Neurology

The nurse taught the caregiver of a child with a ventriculoperitoneal (VP) shunt about when to contact the health care provider (HCP). The caregiver shows understanding of the instructions by contacting the HCP about which symptom? 1. A temperature of 99 F (37 C) that occurs during the evening 2. The child cannot recall items eaten for lunch the previous day 3. The child vomits after awakening from a nap and 1 hour later 4. The VP shunt is palpated along the posterior-lateral portion of the skull(

3. The child vomits after awakening from a nap and 1 hour later The caregiver of a child with a VP shunt must understand symptoms of increased intracranial pressure (ICP), which indicate shunt malfunction. Vomiting may be a sign of increased ICP and would require that the HCP be contacted. Increased ICP may occur with VP shunt malfunctions. The caregiver must recognize symptoms of vomiting, headaches, vision changes, and changes in mental status. Early intervention by the HCP will decrease the risk of damage to the brain tissue.

The nurse is planning care for a client being admitted with newly diagnosed quadriplegia (tetraplegia). Which intervention will the nurse prioritize? 1. Assess vital capacity and tidal volume once per shift and PRN 2. Perform passive range of motion exercises on affected joints every 4 hours 3. Provide time during each shift for the client to express feelings 4. Turn the client every 2 hours throughout the day and night

1. Assess vital capacity and tidal volume once per shift and PRN Quadriplegia (tetraplegia) occurs when the lower limbs are completely paralyzed and there is complete or partial paralysis of the upper limbs. This is usually due to injury of the cervical spinal cord. Depending on the area of injury and extent of cord edema, the airway can be adversely affected. The priority assessment for this client is the status of the airway and oxygenation. The nurse should frequently assess breath sounds, accessory muscle use, vital capacity, tidal volume, and arterial blood gas values (if prescribed). Educational objective: The priority assessment in a client newly diagnosed with quadriplegia (tetraplegia) is airway management and oxygenation.

A child with autism spectrum disorder is being admitted to an acute care unit. Which is the most important nursing action? 1. Placing the child in a private room away from the nurses' station 2. Placing the child in a private room near the playroom 3. Placing the child in a semi-private room near the nurses' station 4. Placing the child in a semi-private room with another child with autism spectrum disorder

1. Placing the child in a private room away from the nurses' station Children with autism spectrum disorder (ASD) often exhibit sensory processing problems; they may be hyper- or hypo-sensitive to sounds, lights, movement, touch, taste, and smells. A calming environment with minimal stimulation should be provided; a private room away from the nurses' station is the best location. The nurse can also facilitate a calming environment by: Using a quiet or monotone voice when speaking to the child Using eye contact and gestures carefully Moving slowly Limiting visual clutter Maintaining minimal lighting Providing the child with a single object to focus on Because children with autism spectrum disorder often exhibit sensory processing problems, they need a calming environment with minimal stimulation.

The nurse is assessing a client with advanced amyotrophic lateral sclerosis. Which of the following assessment findings does the nurse expect? Select all that apply. 1. Diarrhea 2. Difficulty breathing 3. Difficulty swallowing 4. Muscle weakness 5. Resting tremor

2. Difficulty breathing 3. Difficulty swallowing 4. Muscle weakness Amyotrophic lateral sclerosis (ALS, Lou Gehrig disease) is a debilitating neurodegenerative disease with no cure. ALS causes progressive degeneration of motor neurons in the brain and spinal cord. Physical symptoms include fatigue, progressive muscle weakness, twitching and muscle spasms, difficulty swallowing, difficulty speaking, and respiratory failure (Options 2, 3, and 4). Most clients survive only 3-5 years after the diagnosis as there is no cure. Treatment focuses on symptom management. Interventions include: Respiratory support with noninvasive positive pressure (eg, bilevel positive airway pressure [BiPAP]) or invasive mechanical ventilation (eg, via tracheostomy) Feeding tube for enteral nutrition Medications to decrease symptoms (eg, spasms, uncontrolled secretions, dyspnea) Mobility assistive devices (eg, walker, wheelchair) Communication assistive devices (eg, alphabet boards, specialized computers) Educational objective: Amyotrophic lateral sclerosis causes motor neuron degeneration that leads to progressive muscle weakness, twitching and muscle spasms, difficulty swallowing, difficulty speaking, and respiratory failure. There is no cure. Treatment focuses on symptom management.

