Neuro Practice test

Select all the signs and symptoms below that can present in myasthenia gravis:* A. Respiratory failure B. Increased salivation C. Diplopia D. Ptosis E. Slurred speech F. Restlessness G. Mask-like appearance of looking sleepy H. Difficulty swallowing

A, C, D, E, F (restlessness from hypoxia, which is experienced with respiratory failure), G, and H.

The parents of a 4-year-old child with cerebral palsy have brought him in for a routine physical exam. The parents ask the nurse about vaccinations for their child and if the child should get the annual flu shot. Which response from the nurse is correct? a. You should avoid giving him the flu shot. Instead, keep him indoors and practice good hand hygiene b. He should get the flu shot because he can have worse symptoms from influenza compared to another child c. He should not get the flu shot because he is too high risk from his medical condition d. He should get the flu shot because there is a chance of death from influenza infection

A. Neurological disorders can worsen the symptoms of influenza. A client with a stable neurological disorder like controlled seizures or cerebral palsy should still be counseled to receive the flu shot. A stable neurological condition is not a contraindication for the flu vaccine. he client with CP benefits from the flu vaccine. There is a chance of increased complications for a child with cerebral palsy if the child contracts influenza, but saying the word 'death' to the parents would cause alarm and should be avoided.

You're preparing to help the neurologist with conducting a Tensilon test. Which antidote will you have on hand in case of an emergency?* A. Atropine B. Protamine sulfate C. Narcan D. Leucovorin

A. Atropine will help reverse the effects of the drug given during a Tensilon test, which is Edrophonium, in case an emergency arises. Edrophonium is a short-acting cholinergic drug, while atropine is an anticholinergic.

A nurse is caring for a client newly diagnosed with myasthenia gravis; understand that teaching has been effective when the patient states _______. Select all that apply a. My immune system is attacking my healthy tissues b. Prednisone and immunosuppressant are helping cure my disease c. My condition may cause life-threatening breathing problems called myasthenia crisis d. I am now at high risk of developing rheumatoid arthritis e. Heat exposure will help relax my muscles and decrease the symptoms

ACD As previously stated, myasthenia gravis is an autoimmune, neuromuscular disorder wherein the body attacks itself by targeting the acetylcholine receptors. Unfortunately, there is no cure for myasthenia gravis. The symptoms, however, are treatable with drugs like Prednisone, a steroid that brings down inflammation and reduces stress exerted on the immune system, causing it to calm down and stop attacking the receptors. Immunosuppressants also help in decreasing the immune response that leads to less attacking. Myasthenia gravis can cause life-threatening breathing problems because of muscle weakness. Taking in deep breaths require a lot of muscle movement; therefore, having MG can severely affect this action. his needs a bit of explaining. But this one's simple. So, when you think about rheumatoid arthritis (RA), it's the same immune response but, instead of the body attacking the neurons, it's striking the joints where your cartilages are located. The attack on the cartilages can cause inflammation or puffiness; therefore, prednisone and immunosuppressants are administered to decrease swelling and inflammation. Because of that, there is a possibility that when a patient has MG, he or she can also develop RA. Heavy sunlight, rigorous activities, exposure to indisposed people, getting the flu, over-exercising, and any tiring activity will stress out the immune system. So when a person gets exposed to heat, the immune system gets stressed out because it will prompt the need to defend itself.

Myasthenia gravis occurs when antibodies attack the __________ receptors at the neuromuscular junction leading to ____________.* A. metabotropic; muscle weakness B. nicotinic acetylcholine; muscle weakness C. dopaminergic adrenergic; muscle contraction D. nicotinic adrenergic; muscle contraction

B. In myasthenia gravis, either the nicotinic acetylcholine receptors are attacked by antibodies created by the immune system (hence why this disease is considered autoimmune) or antibodies are inhibiting the function of muscle-specific kinase (which is a receptor tyrosine kinase that helps with maintaining and building the neuromuscular junction). Either way this leads to the neurotransmitter acetylcholine from being able to communicate with the muscle fiber to make it contract.

You're a home health nurse providing care to a patient with myasthenia gravis. Today you plan on helping the patient with bathing and exercising. When would be the best time to visit the patient to help these tasks?* A. Mid-afternoon B. Morning C. Evening D. Before bedtime

B. Patients with MG tend to have the best muscle strength in the morning after sleeping or resting rather than at the end of the day....the muscles are tired from being used and the muscle become weaker as the day progresses etc. Therefore any rigorous activities are best performed in the morning or after the patient has rested.

