manifest in behavior." 4- "All traumatic brain injury clients act in this similar way."

1

When performing a postoperative assessment on a client who has undergone surgery to manage increased intracranial pressure (ICP), a nurse notes an ICP reading of 0 mm Hg. Which action should the nurse perform first? 1- Check the equipment. 2- Contact the physician to review the care plan. 3- Continue the assessment because no actions are indicated at this time. 4- Document the reading because it reflects that the treatment has been effective.

1

Which drug should be available to counteract the effect of edrophonium chloride? 1- Prednisone 2- Atropine 3- Azathioprine 4- Pyridostigmine bromide

2

A nurse is caring for a client with a brain tumor and increased intracranial pressure (ICP). Which intervention should the nurse include in the care plan to reduce ICP? 1- Encourage coughing and deep breathing. 2- Position the client with the head turned toward the side of the brain tumor. 3- Administer stool softeners. 4- Provide sensory stimulation.

3

A client is receiving intravenous (IV) mannitol to prevent increased intracranial pressure. The order is for mannitol 1.5 grams per kg of body weight IV now. The client weighs 143 lbs (65 kg). How many grams will the nurse administer to the client? Enter the correct number ONLY.

97.5

A client is diagnosed with meningococcal meningitis. The 22-year-old client shares an apartment with one other person. What would the nurse expect as appropriate care for the client's roommate? 1- Treatment with antimicrobial prophylaxis as soon as possible 2- Admission to the nearest hospital for observation 3- No treatment unless the roommate begins to show symptoms 4- Bedrest at home for 72 hours

1

A client's spouse relates how the client reported a severe headache, and shortly after was unable to talk or move their right arm and leg. The spouse indicates the client has hypertension. What should be the focus of management during this phase? 1- preventing further neurologic damage 2- reporting changes to the physician 3- destabilizing client's condition 4- assessing vital signs frequently

1

The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe? 1- Diplopia and ptosis 2- Numbness 3- Patchy blindness 4- Loss of proprioception

1

The parents of a client intubated due to the progression of Guillain-Barré syndrome ask whether their child will die. What is the best response by the nurse? 1- "Don't worry; your child will be fine." 2- "Once Guillain-Barré syndrome progresses to the diaphragm, survival decreases significantly." 3- "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive." 4- "It's too early to give a prognosis."

3

Cerebrospinal fluid (CSF) studies would indicate which of the following in a patient suspected of having meningitis? Select all that apply. 1- Decreased glucose 2- Increased protein 3- Increased white blood cells 4- Decreased protein 5- Increased glucose

1,2,3

The nurse is caring for a patient with an altered LOC. What is the first priority of treatment for this patient? 1- Assessment of pupillary light reflexes 2- Determination of the cause 3- Positioning to prevent complications 4- Maintenance of a patent airway

4

When caring for a client with trigeminal neuralgia, which intervention has the highest priority? 1- Providing emotional support while the client adjusts to changes in his physical appearance 2- Monitoring intake and output 3- Assisting with ambulation 4- Encouraging the client to bathe with care

4

A male client who has undergone a cervical discectomy is being discharged with a cervical collar. Which of the following would be most appropriate to include the client's discharge plan? 1- Keeping the head in a neutral position 2- Wearing the cervical collar when sleeping 3- Removing the entire collar when shaving 4- Moving the neck from side to side when the collar is off

1

A patient is being treated in hospital for St. Louis encephalitis. When planning this patient's care, the nurse should be aware that this specific variant of encephalitis creates a potential for what nursing diagnosis? 1- Excess fluid volume 2- Risk for deficient fluid volume 3- Imbalanced nutrition: less than body requirements 4- Risk for unstable blood glucose

1

Bell palsy is a disorder of which cranial nerve? 1- Trigeminal (V) 2- Vestibulocochlear (VIII) 3- Facial (VII) 4- Vagus (X)

3

Impaired balance and uncontrolled tremors of Parkinson's disease is correlated with which neurotransmitter? 1- Glutamate 2- Acetylcholine 3- Dopamine 4- Serotonin