When performing developmental screenings in the well-child clinic, the registered nurse understands that which child is at highest risk of developing autism spectrum disorder? 1. 2-year-old who has a vocabulary of 10 words 2. 3-year-old who received measles, mumps, and rubella immunization at age 1 year 3. 4-year-old whose 10-year-old sibling has the disorder 4. 5-year-old whose parents were age 42 at the time of birth

3. 4-year-old whose 10-year-old sibling has the disorder Although the cause of autism spectrum disorder (ASD) is unknown, numerous studies indicate that it has a strong genetic component. The underlying genetic source is unknown in the majority of cases; however, researchers hypothesize that genetic factors predispose to an autism phenotype and that genetic expression is influenced by environmental factors. There is strong scientific evidence of a genetic component to autism spectrum disorder (ASD). As a result, parents who have a child with ASD are at higher risk of having another child with this disorder. There is no evidence that supports a link between vaccines and ASD, and studies on associations between advanced parental age and the disorder are inconclusive.

The clinic nurse is assessing a previously healthy 60-year-old client when the client says, "My hand has been shaking when I try to cut food. I did some research online. Could I have Parkinson's disease?" Which response from the nurse is the most helpful? 1. "It can't be Parkinson's disease because you aren't old enough." 2. "Make sure you tell the physician about your concerns." 3. "Parkinson's disease does not cause that kind of hand shaking." 4. "Tell me more about your symptoms. When did they start?"

4. "Tell me more about your symptoms. When did they start?" Parkinson's disease (PD) is a chronic, progressive neurodegenerative disorder that involves degeneration of the dopamine-producing neurons. Damage to dopamine neurons makes it difficult to control muscles through smooth movement. PD is characterized by a delay in initiation of movement (bradykinesia), increased muscle tone (rigidity), resting tremor, and shuffling gait. The most helpful response by the nurse is the one that acknowledges the concern of the client and also asks for more information. The nurse should assess for additional information and perform a more focused physical assessment given this new information. Educational objective: Therapeutic communication includes acknowledging concerns and probing for additional information as part of an assessment.

A nurse is teaching the parent of an 8-month-old infant who had a febrile seizure about management of future fevers. Which instruction is appropriate to include in the teaching? 1. "Give acetaminophen or ibuprofen every 6 hours to control the fever." 2. "Give the infant frequent tepid sponge baths to control the fever." 3. "If the infant develops another seizure, wait 15 minutes to see if it subsides." 4. "Place ice bags under the arms and around the neck to reduce the fever."

1. "Give acetaminophen or ibuprofen every 6 hours to control the fever." Febrile seizures are an alarming experience for parents. They most commonly occur in children between ages 6 months to 6 years, with the peak of incidence occurring at age 18 months. The etiology is unknown. Simple febrile seizure management typically involves reassurance regarding the benign nature of most febrile seizures, and education about the risk of recurrence and seizure safety precautions (eg, side-lying positioning, removal from harmful environments). Parents should use antipyretics such as acetaminophen or ibuprofen (in children age >6 months) to control fever and make the child more comfortable (Option 1). However, there is no evidence that antipyretics reduce the risk of future febrile seizures. After the administration of antipyretics, additional cooling methods that may be beneficial for reducing fever include applying cool, damp compresses to the forehead; increasing air circulation in the room; and wearing loose or minimal clothing. Educational objective:Febrile seizures, although alarming, are generally benign. Parents should be instructed on appropriate cooling methods (eg, antipyretics, cool compresses), seizure safety precautions, and the avoidance of shivering.

An 81-year-old client is admitted to a rehabilitation facility 3 days after total hip replacement. The next morning, the unlicensed assistive personnel (UAP) takes the client's vital signs, but when the UAP goes back to assist the client with a shower, the client curses at and tries to hit the UAP. Which of the following is the most appropriate response by the registered nurse? Click on the exhibit button for additional information. 1. "I need to assess the client." 2. "It sounds like the client is not satisfied with the care provided. I'll see if we can make the client more comfortable." 3. "Just leave the client alone now and try again later." 4. "The client probably has dementia and is under a lot of stress with the change of environment."