You're providing teaching to a group of patients with myasthenia gravis. Which of the following is not a treatment option for this condition?* A. Plasmapheresis B. Cholinesterase medications C. Thymectomy D. Corticosteroids

B. These medications are not used to treat MG, but ANTIcholinesterase medications (like Pyridostigmine) are used to treat this condition.

Which meal option would be the most appropriate for a patient with myasthenia gravis?* A. Roasted potatoes and cubed steak B. Hamburger with baked fries C. Clam chowder with mashed potatoes D. Fresh veggie tray with sliced cheese cubes

C. Patients with MG have weak muscles and this can include the muscles that are used for chewing and swallowing. The patient should choose meal options that require the least amount of chewing and that are easy to swallow. Option C is a thick type of soup and the mashed potatoes are soft....both are very easy to eat and swallow compared to the other options.

A patient with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take Pyridostigmine. At what time should you administer this medication so the patient will have the maximum benefit of this medication? A. As soon as possible B. 1 hour after the patient has eaten (at 1300) C. 1 hour before the patient eats (at 1100) D. at 1200 right before the patient eats

C. Pyridostigmine is an anticholinesterase medication that will help improve muscle strength. It is important the patient has maximum muscle strength while eating for the chewing and swallowing process. Therefore, the medication should be given 1 hour before the patient eats because this medication peaks (has the maximum effect) at approximately 1 hour after administration. How does the medication improve muscle strength? It does this by preventing the breakdown of acetylcholine. Remember the nicotinic acetylcholine receptors are damaged and the patient needs as much acetylcholine as possible to prevent muscle weakness. Therefore, this medication will allow more acetylcholine to be used...hence improving muscle strength.

You're educating a patient about the pathophysiology of myasthenia gravis. While explaining the involvement of the thymus gland, the patient asks you where the thymus gland is located. You state it is located?* A. behind the thyroid gland B. within the adrenal glands C. behind the sternum in between the lungs D. anterior to the hypothalamus

C. The thymus is located anteriorly in the upper part of the chest behind the sternum in between the lungs.

The neurologist is conducting a Tensilon test (Edrophonium) at the bedside of a patient who is experiencing unexplained muscle weakness, double vision, difficulty breathing, and ptosis. Which findings after the administration of Edrophonium would represent the patient has myasthenia gravis? A. The patient experiences worsening of the muscle weakness. B. The patient experiences wheezing along with facial flushing. C. The patient reports a tingling sensation in the eyelids and sudden ringing in the ears. D. The patient experiences improved muscle strength.

D. During a Tensilon test Edrophonium is administered. This medication prevents the breakdown of acetylcholine, which will allow more of the neurotransmitter acetylcholine to be present at the neuromuscular junction....hence IMPROVING muscle strength IF myasthenia gravis is present. Therefore, if a patient with MG is given this medication they will have improved muscle strength.

Which patient below is MOST at risk for developing a cholinergic crisis?* A. A patient with myasthenia gravis is who is not receiving sufficient amounts of their anticholinesterase medication. B. A patient with myasthenia gravis who reports not taking the medication Pyridostigmine for 2 weeks. C. A patient with myasthenia gravis who is experiencing a respiratory infection and recently had left hip surgery. D. A patient with myasthenia gravis who reports taking too much of their anticholinesterase medication.

D. Remember patients who experience a cholinergic crisis are most likely to because they've received too much of their anticholinesterase medications (example Pyridostigmine). However, on the other hand, patients who have received insufficient amount of their anticholinesterase medication or have experienced an illness/stress/surgery are most likely to experience a myasthenia crisis. Both conditions will lead to muscle weakness and respiratory failure but from different causes, which is why a Tensilon test is used to help differentiate between the two conditions.

A client with Parkinson's disease has been started on carbidopa-levodopa for the management of tremors and slow movement. The nurse instructs the client's family about serious side effects of this drug, which include which of the following? a. Tardive dyskinesia b. Catatonia c. Orthostatic hypotension d. Ventricular tachycardia

a Carbidopa is a medication prescribed for the treatment of symptoms associated with Parkinson's disease, including tremor and slow movements. Carbidopa works by preventing the breakdown of the neurotransmitter dopamine, which reduces some of the negative effects of Parkinson's disease. Unfortunately, tardive dyskinesia is a side effect that can occur with chronic use of medications such as carbidopa and levodopa. TD causes involuntary movements of the face, mouth, tongue, neck, arms, and legs.

