Med Surge Exam #1

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? a.Dysphagia b.Dysphonia c.Hypokinesia d. Micrographia

b. Dysphonia

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? a.Ambenonium (Mytelase) b.Pyridostigmine (Mestinon) c.Edrophonium (Tensilon) d.Carbachol (Carboptic)

c.Edrophonium (Tensilon)

The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease? a. Drugs administered may not cause the requisite therapeutic effect. b.Clients take an assortment of different drugs. c.Clients generally do not adhere to the drug regimen. d.Drugs administered may cause a wide variety of adverse effects.

d. Drugs administered may cause a wide variety of adverse effects

In myasthenia gravis (MG), there is a decrease in the number of receptor sites of which neurotransmitter? a.Acetylcholine b.Epinephrine c.Norepinephrine d.Dopamine

a.Acetylcholine

The nurse reviews the patient's drug regimen for treatment of a brain tumor. She explains to the patient why one of the following drugs would not be prescribed, even though it might have therapeutic benefits. Which drug would not be prescribed for this patient? a.Paclitaxel b.Coumadin c.Decadron d.Dilantin

b.Coumadin

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: a.take a hot bath. b.rest in an air-conditioned room. c.increase the dose of muscle relaxants. d.avoid naps during the day.

b.rest in an air-conditioned room.

Bell palsy is a disorder of which cranial nerve? a.Trigeminal (V) b.Vestibulocochlear (VIII) c.Facial (VII) d.Vagus (X)

c.Facial (VII)

A client with a neurologic deficit is feeling frustrated because it is very difficult to pronounce words since having a stroke. The client is struggling with: a.dysphasia. b.ataxia. c.dysarthria. d.dysphagia.

c.dysarthria.

The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease? a.Drugs administered may not cause the requisite therapeutic effect. b.Clients take an assortment of different drugs. c.Clients generally do not adhere to the drug regimen. d.Drugs administered may cause a wide variety of adverse effects.

d.Drugs administered may cause a wide variety of adverse effects.

The nurse is performing an initial assessment on a client with suspected Bell's palsy. Which of the following findings would the nurse be most focused on related to this medical diagnosis? a. Facial distortion and pain b. Hyporeflexia and weakness of the lower extremities c.Ptosis and diplopia d.Fatigue and depression

a. Facial distortion and pain

Which nursing intervention is the priority for a client in myasthenic crisis? a.Assessing respiratory effort b.Administering intravenous immunoglobin (IVIG) per orders c.Preparing for plasmapheresis d.Ensuring adequate nutritional support

a.Assessing respiratory effort

Guillain-Barré syndrome is an autoimmune attack on the peripheral myelin sheath. Which of the following is an action of myelin? a.Speeds nerve impulse transmission b.Carries message to the next nerve cell c.Represents building block of nervous system d.Acts as chemical messenger

a.Speeds nerve impulse transmission

The nurse is caring for a client admitted with a diagnosis of septic meningitis. The nurse is aware that this infection is caused by which of the following? a.Bacteria b.Virus c.Lymphoma d.Leukemia

a.Bacteria

A client is undergoing testing to confirm a diagnosis of myasthenia gravis. The nurse explains that a diagnosis is made if muscle function improves after the client receives an IV injection of a medication. What is the medication the nurse tells the client he'll receive during this test? a.Cyclosporine (Sandimmune) b.Edrophonium (Tensilon) c.Immunoglobulin G (Iveegam EN) d.Azathioprine (Imuran)

b.Edrophonium (Tensilon)

While caring for clients who have suffered neurologic deficits from causes such as cerebrovascular accident and closed head injury, an important nursing goal that motivates nurses to offer the best care possible is preventing: a. falls. b.choking. c.complications. d.infection.

c.complications.

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? a."Have you experienced any viral infections in the last month?" b."Have you experienced any ptosis in the last few weeks?" c."Have you had difficulty with urination in the last 6 weeks?" d."Have you developed any new allergies in the last year?"

a."Have you experienced any viral infections in the last month?"

