complex questions

a patient presents with a Bell's palsy--what cranial nerve is affected?

Cranial Nerve VII

Pyridostigmine bromide (Mestinon) is the first line therapy for the treatment of MG? (TRUE OR FALSE)

True

The nurse is advising a patient with multiple sclerosis on methods to minimize spasticity and contractures. Which techniques would the nurse instruct the patient to perform? a. Apply warm packs to the affected area b. Relax in a hot tub c. Exercise following a circuit training regimen d. Avoid swimming and any weight bearing exercises

a. Apply warm packs to the affected area

The nurse is caring for a patient diagnosed with Guillain-Barre syndrome. The spouse asks about recovery rates. The nurse can correctly relate which information? a. Approximately 60-70% of patients recover completely b. Only a very small percentage 5-8% of patients recover completely c. Usually 100% of patients recover completely d. No one with Guillain-Barre syndrome recovers completely

a. Approximately 60-70% of patients recover completely

A patient with traumatic brain injury is leaking clear fluid from the nose. What action should the nurse take? a. Collecting the fluid with gauze b. Applying pressure over bridge of the nose c. Suctioning the nares d. Inserting a nasal pack in the nostril to block the leak

a. Collecting the fluid with gauze (want CSF to drain out --no PRESSURE)

In monitoring a patient recovering from a craniotomy for treatment of a brain tumor, which assessment findings require the nurse to notify the surgeon? Select all that apply. (worried about increase in intracranial pressure) a. Heart rate 52 bpm b. Temperature 99.2 c. Respiratory rate 10 and irregular d. Urine output 200 mL over 4 hrs e. Systolic blood pressure 198 mm Hg

a. Heart rate 52 bpm (decrease HR) c. Respiratory rate 10 and irregular e. Systolic blood pressure 198 mm Hg d. normal post op

Which are the most commonly reported clinical manifestations of multiple sclerosis? Select all that apply. a. Pain b. Fatigue c. Spasticity d. Aphasia e. Depression f. Numbness

a. Pain b. Fatigue c. Spasticity e. Depression f. Numbness aphasia is stroke

A patient is demonstrating a sign of increasing ICP. which nursing actions are indicated to decrease ICP? Select all that apply. a. Placing the head in a neutral position b. Turn the patient to the left side (wont help) c. Raise the head of the bed 45 degrees d. Elevating the foot of the bed 30 degrees e. Placing the patient supine with a pillow under the head

a. Placing the head in a neutral position (promotes venous outflow) c. Raise the head of the bed 45 degrees (increase outflow) b . wont help d. (increase intraabdominal flow causing increased ICP)

The nurse is assessing a patient newly diagnosed with myasthenia gravis. Which signs would the nurse most likely observe? a. Ptosis b. Blurred vision c. Tinnitus d. Patchy blindness

a. Ptosis

A 48 year old patient had had multiple sclerosis for 15 years, and is receiving interferon injections. What is the purpose of interferon injections? a. To modify the immune response by suppressing antibody production and cellular immunity b. To give rise to numerous cell types able to form tissues in three germ layers c. To complement receptors and, as a result, play an important role in the clearance of antigens d. To complement components, prostaglandins, leukotrienes, and other inflammatory mediators

a. To modify the immune response by suppressing antibody production and cellular immunity

in myasthenia gravis, there is a reduction of ________ receptor sites

acetylcholine

The nurse is preparing the patient for an acetylcholinesterase inhibitor test to rule out myasthenia gravis. What is the priority nursing action? a. Assess facial weakness 5 minutes after injection b. Ensure atropine is readily available c. Administer edrophonium chloride per orders d. Document the results

b. Ensure atropine is readily available (issue with test is reaction cholinergic crisis -- Boulbar weakness- difficultly swallowing)

Dexamethasone (Decadron) 10 mg IVP now and repeat in 4 hours The nurse correlates which clinical manifestations to autonomic dysrelexia in a patient with a spinal cord injury? a. Hypertension with tachycardia b. Hypertension with bradycardia c. Hypotension with bradycardia d. Hypotension with tachycardia

b. Hypertension with bradycardia (hr trying to decrease BP) (causes bladder distention, stretch receptors)