3

The critical care nurse is caring for a client with bacterial meningitis. The client has developed cerebral vasculitis and increased ICP. What neurologic sequelae might this client develop? Damage to the optic nerve Damage to the vagal nerve Damage to the olfactory nerve Damage to the facial nerve

1

A nurse is caring for a client admitted to the unit with a seizure disorder. The client seems upset and asks the nurse, "What will they do to me? I'm scared of the tests and of what they'll find out." The nurse should focus her teaching plans on which diagnostic tests? Transesophageal echocardiogram (TEE), troponin levels, and a complete blood count 1- EEG, blood cultures, and neuroimaging studies 2- X-ray of the brain, bone marrow aspiration, and EEG 3- Electrocardiography, TEE, prothrombin time (PT), and International 4- Normalized Ratio (INR)

1

A client undergoes a craniotomy with supratentorial surgery to remove a brain tumor. On the first postoperative day, the nurse notes the absence of a bone flap at the operative site. How should the nurse position the client's head? 1- Flat 2- Turned onto the operative side 3- Elevated no more than 10 degrees 4- Elevated 30 degrees

4

The nurse is assessing a client with meningitis. Which of the following signs would the nurse expect to observe? 1- Headache and nuchal rigidity 2- Ptosis and diplopia 3- Hyporeflexia in the lower extremities 4- Numbness and vomiting

1

The nurse is caring for a patient postoperatively after intracranial surgery for the treatment of a subdural hematoma. The nurse observes an increase in the patient's blood pressure from the baseline and a decrease in the heart rate from 86 to 54. The patient has crackles in the bases of the lungs. What does the nurse suspect is occurring? 1- Increased ICP 2- Exacerbation of uncontrolled hypertension 3- Infection 4- Increase in cerebral perfusion pressure

1

Which of the following drugs may be used after a seizure to maintain a seizure-free state? 1- Valium 2- Phenobarbital 3- Ativan 4- Cerebyx

2

A patient has been admitted to the intensive care unit (ICU) for the treatment of bacterial meningitis. The ICU nurse is aware of the need for aggressive treatment and vigilant nursing care because meningitis has the potential to cause what sequela? 1- Hydrocephalus 2- Glioma 3- Increased intracranial pressure (ICP) 4- Cerebrovascular accident (CVA)

3

A new ancillary staff member is assisting the nurse with a client diagnosed with Parkinson's disease. The client needs assistance with eating but doesn't require thickened liquids to aid swallowing. Which instruction should the nurse give the ancillary staff member about eating assistance? 1- Make sure the client is sitting with the head of bed elevated to 90 degrees. 2- Assist the client into a comfortable position and stay alert for coughing, which signifies aspiration. 3- Clients with Parkinson's disease shouldn't have liquids; remove them from the dinner tray before serving food to the client. 4- There are no special precautions for the client with Parkinson's disease.

1

The nurse is assisting with administering a Tensilon test to a patient with ptosis. If the test is positive for myasthenia gravis, what outcome does the nurse know will occur? 1- Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes. 2- After administration of the medication, there will be no change in the status of the ptosis or facial weakness. 3- The patient will have recovery of symptoms for at least 24 hours after the administration of the Tensilon. 4- Eight hours after administration, the acetylcholinesterase begins to regenerate the available acetylcholine and will relieve symptoms.

1

Which nursing intervention is the priority for a client in myasthenic crisis? 1- Assessing respiratory effort 2- Administering intravenous immunoglobin (IVIG) per orders 3- Preparing for plasmapheresis 4- Ensuring adequate nutritional support

1

Which positions is used to help reduce intracranial pressure (ICP)? 1- Avoiding flexion of the neck with use of a cervical collar 2- Keeping the head flat, avoiding the use of a pillow 3- Rotating the neck to the far right with neck support 4- Extreme hip flexion, with the hip supported by pillows

1

A patient 3 days postoperative from a craniotomy informs the nurse, "I feel something trickling down the back of my throat and I taste something salty." What priority intervention does the nurse initiate? 1- Give the patient some mouthwash to gargle with. 2- Request an antihistamine for the postnasal drip. 3- Ask the patient to cough to observe the sputum color and consistency. 4- Notify the physician of a possible cerebrospinal fluid leak.