1. "I need to assess the client." This client is exhibiting behaviors that are concerning for delirium. Therefore, the nursing priority is to perform a targeted assessment to determine whether the client has delirium and its cause. Delirium is characterized by behavior changes and confusion that have an acute onset, and it is usually reversible. Common causes in older adults include infection, medications, and hypoxia. This client's vital signs (mildly elevated temperature, respiratory rate, and hypoxia) and recent surgery suggest pulmonary infection as the cause of the delirium. Although a temperature of 98.7 F (37 C) is normal for younger adults, it may indicate fever in an 81-year-old as mean body temperature decreases with age. Other signs of pulmonary infection include crackles in the lungs, productive cough, and pleuritic chest pain. Educational objective: Delirium is a common manifestation of a serious physiologic instability in older adults and is characterized by acute changes in cognition and behavior. When a client is suspected of having delirium, the nursing priority is assessment for the cause of the delirium to guide interventions.

The emergency department triage nurse is assessing 4 pediatric clients. Which client is a priority for further diagnostic workup and definitive care? 1. 1-year-old with ventriculoperitoneal shunt who has "lethargy" and pulse of 78/min 2. 3-year-old with history of meningocele who has unilateral ear pain and urinary incontinence 3. 6-year-old with muscular dystrophy who has "flu-like" symptoms and temperature of 100.4 F (38 C) 4. 8-year-old with history of cerebral palsy who has foot injury and spastic clonus

1. 1-year-old with ventriculoperitoneal shunt who has "lethargy" and pulse of 78/min A ventriculoperitoneal shunt is used to treat hydrocephalus and is usually placed at age 3-4 months. Blockage and infection are complications of shunt placement. Blockage results in signs of increased intracranial pressure (ICP). The normal pulse range for a 1-year-old is 100-160/min. A pulse of 78/min is considered bradycardia, a part of Cushing's triad (bradycardia, slowed respiration, widened pulse pressure). A ventriculoperitoneal shunt is used to treat hydrocephalus. Complications include blockage (with signs of increased intracranial pressure [ICP]) and infection. The normal pulse range for a 1-year-old is 100-160/min; bradycardia can be a sign of increased ICP.

The nurse receives new prescriptions for a 6-month-old client with bacterial meningitis. Which action is the priority of care? 1. Administer 400 mg ceftriaxone IV every 12 hours 2. Apply padding to the crib siderails 3. Implement low-stimulation environment 4. Monitor head circumference daily

1. Administer 400 mg ceftriaxone IV every 12 hours Bacterial meningitis is an inflammation of the membranes covering the brain and spinal cord (ie, meninges) caused by a bacterial infection. The inflammatory process and bacterial growth within the meninges lead to increased volumes of cerebrospinal fluid and, subsequently, increased intracranial pressure (ICP). Without intervention, increased ICP may lead to nerve ischemia, permanent functional impairment (eg, hearing loss, visual impairment, paralysis), brain damage, herniation, and death. The initial priority of nursing care is protecting other clients and staff from exposure, as bacterial meningitis is highly contagious and transmitted by droplets. After isolating the client, the nurse should initiate prescribed antibiotics as quickly as possible, as bacterial meningitis can progress rapidly and lead to death without treatment (Option 1). Bacterial meningitis is an inflammation of the membranes covering the brain and spinal cord that can lead to severe complications (eg, hearing loss, brain damage) or death without treatment. To reduce the risk of complications, the nurse should prioritize initiation of prescribed antibiotic therapy as soon as possible.

The nurse reinforces education about safety modifications in the home for the spouse of a client diagnosed with Alzheimer disease. What instructions should the nurse include? Select all that apply. 1. Arrange furniture to allow for free movement 2. Keep frequently used items within easy reach 3. Lock doors leading to stairwells and outside areas 4. Place an identifying symbol on the bathroom door 5. Provide a dark room free of shadows for sleeping

1. Arrange furniture to allow for free movement 2. Keep frequently used items within easy reach 3. Lock doors leading to stairwells and outside areas 4. Place an identifying symbol on the bathroom door When a client with Alzheimer disease is being cared for in the home, the caregiver should be instructed regarding safety modifications to ease the burden of caregiving and promote the client's independence and dignity. Injury-prevention modifications include: Arrange furniture to allow for free movement to prevent falls (Option 1). Place frequently used items within easy, visible reach of the client (Option 2). Place locks on stairwells and outside doors to decrease the client's risk of falls and becoming lost during periods of wandering (Option 3). Label the doors to the bathroom and other commonly used rooms to assist with environment interpretation and promote independent functioning (Option 4). Educational objective: Caregivers of clients with Alzheimer disease should be taught safety modifications for the home, such as placing frequently used items within reach, arranging furniture to allow for free movement, labeling doors to commonly used rooms, providing a night light, and locking stairwell and outside doors.

