221 Mod 2.3 - Practice Problems

A patient has been diagnosed with myasthenia gravis. The nurse documents the initial and most common manifestation of: A. Diplopia. B. Dysphoria. C. Facial muscle weakness. D. Generalized fatigue.

A. The initial manifestation of MG usually involves the ocular muscles. Diplopia (double vision) and ptosis (drooping of the eyelids) are common. The majority of patients also experience weakness of the muscles of the face and throat, generalized weakness, and weakness of the facial muscles.

A nurse is conducting an assessment of a client who is suspected of having a brain tumor. Assessment reveals reports of a headache, for which the nurse gathers additional information. The nurse determines that these reports support the suspicion of a brain tumor when the client reports that the headache occurs: A. early in the morning. B. around lunchtime. C. in the middle of the afternoon. D. at bedtime.

ANS: A Rationale: Headache, although not always present, is most common in the early morning and improves during the day. Pain is made worse by coughing, straining, or sudden movement. Headache is thought to be caused by the tumor invading, compressing, or distorting the pain-sensitive structures, or by edema that accompanies the tumor.

The nurse is working with a client who is newly diagnosed with MS. What basic information should the nurse provide to the client? A. MS is a progressive demyelinating disease of the nervous system. B. MS usually occurs more frequently in men. C. MS typically has an acute onset. D. MS is sometimes caused by a bacterial infection.

ANS: A Rationale: MS is a chronic, degenerative, progressive disease of the central nervous system, characterized by the occurrence of small patches of demyelination in the brain and spinal cord. The cause of MS is not known, and the disease affects twice as many women as men.

The clinic nurse is caring for a client with a recent diagnosis of myasthenia gravis. The client has begun treatment with pyridostigmine bromide. What change in status would most clearly suggest a therapeutic benefit of this medication? A. Increased muscle strength B. Decreased pain C. Improved GI function D. Improved cognition

ANS: A Rationale: The goal of treatment using pyridostigmine bromide is improvement of muscle strength and control of fatigue. The drug is not intended to treat pain, or cognitive or GI functions.

The nurse is caring for a 77-year-old client with MS. The client is very concerned about the progress of the disease and what the future holds. The nurse should know that older adult clients with MS are known to be particularly concerned about what variables? Select all that apply. A. Possible nursing home placement B. Pain associated with physical therapy C. Increasing disability D. Becoming a burden on the family E. Loss of appetite

ANS: A, C, D Rationale: Older adult clients with MS are particularly concerned about increasing disability, family burden, marital concern, and the possible future need for nursing home care. Older adults with MS are not noted to have particular concerns regarding the pain of therapy or loss of appetite.

A client diagnosed with MS has been admitted to the medical unit for treatment of an MS exacerbation. Included in the admission orders is baclofen. What should the nurse identify as an expected outcome of this treatment? A. Reduction in the appearance of new lesions on the MRI B. Decreased muscle spasms in the lower extremities C. Increased muscle strength in the upper extremities D. Decreased severity and duration of exacerbations

ANS: B Rationale: Baclofen, a -aminobutyric acid (GABA) agonist, is the medication of choice in treating spasms. It can be given orally or by intrathecal injection. Avonex and Betaseron reduce the appearance of new lesions on the MRI. Corticosteroids limit the severity and duration of exacerbations. Anticholinesterase agents increase muscle strength in the upper extremities.

The nurse is caring for a client who is scheduled for a cervical discectomy the following day. During health education, the client should be made aware of what potential complications? A. Vertebral fracture B. Hematoma at the surgical site C. Scoliosis D. Renal trauma

ANS: B Rationale: Based on all the assessment data, the potential complications of discectomy may include hematoma at the surgical site, resulting in cord compression and neurologic deficit and recurrent or persistent pain after surgery. Renal trauma and fractures are unlikely; scoliosis is a congenital malformation of the spine.

A client with MS has developed dysphagia as a result of cranial nerve dysfunction. What nursing action should the nurse consequently perform? A. Arrange for the client to receive a low residue diet. B. Position the client upright during feeding. C. Suction the client following each meal. D. Withhold liquids until the client has finished eating.

ANS: B Rationale: Correct, upright positioning is necessary to prevent aspiration in the client with dysphagia. There is no need for a low-residue diet and suctioning should not be performed unless there is an apparent need. Liquids do not need to be withheld during meals in order to prevent aspiration.

The nurse is caring for a client with multiple sclerosis (MS). The client tells the nurse the hardest thing to deal with is the fatigue. When teaching the client how to reduce fatigue, what action should the nurse suggest? A. Taking a hot bath at least once daily B. Resting in an air-conditioned room whenever possible C. Increasing the dose of muscle relaxants D. Avoiding naps during the day

ANS: B Rationale: Fatigue is a common symptom of clients with MS. Lowering the body temperature by resting in an air-conditioned room may relieve fatigue; however, extreme cold should be avoided. A hot bath or shower can increase body temperature, producing fatigue. Muscle relaxants, prescribed to reduce spasticity, can cause drowsiness and fatigue. Planning for frequent rest periods and naps can relieve fatigue. Other measures to reduce fatigue in the client with MS include treating depression, using occupational therapy to learn energy conservation techniques, and reducing spasticity.

The nurse is planning the care of a client with Parkinson disease. The nurse should be aware that treatment will focus on what pathophysiologic phenomenon? A. Premature degradation of acetylcholine B. Decreased availability of dopamine C. Insufficient synthesis of epinephrine D. Delayed reuptake of serotonin

ANS: B Rationale: Parkinson disease develops from decreased availability of dopamine, not acetylcholine, epinephrine, or serotonin.