4

The causes of acquired seizures include what? (Mark all that apply.) 1- Cerebrovascular disease 2- Metabolic and toxic conditions 3- Hypernatremia 4- Brain tumor 5- Drug and alcohol withdrawal

1,2,4,5

The nurse is taking health history from a client admitted to rule out Guillain-Barre syndrome. An important question to ask related to the diagnosis is which of the following? 1- "Have you experienced any viral infections in the last month?" 2- "Have you experienced any ptosis in the last few weeks?" 3- "Have you had difficulty with urination in the last 6 weeks?" 4- "Have you developed any new allergies in the last year?"

1

An infusion of phenytoin (Dilantin) has been ordered for a patient whose brain tumor has just caused a seizure. The patient has been receiving D5W at 100 mL/hour to this point and has only one IV access site at this point. How should the nurse prepare to administer this drug to the patient? 1- Saline lock the patient's IV and wait 15 minutes before administering phenytoin. 2- Administer the drug orally due to the risk of precipitation. 3- Thoroughly flush the patient's IV with normal saline. 4- Mix the phenytoin in a 50 mL minibag of D5W.

3

During a Tensilon test to determine if a patient has myasthenia gravis, the patient complains of cramping and becomes diaphoretic. Vital signs are BP 130/78, HR 42, and respiration 18. What intervention should the nurse prepare to do? 1- Place the patient in the supine position. 2- Administer diphenhydramine (Benadryl) for the allergic reaction. 3- Administer atropine to control the side effects of edrophonium. 4- Call the rapid response team because the patient is preparing to arrest.

3

The nurse has been educating a client newly diagnosed with MS. Which statement by the client indicates an understanding of the education? 1- "I will take hot tub baths to decrease spasms." 2- "I should participate in non-weight-bearing exercises." 3- "I will stretch daily as directed by the physical therapist." 4- "The exercises should be completed quickly to reduce fatigue."

3

A client with fungal encephalitis receiving amphotericin B reports fever, chills, and body aches. The nurse knows that these symptoms 1- indicate renal toxicity and a worsening condition. 2- are primarily associated with infection with Coccidioides immitis and Aspergillus. 3- indicate the need for immediate blood and cerebral spinal fluid (CSF) cultures. 4- may be controlled by the administration of diphenhydramine and acetaminophen approximately 30 minutes before administration of the amphotericin.

4

Which of the following tests confirms the diagnosis of myasthenia gravis (MG)? 1- Tensilon test 2- Computed tomography (CT) scan 3- Electromyogram (EMG) 4- Serum studies

1

A client has been diagnosed with a frontal lobe brain abscess. Which nursing intervention is appropriate? 1- Assess for facial weakness. 2- Initiate seizure precautions. 3- Assess visual acuity. 4- Ensure that client takes nothing by mouth.

2

A 70-year-old woman is being treated at home for Parkinson's disease (PD), a health problem that she was diagnosed with 18 months ago. The nurse who is participating in the woman's care should be aware that her initial symptoms most likely consisted of: 1- Increasing forgetfulness and confusion 2- Tremors and muscle rigidity 3- Visual disturbances and muscle weakness 4- Fatigue and respiratory difficulties

2

A patient with amyotrophic lateral sclerosis (ALS) asks if the nurse has heard of a drug that will prolong the patient's life. The nurse knows that there is a medication that may prolong the life by 3 to 6 months. To which medication is the patient referring? 1- Baclofen 2- Riluzole 3- Dantrolene sodium 4- Diazepam

2

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding? 1- Dysphagia 2- Dysphonia 3- Hypokinesia 4- Micrographia

2

A client with newly diagnosed seizures asks about stigma associated with epilepsy. The nurse will respond with which of the following statements? 1- "In most people, epilepsy is usually synonymous with intellectual disability." 2- "For many people with epilepsy, the disorder is synonymous with mental illnes." 3- "Many people with developmental disabilities resulting from neurologic damage also have epilepsy." 4- "Cases of epilepsy are often associated intellectual level."