The nurse is planning care for an 8-year-old client with mild cognitive impairment who is hospitalized for diagnostic testing. Which of the following interventions are appropriate to include in the plan of care? Select all that apply. 1. Consistently assign the same nurse and unlicensed assistive personnel to care for the client 2. Give direct procedural education and explanations to the parent rather than the client 3. Provide appropriate toys based on developmental level rather than chronological age 4. Reinforce parental limit-setting measures for preventing self-injurious behavior 5. Use a picture board to facilitate communication and promote understanding of procedures

1. Consistently assign the same nurse and unlicensed assistive personnel to care for the client 3. Provide appropriate toys based on developmental level rather than chronological age 4. Reinforce parental limit-setting measures for preventing self-injurious behavior 5. Use a picture board to facilitate communication and promote understanding of procedures Clients with cognitive impairment (intellectual disability) are diagnosed prior to adulthood and have limited levels of intellectual functioning and adaptive skills for their chronological age. Manifestations may include a decreased ability to perform abstract or logical reasoning, interpret complex ideas, and learn by experience. Cognitive impairment results in developmental delays of varying levels (eg, mild, moderate) and types (eg, cognitive, physical, social, emotional, behavioral) and requires the nurse to assess the client's skills and abilities and provide individualized care. Appropriate nursing interventions for a client with cognitive impairment include: Promoting the staff's understanding of client behavior/needs and maintaining a familiar environment for the client by consistently assigning the same staff (eg, nurse) for care Fostering playtime by providing toys that are developmentally appropriate, not necessarily age appropriate Preventing self-injury by reinforcing the parents' limit-setting measures (eg, time-outs) and positively reinforcing good behavior Facilitating communication and learning by using visual demonstration (eg, picture board) rather than complex explanations Appropriate nursing interventions when caring for a pediatric client with cognitive impairment include providing consistency in staff assignments, providing toys appropriate for the client's developmental (not chronological) age, preventing self-injurious behavior (eg, reinforce parental limit setting), and using visual demonstration (eg, picture board) and simple explanations to facilitate communication and learning.

The nurse is caring for a client in the medical-surgical unit who has delirium according to the Confusion Assessment Method assessment tool. Which of the following assessment findings are likely contributing to the client's delirium? Select all that apply. 1. Multiple doses of IV hydromorphone administered in the past 12 hours 2. Serum sodium of 123 mEq/L (123 mmol/L) 3. SpO2 of 82% on room air 4. Temperature of 103.1 F (39.5 C) 5. Urine culture positive for gram-positive cocci in chains

1. Multiple doses of IV hydromorphone administered in the past 12 hours 2. Serum sodium of 123 mEq/L (123 mmol/L) 3. SpO2 of 82% on room air 4. Temperature of 103.1 F (39.5 C) 5. Urine culture positive for gram-positive cocci in chains Delirium is characterized by an acute or fluctuating change in mental status that is often reversible and related to an underlying medical condition. Evidence-based assessment tools, such as the Confusion Assessment Method (CAM), help clinicians quickly recognize delirium. Criteria of the CAM tool include an acute or fluctuating change in mentation, inattention, disorganized thinking, and altered level of consciousness. Precipitating factors of delirium are numerous and include: Medications (eg, opioids, anticholinergics) (Option 1) Electrolyte imbalances (eg, hyponatremia) (Option 2) Hypoxia (Option 3) Acute infection (eg, fever, positive culture) (Options 4 and 5) Sleep deprivation Dehydration or malnutrition Metabolic disorders (eg, hypoglycemia) Nursing interventions include treating the underlying cause as prescribed to resolve delirium (eg, antibiotics, supplemental oxygen), maintaining a safe environment (eg, continuous monitoring, room near the nurses' station, bed alarm), reorienting the client frequently, promoting a regular sleep cycle, providing familiar items from home, and encouraging family and friends to stay with the client. Educational objective:The Confusion Assessment Method is an assessment tool that helps clinicians quickly recognize delirium, which is characterized by an acute or fluctuating change in mental status and is often caused by medications (eg, opioids) or an underlying medical condition (eg, hypoxia, electrolyte imbalances, infection).