In assessing a patient with increased intracranial pressure, the nurse notes that the patient's left pupil is larger than the right pupil. The nurse correlates the larger left pupil to compression of which cranial nerve? a. Left optic nerve b. Left oculomotor nerve c. Right optic nerve d. Right oculomotor nerve

b. Left oculomotor nerve --controls pupil constriction/dilation

Which disorder is related to damage to the central nervous system (CNS)? a. Myasthenia gravis b. Multiple sclerosis c. Guillain-barre d. Bell's palsy

b. Multiple sclerosis

In monitoring a patient with increased intracranial pressure who is mechanically ventilated, the nurse correlates which arterial blood gas value to effective management of the increased ICP? a. pH 7.32 b. PaCO2 35 mm Hg c. PaCO2 32 mm Hg d. HCO3 22 mEq/L

b. PaCO2 35 mm Hg c. PaCO2 32 mm Hg PaCO2 Want to be on low < 32 causes vasoconstriction (paCO248 --vasodilation causes increased ICP)

A patient diagnosed with myasthenia gravis has been hospitalized to receive therapeutic plasma exchange (TPE) (removing antibodies) for a myasthenic exacerbation. The nurse should anticipate what therapeutic response? a. Permanent improvement after 4-6 months of treatment b. Symptom improvement that lasts a few weeks after TPE cease c. Permanent improvement after 60--90 treatments d. Gradual improvement over several months

b. Symptom improvement that lasts a few weeks after TPE cease

A 30 year old was diagnosed with amyotrophic lateral sclerosis (ALS). Which statement by the patient would indicate a need for more teaching from the nurse? a. "I will have progressive muscle weakness." b. "I will lose strength in my arms." c. "My children are at greatest risk to develop this disease." d. "I need to remain active for as long as possible."

c. "My children are at greatest risk to develop this disease."

In monitoring a trauma patient for shock, the nurse differentiates neurogenic shock from hypovolemic shock by correlating which parameters to neurogenic shock? (peripheral vasodilation) a. Tachycardia with increased afterload b. Tachycardia with decreased afterload c. Bradycardia with decreased afterload d. Bradycardia with increased afterload

c. Bradycardia with decreased afterload (**bradycardia with neuro shock)

The nurse correlates which clinical manifestation in the patient diagnosed with a basilar skull fracture? a. Hyperthermia b. Episodic tachycardia c. Cerebrospinal leak d. Rapid neurological deterioration

c. Cerebrospinal leak --leaking out can cause infection

A patient is diagnosed with amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). The nurse understands that the symptoms of the disease will begin in what way? a. Ascending paralysis (GB) b. Numbness and tingling in the lower extremities c. Weakness starting in the muscles supplied by the cranial nerves d. Jerky, uncontrolled movements in the extremities

c. Weakness starting in the muscles supplied by the cranial nerves

what condition should the nurse assess for if a patient gave themselves too much of their anti-cholinesterase meds?

cholinergic crisis

The nurse is reviewing orders written for a patient with a new spinal cord injury. Which order does the nurse question? a. Place on an air mattress b. Insert a nasogastric tube and attach to low intermittent suction c. Insert indwelling urinary catheter, strict intake and output d. Dexamethasone (Decadron) 10 mg IVP now and repeat in 4 hours

d. Dexamethasone (Decadron) 10 mg IVP now and repeat in 4 hours

The latest blood pressure reading for a patient with a spinal cord injury is 210/140 mmHg. What action should the nurse take first? a. Palpating the bladder for distention b. Assessing for a bowel impaction c. Remeasuring the blood pressure d. Raising the head of the bed 45 degree

d. Raising the head of the bed 45 degree (to increase venous pooling lower extremities to lower BP)

multiple sclerosis is an immune-mediated progressive _____ disease of the CNS

demyelinization

_____ is the inflammation of the protective mechanism covering the brain and the spinal cord

meningitis

An MS patient presents with ptosis and diplopia. what cranial nerves are affected?

oculomotor (CN III) abducens (CN VI)