3

A patient with Parkinson's disease asks the nurse what can be done to prevent problems with bowel elimination. What would be an intervention that would assist this patient with a regular stool pattern? 1- Take psyllium (Metamucil) daily. 2- Take a laxative whenever bloating is experienced. 3- Adopt a diet with moderate fiber intake. 4- Adopt a high-fiber diet.

3

A nurse is teaching a client with multiple sclerosis (MS). When teaching the client how to reduce fatigue, the nurse should tell the client to: 1- take a hot bath. 2- rest in an air-conditioned room. 3- increase the dose of muscle relaxants. 4- avoid naps during the day.

2

The nurse is caring for a client with Guillain-Barré syndrome. Which assessment finding would indicate the need for oral suctioning? 1- Decreased pulse rate, respirations of 20 breaths/minute 2- Increased pulse rate, adventitious breath sounds 3- Increased pulse rate, respirations of 16 breaths/minute 4- Decreased pulse rate, abdominal breathing

2

Which client goal, established by the nurse, is most important as the nurse plans care for a seizure client in the home setting? 1- The client will take the seizure medication at the same time daily. 2- The client will remain free of injury if a seizure does occur. 3- The client will verbalize an understanding of feelings that preempt seizure activity. 4- The client will post emergency numbers on the refrigerator for ease of obtaining.

2

An older adult man has been diagnosed with Parkinson's disease and has begun treatment with levodopa and carbidopa. When providing health education about his new medication regimen, what should the nurse teach the man? 1- "If you're consistent with taking your medication, you might not experience symptoms for several more years." 2- "This medication can cure Parkinson's disease, but this is not necessarily the case for everyone." 3- "The beneficial effects of this medication usually increase over time, so you may not get maximum relief for a few years." 4- "This medication helps significantly but the benefits tend to decrease over time."

4

The nurse is taking care of a client with a history of headaches. The nurse takes measures to reduce headaches and administer medications. Which appropriate nursing interventions may be provided by the nurse to such a client? 1- Apply warm or cool cloths to the forehead or back of the neck 2- Maintain hydration by drinking eight glasses of fluid a day 3- Perform the Heimlich maneuver 4- Use pressure-relieving pads or a similar type of mattress

1

A male patient presents to the clinic complaining of a headache. The nurse notes that the patient is guarding his neck, and he tells the nurse that he has stiffness in the neck area. The nurse suspects the patient may have meningitis. What is another well-recognized sign of this infection? 1- Negative Brudzinski's sign 2- Positive Kernig's sign 3- Hyperpatellar reflex 4- Sluggish pupil reaction

2

Which condition is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain? 1- Multiple sclerosis 2- Creutzfeldt-Jakob disease 3- Parkinson disease 4- Huntington disease

2

Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem? 1- Parkinson disease 2- Amyotrophic lateral sclerosis 3- Alzheimer disease 4- Huntington disease

2

Which is the most common cause of acute encephalitis in the United States? 1- Western equine bacteria 2- Herpes simplex virus (HSV) 3- Lyme Disease 4- Human immunodeficiency virus (HIV)

2

Which is the primary medical management of arthropod-borne virus (arboviral) encephalitis? 1- Preventing renal insufficiency 2- Controlling seizures and increased intracranial pressure 3- Maintaining hemodynamic stability and adequate cardiac output 4- Preventing muscular atrophy

2

Which is a late sign of increased intracranial pressure (ICP)? 1- Irritability 2- Slow speech 3- Altered respiratory patterns 4- Headache

3

A client is brought to the emergency department in a confused state, with slurred speech, characteristics of a headache, and right facial droop. The vital signs reveal a blood pressure of 170/88 mm Hg, pulse of 92 beats/minute, and respirations at 24 breaths/minute. On which bodily system does the nurse focus the nursing assessment? 1- Cardiovascular system 2- Respiratory system 3- Endocrine system 4- Neurovascular system

4