A child is scheduled to have an electroencephalogram (EEG). Which statement by the parent indicates understanding of the teaching? 1. "I will let my child drink cocoa as usual the morning of the procedure." 2. "I will wash my child's hair using shampoo the morning of the procedure." 3. "My child may have scalp tenderness where the electrodes were applied." 4. "My child will not remember the procedure."

2. "I will wash my child's hair using shampoo the morning of the procedure." An electroencephalogram (EEG) is a diagnostic procedure used to evaluate the presence of abnormal electrical discharges in the brain, which may result in a seizure disorder. The EEG can be done in a variety of ways, such as with the child asleep or awake with or without stimulation. Teaching for the parent includes the following: Hair should be washed to remove oils and hair care products, and accessories such as ribbons or barrettes should be removed. Hair may need to be washed after the procedure to remove electrode gel. Avoid caffeine, stimulants, and central nervous system depressants prior to the test. The test is not painful, and no analgesia is required. Educational objective: An EEG is used to diagnose the presence of a seizure disorder. Electrodes are secured to the scalp to observe for abnormal electrical discharges in the brain. Preprocedure teaching includes avoiding stimulants and CNS depressants and washing the hair.

The clinic nurse performs assessments on four infants. The nurse should alert the health care provider to see which client first? 1. 3-month-old whose posterior occiput appears flattened 2. 4-month-old who has sclera visible above the iris (sunset eyes) 3. 6-month-old who has vomited twice and has had 8 wet diapers in the last 24 hours 4. 9-month-old whose toes fan out and big toe dorsiflexes when plantar surface is stroked

2. 4-month-old who has sclera visible above the iris (sunset eyes) Hydrocephalus is an increase in intracranial pressure (ICP) that results from obstruction of cerebrospinal fluid flow. Increased ICP can progress to brain damage and death. Signs of increased ICP in children include bulging fontanelles, increasing head circumference, and sunset eyes (or setting-sun sign) (sclera visible above the iris). Sunset eyes occur when periaqueductal structures are compressed from increased ICP, paralyzing the upward gaze. This is a late sign of increased ICP that requires timely treatment (eg, shunt placement) and is the priority The presence of sunset eyes (sclera visible above the iris) is a late sign of increased intracranial pressure and a priority to report to the health care provider.

A newborn has a large myelomeningocele. What nursing intervention is priority? 1. Assess the anus for muscle tone 2. Cover the area with a sterile, moist dressing 3. Measure the occipital frontal circumference 4. Place the newborn supine with the head of the bed elevated

2. Cover the area with a sterile, moist dressing Myelomeningocele occurs when the neural tube fails to fuse properly during fetal development. An outpouching of spinal fluid, spinal cord, and nerves covered by only a thin membrane occurs, typically in the lumbar area. The newborn is at high risk for infection at this area. A priority nursing intervention is to cover the area with a sterile, moist dressing to decrease the risk of infection until surgical repair can occur. The newborn with a myelomeningocele is at risk for infection. Covering the myelomeningocele with a sterile, moist dressing is indicated to decrease the risk of infection at the site. The infant should be placed on the abdomen (prone) with the face turned to the side.

The nurse is caring for an infant with suspected meningitis and preparing to assist with a lumbar puncture. What is the appropriate nursing intervention? 1. Administer oxygen via nasal cannula for client comfort and safety 2. Clean area with povidone iodine in a circular motion moving outward 3. Hold the child with the head and knees tucked in and the back rounded out 4. Monitor and record vital signs every 15 minutes throughout the procedure

3. Hold the child with the head and knees tucked in and the back rounded out The optimal position for access during a lumbar puncture is to have the client's head and knees tucked in and the back rounded out. This provides the most room for the health care provider (HCP) to perform the procedure and allows for a good hold to keep the client still. A lumbar puncture is a sensitive procedure, and it is important to keep the child from moving during needle insertion. Performing a lumbar puncture on a child is a very sensitive procedure that requires accuracy. The correct position and ability to hold the child still are important to achieve the best result and minimize the risk for complications.