A client has a neurological defect and will be transferred to a nursing home because family members are unable to care for the client at home. While receiving a bed bath, the client yells at the nurse, "You don't know what you are doing!" What is the best reaction by the nurse? a.Accept the patient's behavior and do not take it personally. b.Request that the patient be cared for by another nurse. c.Discontinue the bath and resume it later. d.Explain that the client is getting good care.

a.Accept the patient's behavior and do not take it personally.

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

b.Increased pulse rate, adventitious breath sounds

A patient with Bell's palsy says to the nurse, "It doesn't hurt anymore to touch my face. How am I going to get muscle tone back so I don't look like this anymore?" What interventions can the nurse suggest to the patient? a.Suggest applying cool compresses on the face several times a day to tighten the muscles. b.Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone. c.Inform the patient that the muscle function will return as soon as the virus dissipates. d.Tell the patient to smile every 4 hours.

b.Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone.

A client is experiencing muscle weakness and an ataxic gait. The client has a diagnosis of multiple sclerosis (MS). Based on these symptoms, the nurse formulates "Impaired physical mobility" as one of the nursing diagnoses applicable to the client. What nursing intervention should be most appropriate to address the nursing diagnosis? a.Use pressure-relieving devices when the client is in bed or in a wheelchair. b.Change body position every 2 hours. c.Help the client perform range-of-motion (ROM) exercises every 8 hours. d.Use a footboard and trochanter rolls.

c.Help the client perform range-of-motion (ROM) exercises every 8 hours.

The nursing instructor gives their students an assignment of making a plan of care for a client with Huntington's disease. What would be important for the students to include in the teaching portion of the care plan? a.How to exercise b.How to perform household tasks c. How to take a bath d. How to facilitate tasks such as using both hands to hold a drinking glass

d. How to facilitate tasks such as using both hands to hold a drinking glass

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? a.Place the patient in the supine position. b.Administer diphenhydramine (Benadryl) for the allergic reaction. c.Administer atropine to control the side effects of edrophonium. d.Call the rapid response team because the patient is preparing to arrest.

c.Administer atropine to control the side effects of edrophonium.

Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of demyelination in the brain and spinal cord? a.b.Parkinson disease b.Huntington disease c.Creutzfeldt-Jakob disease d.Multiple sclerosis

d.Multiple sclerosis

Myasthenia gravis occurs when antibodies attack which receptor sites? a.Serotonin b.Dopamine c.Acetylcholine d.Gamma-aminobutyric acid

c.Acetylcholine

A client with myasthenia gravis is admitted with an exacerbation. The nurse is educating the client about plasmapheresis and explains this in which of the following statements? a.Antibodies are removed from the plasma. b.The thymus gland is removed. c.Immune globulin is given intravenously. d.Mestinon therapy is initiated.

a.Antibodies are removed from the plasma.

The nurse is caring for a patient with Huntington's disease in the long-term care facility. What does the nurse recognize as the most prominent symptom of the disease that the patient exhibits? a.Rapid, jerky, involuntary movements b.Slow, shuffling gait c.Dysphagia and dysphonia d.Dementia

a.Rapid, jerky, involuntary movements

A client who recently experienced a stroke tells the nurse that he has double vision. Which nursing intervention is most appropriate? a.Encourage the client to close his eyes. b.Alternatively patch one eye every 2 hours. c.Turn out the lights in the room. d.Instill artificial tears.

b.Alternatively patch one eye every 2 hours.

The nurse is caring for a patient with GBS in the intensive care unit and is assessing the patient for autonomic dysfunction. What interventions should be provided in order to determine the presence of autonomic dysfunction? a.Assess the respiratory rate and oxygen saturation. b.Assess the blood pressure and heart rate. c.Assess the peripheral pulses. d.Listen to the bowel sounds.

b.Assess the blood pressure and heart rate.