A nurse is helping a 47-year-old client with getting up in the morning and performing activities of daily living. The client was diagnosed with myasthenia gravis 6 years ago. Which of the following would the nurse most likely expect the client to find difficult because of this diagnosis? a. Eating breakfast b. Controlling bowel movements c. Listening to a radio program d. Sitting in a chair

a Myasthenia gravis is an autoimmune disorder characterized by weakness of skeletal muscles and fatigue with exertion. The client would most likely have difficulties with performing activities of daily living that require exertion or use of muscles; this would include eating or grooming. It would be less difficult for a client to participate in more passive activities.

A nurse is educating a 65-year-old client who has recently been diagnosed with Parkinson's disease. The client asks the nurse, "Will my daughter get Parkinson's when she is my age?" Which answer from the nurse is correct? a. There is no connection between family members with Parkinson's disease and development of the condition b. There are some genetic links to the disease, but she will not necessarily develop the condition c. Yes, your daughter will most likely inherit the condition d. Parkinson's is caused by an environmental trigger, so she will only develop it if she has the same exposures as you did

a Parkinson's disease is thought to be caused by a combination of environmental and genetic factors. Approximately 15% of people who with Parkinson's disease have a family history of the disorder. It is more common for the condition to develop in someone who has no family history of Parkinson's. In most cases of Parkinson's disease, genetic mutations are not present. Instead, deposits of proteins called Lewy bodies are found on dying dopamine-producing neurons.

A 58-year-old client with multiple sclerosis is suffering from bowel incontinence after having a stroke. Which intervention would most likely help the client to manage this condition? a.Teach the client about what foods to eat and how much fluid to drink to help with stool consistency b. Discuss with the client why the client is struggling with bowel incontinence c. Explain that the client needs to increase fiber intake and provide a list of foods to eat d. Tell the client to write down how many bowel movements occur each day

a. New onset fecal incontinence after a stroke can be frustrating for a client. The nurse can help the client cope with this situation by developing a bowel program to improve bowel control. The goals of bowel incontinence include an optimal stool consistency, reduced bowel motility, and minimizing how much stool is in the rectum through regular bowel movements. The nurse should teach the client to have a regular intake of fiber, drink plenty of fluids, and avoid food and drink that cause diarrhea or urgency. The reason is already known, the client had a stroke. An appropriate amount of fiber is important, but if the client has too much fiber it will lead to too much bulk in the stool, and can potentially increase incontinence problems. Fiber intake, along with other aspects of a bowel program are necessary to help the client with fecal incontinence. It is appropriate for the client to keep track of bowel movements to get an idea of management strategies, but the dietary training component of a bowel program is more important.

The parents of a 13-month-old diagnosed with spastic cerebral palsy have asked the nurse how this happened. The nurse explains that which of the following are possible causes of cerebral palsy? Select all that apply. a. Bacterial meningitis b. Hypoglycemia c. Traumatic brain injury d. Intracranial hemorrhage e. Respiratory syncytial virus

abcd All of these could damage the brain and lead to cerebral palsy

The nurse is caring for a 9-month-old client diagnosed with cerebral palsy. The nurse knows that which of the following are signs of abnormal tone in an infant? Select all that apply. a. Difficulty feeding b. Repeatedly arching back c. Persistent fisting of the right hand d. Rocking back and forth on hands and knees e. Scissoring of legs

abce Difficulty feeding,scissoring of the legs, persistent fisting of the right hand and repeatedly arching the back are all signs that increased tone and tightness are present in an infant.

The nurse is caring for a client who is newly diagnosed with Parkinson's disease. Which of the following statements by the client's spouse indicates that more education is needed? Select all that apply. a. "I will make sure to increase his fiber and protein intake" b. "I will follow up to make sure we have appointments scheduled with physical and occupational therapy" c. "I will provide only a few larger meals during the day" d. "I will limit his fluid intake to 2L/day" e. "I will make sure he eats a lot of sunflower seeds"

acd Sunflower seeds are high in Vitamin B6, which blocks the effects of antiparkinson's medications. This statement requires further teaching. Increasing protein and fiber intake is appropriate for the client with Parkinson's disease. Clients with Parkinson's benefit from small. frequent, nutrient-dense meals rather than fewer, larger meals. The spouse should encourage fluid intake, not limit it. Communicating with PT/OT to ensure they've got appointments lined up is appropriate, and does not indicate the need for further teaching.