A 7-month-old infant is admitted to the unit with suspected bacterial meningitis after receiving an initial dose of antibiotics in the emergency department. Frequent assessment of which of the following is most important in the plan of care? 1. Babinski reflex 2. Fontanel assessment 3. Pulse pressure 4. Pupillary light response

2. Fontanel assessment Bacterial meningitis is inflammation of the meninges of the brain and spinal cord caused by infection. General manifestations in infants and children age <2 include fever, restlessness, and a high-pitched cry. One common acute complication of bacterial meningitis is hydrocephalus, an increase in intracranial pressure (ICP) resulting from obstruction of cerebrospinal fluid flow. Increased ICP can progress to permanent hearing loss, learning disabilities, and brain damage. Bulging/tense fontanels and increasing head circumference are important early indicators of increased ICP in children. Frequent assessment for developing complications is vital for any client with suspected bacterial meningitis. Educational objective:Infants with bacterial meningitis can develop hydrocephalus. Bulging/tense fontanels and increasing head circumference are important early indicators of increased ICP in children and should be monitored to prevent long-term complications.

A nurse is caring for a 3-month-old infant who has bacterial meningitis. Which clinical findings support this diagnosis? Select all that apply. 1. Depressed anterior fontanelle 2. Frequent seizures 3. High-pitched cry 4. Poor feeding 5. Presence of the Babinski sign 6. Vomiting

2. Frequent seizures 3. High-pitched cry 4. Poor feeding 6. Vomiting Bacterial meningitis is an inflammation of the meninges in the brain and spinal cord that is caused by specific types of bacteria, including group B streptococcal, meningococcal, or pneumococcal pathogens. Clinical manifestations of bacterial meningitis in infants age <2 include: Fever or possible hypothermia Irritability, frequent seizures High-pitched cry Poor feeding and vomiting Nuchal rigidity Bulging fontanelle possible but not always present One of the most common acute complications of bacterial meningitis in children is hydrocephalus. Long-term complications include hearing loss, learning disabilities, and brain damage. Due to the severity of potential complications, prompt identification and immediate treatment are vital for any client with suspected bacterial meningitis. Bacterial meningitis is inflammation of the meninges in the brain and spinal cord caused by bacterial infection. Key characteristics of bacterial meningitis in infants under age 2 include frequent seizures, a high-pitched cry, poor feeding, nuchal rigidity, and possible bulging fontanelles.

The nurse is preparing for the admission of a 9-year-old client with new-onset tonic-clonic seizures. It is important for the nurse to ensure that what is in the room? Select all that apply. 1. Oral bite prevention device 2. Oxygen delivery system 3. Padding on the bed siderails 4. Soft arm and leg restraints 5. Suction equipment

2. Oxygen delivery system 3. Padding on the bed siderails 5. Suction equipment Client safety is a priority when caring for a client with seizure activity. Protecting the airway and improving oxygenation includes turning the client on the side and providing oxygen and oral suctioning as needed. Padding the bed siderails provides the client protection and decreases the potential for injury from the metal in the event that the head or extremities hit the siderails during seizure activity. Educational objective: Turning the client on the side, providing oxygen and suctioning as needed, and padding the siderails or removing objects that are near the client can decrease the risk for injury during a seizure. Avoid restraints.

A nurse is teaching the parent of a child who has a new diagnosis of absence seizures. Which statement by the parent indicates understanding of the teaching? 1. "My child may experience incontinence." 2. "My child may seem confused afterwards." 3. "My child may stare and seem inattentive." 4. "My child will notice unusual odors prior to the event."