A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond? a."You should ask your physician about that." b. "The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight disability." c."You may experience progressive deterioration in all voluntary muscles." d."This form of muscular dystrophy is a relatively benign disease that progresses slowly."

c."You may experience progressive deterioration in all voluntary muscles."

A client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond? a."The paralysis caused by this disease is temporary." b."You'll be permanently paralyzed; however, you won't have any sensory loss." c."It must be hard to accept the permanency of your paralysis." d."You'll first regain use of your legs and then your arms."

a."The paralysis caused by this disease is temporary."

Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem? Parkinson disease a.Amyotrophic lateral sclerosis b. Alzheimer disease c. Huntington disease d.Parkinson's disease

a. Amyotrophic lateral sclerosis

A client is diagnosed with a brain angioma. When teaching the client about the risks associated with this type of brain tumor, the nurse would educate about signs and symptoms associated with which condition? a. Hemorrhagic stroke b. Thyroid disorders c. Hearing loss d. Visual loss

a. Hemorrhagic stroke

The nurse is performing an initial nursing assessment on a client with possible Guillain-Barre syndrome. Which of the following findings would be most consistent with this diagnosis? a. Muscle weakness and hyporeflexia of the lower extremities b.Fever and cough c. Hyporeflexia and skin rash d.Ptosis and muscle weakness of upper extremities

a. Muscle weakness and hyporeflexia of the lower extremities

A neurologic deficit is best defined as a deficit of the: a.central and peripheral nervous systems with decreased, impaired, or absent functioning. b.central nervous system that affects one body system. c.central nervous system with absent functioning. d.peripheral nervous system with decreased or impaired functioning.

a.central and peripheral nervous systems with decreased, impaired, or absent functioning.

The nurse is aware that, when assessing a patient for symptoms of a brain tumor, the symptom most frequently found is: a. Sharp, unrelenting headaches. b. Simple to generalized seizures. c.Vertigo and fainting. d.Unilateral loss of motor coordination.

b. Simple to generalized seizures.

The nurse is caring for a client with tetraplegia following a motor vehicle accident. A family member of the client states, "I know there is grief associated with the loss of independence, but how do I help my loved one to move past that?" The nurse is most helpful to say which of the following? a."There is nothing you can do. It must come from the client." b."Grief is a normal process. Let's discuss offering support throughout the process." c."Ask your loved one what you can do and decorate the room to elevate mood." d."Provide comfort foods, which expresses your love and support."

b."Grief is a normal process. Let's discuss offering support throughout the process."

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? a."Don't worry; your child will be fine." b."Once Guillain-Barré syndrome progresses to the diaphragm, survival decreases significantly." c."There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive." d."It's too early to give a prognosis."

c."There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive."

A patient diagnosed with MS 2 years ago has been admitted to the hospital with another relapse. The previous relapse was followed by a complete recovery with the exception of occasional vertigo. What type of MS does the nurse recognize this patient most likely has? a.Benign b.Primary progressive c.Relapsing-remitting (RR) d.Disabling

c.Relapsing-remitting (RR)

The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe? a.Numbness b.Patchy blindness c.Loss of proprioception d.Diplopia and ptosis

d.Diplopia and ptosis

The nurse identifies a nursing diagnosis of imbalanced nutrition, less than body requirements related to difficulty in chewing and swallowing for a client with Parkinson's disease. Which of the following would be most appropriate for the nurse to integrate into the client's plan of care? a.Raise the head of the client's bed about 30 degrees during meals. b.Encourage the use of liquids that are thin in consistency. c.Arrange for specialized utensils for the client to use when eating. d.Encourage the client to massage the facial and neck muscles before eating.

d.Encourage the client to massage the facial and neck muscles before eating.

A nurse is teaching a client who has facial muscle weakness and has recently been diagnosed with myasthenia gravis. The nurse should teach the client that myasthenia gravis is caused by: a.genetic dysfunction. b.upper and lower motor neuron lesions. c.decreased conduction of impulses in an upper motor neuron lesion. d.a lower motor neuron lesion.

d.a lower motor neuron lesion.