A 66-year-old client who has just been diagnosed with Parkinson's disease has many questions for the nurse. Which information regarding cognitive changes is associated with early Parkinson's disease? Select all that apply. a. Slowness in memory recall b. A significant decline in physical abilities c. Difficulties with planning d. Feeling distracted e. Dementia that interferes with activities of daily living

acd The early stages of Parkinson's disease may cause mild cognitive changes that are noticeable to the client. Examples include difficulties with planning, feeling distracted, or having trouble with memory.

A nurse is caring for a 6-month-old recently diagnosed with cerebral palsy. The nurse knows that which of the following diagnoses are commonly associated with cerebral palsy? Select all that apply. a. Scoliosis . b. Hyperbilirubinemia c. Gastroesophageal reflux d. Epilepsy e. Hydrocephalus

acde Children with cerebral palsy are at increased risk of having hydrocephalus., epilepsy, gastroesophageal reflux, and scoliosis. Hyperbilirubinemia is not associated with cerebral palsy. Hyperbilirubinemia is associated with newborns born with ABO blood incompatibility to their mother, large for gestational age, and bruising from delivery.

A case management nurse is working in a long-term care facility. A new resident has been admitted with symptoms of Parkinson's disease. Which of the following activities best demonstrates that the case manager is promoting client independence? a. Asking the client to keep track of his or her own medications b. Helping the client to come up with a daily schedule that the client wants to follow c. Allowing the client to stay up late and wander the halls at night if desired d. Allowing the client to have a private room

b A case manager has many tasks when working to coordinate client care. A client in a long-term care facility may need help with upholding independence in certain activities, which will protect quality of life. The nurse can best help this client by coming up with a daily schedule that fits the clients needs AND that the client wants to follow, which promotes independence but is not overwhelming allowing the client to have a private room is appropriate action based on the severity of Parkinson's symptoms, but it does not necessarily promote independence.

A client with Parkinson's disease has tremors in the hands that make eating difficult. Which of the following adaptive devices could the nurse employ that would help this client eat? a. A divided plate b. Weighted utensils c. A flattened steak knife d. A bendable straw

b A client with a condition that causes tremor, such as Parkinson's disease, may have a difficult time eating. Shakiness and tremor can be significant enough that a client has trouble meeting nutrition and dietary needs. Weighted utensils can be useful for these client, because the heavier weight of the utensils helps to hold the hands steady when bringing food to the mouth.

The nurse is caring for a client with Parkinson's disease. The nurse anticipates that which type of medication will be administered to manage the disease? a. Antipsychotics b. Dopaminergics c. SSRIs d. Dopamine antagonists

b Dopaminergic medications are used in the treatment of Parkinson's disease by stimulating dopamine receptors to increase the level of dopamine available in the central nervous system. This reduces symptoms of the disease and allows the client maximum function. A dopamine antagonist is an antidopaminergic, also known as a typical antipsychotic. This type of drug blocks dopamine receptors, which is the opposite effect of what is desired for treatment of Parkinson's. An example of a dopamine antagonist is haloperidol.

A nurse is caring for a client diagnosed with cerebral palsy that has increased tone in only the left arm. The nurse knows that which of the following accurately describes this? a. Ataxic Hemiplegia b. Spastic Monoplegia c. Ataxic Monoplegia d. Spastic Hemiplegia

b. Spastic cerebral palsy presents as spasticity or increased tone. When only one limb is affected it is called monoplegia.

The nurse is caring for a client with Parkinson's disease. During the physical assessment, the nurse notes that which of the following signs and symptoms are consistent with this disease? Select all that apply. a. Drooping of eyelids b. Shuffling gait c. Pill-rolling tremor d. Tardive dyskinesia e. Difficulty swallowing

bce shuffling gait is a common characteristic of parkinsons This describes a tremor in which the thumb moves against the index finger in a way that resembles rolling a pill. Each client should have a swallow study in order to determine whether they are at risk for aspiration with oral intake. Tardive dyskinesia (TD) is a side effect of antipsychotics. With TD, the client experiences involuntary muscle movements. In akinesia, which is common with Parkinson's, the client experiences muscle rigidity. Some medications taken for Parkinson's disease may cause TD, but this is related to medication use, not Parkinson's disease. Drooping of eyelids is a characteristic of a client with myasthenia gravis, but not Parkinson's.