3. "My child may stare and seem inattentive." Absence seizures occur in children age 4-12 and usually disappear at puberty. Clinical manifestations include a brief loss of consciousness and an appearance of inattention or daydreaming (the absence attack) without loss of postural body tone. However, slight loss of tone may lead to dropping objects held in hands. Most absence seizures last less than 10 seconds and often go unrecognized. Following an attack, behavior and awareness return immediately to normal. The child does not experience a postictal period but usually has no recollection that a seizure has occurred. A child may have multiple absence seizures each day. Treatment includes the use of anticonvulsant medication(s). Educational objective:Absence seizures are characterized by a brief loss of consciousness and an appearance of inattention or daydreaming without loss of postural tone. Most absence seizures last less than 10 seconds. The seizures occur in children age 4-12, and multiple seizures may occur daily.

A nurse working in a neurology clinic receives the following telephone messages. Which client should the nurse call back first? 1. Client prescribed sumatriptan who has throbbing left temple pain preceded by an aura 2. Client taking carbidopa-levodopa who has dizziness when rising from a sitting or lying position 3. Client with myasthenia gravis who has a fever and increasing difficulty swallowing 4. Client with trigeminal neuralgia who reports burning cheek pain after eating ice cream

3. Client with myasthenia gravis who has a fever and increasing difficulty swallowing Myasthenia gravis is an autoimmune disease of the neuromuscular junction resulting in fluctuating muscle weakness. Autoantibodies are formed against the acetylcholine receptors, so fewer receptors are available for acetylcholine to bind. It is treated with pyridostigmine (Mestinon), which increases the amount of acetylcholine at the synaptic junction, augmenting neuromuscular signals and improving muscle strength. Infection, undermedication, and stress can precipitate a life-threatening myasthenic crisis, which is characterized by oropharyngeal and respiratory muscle weakness and respiratory failure. This client's infection and increasing difficulty swallowing indicate the need for immediate intervention. Educational objective: Myasthenia gravis is a chronic neurologic autoimmune disease in which acetylcholine receptors are blocked, causing muscle weakness. Infection, undermedication, and stress can lead to a myasthenic crisis, which is characterized by oropharyngeal and respiratory muscle weakness and respiratory failure.

The nurse is caring for a client with increased intracranial pressure (ICP). Which statement by the unlicensed assistive personnel would require immediate intervention by the nurse? 1. "I will raise the head of the bed so it is easier to see the television." 2. "I will turn down the lights when I leave." 3. "Let me move your belongings closer so you can reach them." 4. "You should do deep breathing and coughing exercises."

4. "You should do deep breathing and coughing exercises." Clients with elevated ICP should avoid anything that increases intrathoracic or intraabdominal pressure as these also indirectly increase ICP. These activities include straining, coughing, and blowing the nose. Respiratory interventions, if needed, may include deep breathing and incentive spirometry in the absence of coughing. The head of the bed should be maintained at 30 degrees, high enough to allow for cerebrospinal fluid drainage, but low enough to maintain cerebral perfusion pressure. Clients should have minimal stimuli, including no bright lights or multiple visitors, as stimulation can increase ICP. Educational objective: Clients with increased ICP should be encouraged not to cough, strain, or increase abdominal or thoracic pressure. The head of the bed should be maintained at 30 degrees, and stimulation in the room should be minimized.

A client is being admitted for a potential cerebellar pathology. Which tasks should the nurse ask the client to perform to assess if cerebellar function is within the defined limits? Select all that apply. 1. Identify the number "8" traced on the palm 2. Shrug the shoulders against resistance 3. Swallow water 4. Touch each finger of one hand to the hand's thumb 5. Walk heel-to-toe

4. Touch each finger of one hand to the hand's thumb 5. Walk heel-to-toe The cerebellum is involved in 2 major functions: coordination of voluntary movements and maintenance of balance and posture. Maintenance of balance is assessed with gait testing and includes watching the client's normal gait first and then the gait on heel-to-toe (tandem), on toes, and on heels (Option 5). Coordination testing involves the following: Finger tapping - ability to touch each finger of one hand to the hand's thumb (Option 4). Rapid alternating movements - rapid supination and pronation Finger-to-nose testing - clients touch the clinician's finger and then their own nose as the clinician's finger varies in location Heel-to-shin testing - client runs each heel down each shin while in a supine position Educational objective:The cerebellum is involved in coordination of voluntary movements and maintenance of balance and posture. Balance is assessed with heel-to-toe gait testing. Coordination is assessed with finger tapping, rapid alternating movements, finger-to-nose testing, and heel-to-shin testing.