A nurse is working with a woman who cares for her mother in her home. The mother has Parkinson's disease and has difficulty getting around. What information would most likely help this client to keep her mother safe in their home? a. Do not allow the client to go into the kitchen when food is being prepared b. Have the client wear socks or slippers when going into the bathroom c. Arrange furniture so that there is plenty of space between items to move around d. Replace wood or vinyl floors with carpet

c A person with Parkinson's disease is at risk of being injured because of changes in mobility and subsequent risk for falls. The nurse should counsel this family to leave enough space between furniture for the client to get through without falling and to decrease clutter to avoid tripping hazards.

A nurse is caring for a client who is experiencing trouble with coordination and balance, spastic muscles, and numbness and tingling in the extremities. This client is most likely suffering from which of the following? a. Fibromyalgia b. Guillain Barre syndrome c. Multiple sclerosis d. Myasthenia gravis

c. Multiple sclerosis is caused by a deterioration of the myelin sheath, and is characterized by fatigue, tremors, weakness, bowel and bladder dysfunction, and muscle spasticity. Myasthenia gravis ischaracterized by double vision, ptosis, and weakness and fatigue. Fibromyalgia is characterized by wide spread muscle pain and weakness. Guillain Barre is characterized by weakness, breathing problems, and numbness and tingling.

The nurse is caring for a client who is newly diagnosed with multiple sclerosis. Which of the following is appropriate teaching for this client? a. "Here is a list of foods containing rye, barley, and oats. You must not consume these if you want to avoid flare ups" b. "You may noticed you start to walk by shuffling, or move your hands like you're rolling a pill. That is normal" c. "Make sure you're getting good fluid intake, around 2L/day" d. "If you are compliant with your treatment regimen, there is a chance this will resolve completely"

c. Multiple sclerosis (MS) can cause incontinence, and this is difficult to cope with. Many clients with MS will drink less to avoid episodes of incontinence, but this leads to dehydration and constipation. The client with MS must be taught to continue adequate fluid intake. MS is a chronic, progressive condition that cannot be cured. Nursing concepts for MS focus on supportive care. Avoiding rye, oats and barley is for those with celiac disease, not MS. A shuffling gait and pill-rolling is common with Parkinson's, not MS.

A 76-year-old client is being seen for a follow-up appointment after starting a prescription for Parkinson's disease. The nurse asks the client if she experiences symptoms that indicate changes in blood pressure. Which symptom would the nurse expect to assess if this client is experiencing this side effect? a. Anxiety and agitation b. Cardiac arrhythmias c. Epistaxis d. Dizziness and fainting

d A client with Parkinson's disease is at increased risk of hypotension because the disease affects the body's ability to maintain normal blood pressure with position changes. Some of the drugs used to manage Parkinson's may also lead to hypotension. The client should be assessed for signs that can indicate a drop in blood pressure, such as dizziness, fainting, lightheadedness, blurred vision, and cool, clammy skin.

A nurse is caring for a client who is experiencing muscle weakness that gets better with rest. The client reports difficulty swallowing and controlling facial expressions. The nurse knows the client's antibodies are blocking and changing the signals sent between nerves and muscles. This client is suffering from which of the following? a. Fibromyalgia b. Guillain Barre syndrome c.Multiple sclerosis d. Myasthenia gravis

d Myasthenia gravis is caused by a disconnect between nerve signals and muscles, most often characterized by difficulty swallowing and difficulty controlling facial expressions as well as eye movement. The KEY words to MG is weakness that gets better with rest.

A client with spastic hemiplegic cerebral palsy has been admitted to the hospital with pneumonia. The client's parent has asked for something to help with the muscle spasms because it is causing pain. The nurse knows that which of the following PRN medications would be best? a. Ibuprofen b. Morphine c. Acetaminophen d. Diazepam

d. The pain experienced by muscle spasms is best treated by a medication that will help relax the muscles such as diazepam.