A client newly diagnosed with a cervical disk herniation is receiving health education from the clinic nurse. What conservative management measures should the nurse teach the client to implement? A. Perform active ROM exercises three times daily. B. Sleep on a firm mattress. C. Apply cool compresses to the back of the neck daily. D. Wear the cervical collar for at least 2 hours at a time.

ANS: B Rationale: Proper positioning on a firm mattress and bed rest for 1 to 2 days may bring dramatic relief from pain. The client may need to wear a cervical collar 24 hours a day during the acute phase of pain from a cervical disc herniation. Hot, moist compresses applied to the back of the neck will increase blood flow to the muscles and help relax the spastic muscles.

A client diagnosed with myasthenia gravis has been hospitalized to receive therapeutic plasma exchange (TPE) for a myasthenic exacerbation. The nurse should anticipate what therapeutic response? A. Permanent improvement after 4 to 6 months of treatment B. Symptom improvement that lasts a few weeks after TPE ceases C. Permanent improvement after 60 to 90 treatments D. Gradual improvement over several months

ANS: B Rationale: Symptoms improve in 75% of clients undergoing TPE; however, improvement lasts only a few weeks after treatment is completed.

A client with Guillain-Barré syndrome has experienced a sharp decline in vital capacity. What is the nurse's most appropriate action? A. Administer bronchodilators as ordered. B. Remind the client of the importance of deep breathing and coughing exercises. C. Prepare to assist with intubation. D. Administer supplemental oxygen by nasal cannula.

ANS: C Rationale: For the client with Guillain-Barré syndrome, mechanical ventilation is required if the vital capacity falls, making spontaneous breathing impossible and tissue oxygenation inadequate. Each of the other listed actions is likely insufficient to meet the client's oxygenation needs.

A nurse is planning the care of a 28-year-old client hospitalized with a diagnosis of myasthenia gravis. What approach would be most appropriate for the care and scheduling of diagnostic procedures for this client? A. All at one time, to provide a longer rest period B. Before meals, to stimulate the client's appetite C. In the morning, with frequent rest periods D. Before bedtime, to promote rest

ANS: C Rationale: Procedures should be spaced to allow for rest in between. Procedures should be avoided before meals, or the client may be too exhausted to eat. Procedures should be avoided near bedtime if possible.

The nurse is creating a plan of care for a client who has a recent diagnosis of MS. Which of the following should the nurse include in the client's care plan? A. Encourage the client to void every hour. B. Order a low-residue diet. C. Provide total assistance with all ADLs. D. Instruct the client on daily muscle stretching.

ANS: D Rationale: A client diagnosed with MS should be encouraged to increase the fiber in his or her diet and void 30 minutes after drinking to help train the bladder. The client should participate in daily muscle stretching to help alleviate and relax muscle spasms.

A patient diagnosed with meningitis would be expected to exhibit which of the following clinical manifestations? Select all that apply. A. Hypothermia B. Positive Kernig's sign C. Nuchal rigidity D. Photophobia E. Positive Brudzinski's sign

B, C, D, E. Signs of meningeal irritation include nuchal rigidity (neck stiffness), a positive Kernig's sign, a positive Brudzinski's sign, and photophobia. Patients may have a fever.

Which of the following is considered a central nervous system (CNS) disorder? A. Myasthenia gravis B. Guillain-Barré C. Bell's palsy D. Multiple sclerosis

D. Multiple sclerosis is an immune-mediated, progressive demyelinating disease of the CNS. Guillain-Barré, myasthenia gravis, and Bell's palsy are peripheral nervous system disorders.

The nurse is assessing a male client with multiple sclerosis (MS). What education would the nurse provide to assist the client in managing this disease? Select all that apply. A. Treatment of any episodes of depression B. Participation in occupational therapy C. Effective treatment of anemia D. Recommend bone mineral density testing E. Avoidance of hot temperatures

A, B, C, E. Multiple sclerosis (MS) is an immune-mediated, progressive demyelinating disease of the central nervous system (CNS). Fatigue affects most people with MS and is often the most disabling symptom. Heat, depression, anemia, deconditioning, and medication may contribute to fatigue. Avoiding high temperatures, effective treatment of depression and anemia, a change in medication, as well as occupational and physical therapy may help manage fatigue. Pain is another common symptom of MS. Bone mineral testing is recommended for women with MS who are perimenopausal. This group of clients are likely to have pain related to osteoporosis.

Myasthenia gravis occurs when antibodies attack which receptor sites? A. Acetylcholine B. Dopamine C. Serotonin D. Gamma-aminobutyric acid

A. In myasthenia gravis, antibodies directed at the acetylcholine receptor sites impair transmission of impulses across the myoneural junction. Serotonin, dopamine, and gamma-aminobutyric acid are not receptor sites that are attacked in myasthenia gravis.

The nurse is teaching a client with Guillain-Barré syndrome about the disease. The client asks how the client can ever recover if demyelination of the nerves is occurring. What would be the nurse's best response? A. Guillain-Barré spares the Schwann cell, which allows for remyelination in the recovery phase of the disease. B. In Guillain-Barré, Schwann cells replicate themselves before the disease destroys them, so remyelination is possible. C. I know you understand that nerve cells do not remyelinate, so the health care provider is the best one to answer your question. D. For some reason, in Guillain-Barré, Schwann cells become activated and take over the remyelination process.

ANS: A Rationale: Myelin is a complex substance that covers nerves, providing insulation and speeding the conduction of impulses from the cell body to the dendrites. The cell that produces myelin in the peripheral nervous system is the Schwann cell. In Guillain-Barré syndrome, the Schwann cell is spared, allowing for remyelination in the recovery phase of the disease. The nurse should avoid downplaying the client's concerns by wholly deferring to the health care provider.

An older adult has encouraged the spouse husband to visit their primary provider, stating that concern that spouse may have Parkinson disease. Which description of the spouse's health and function is most suggestive of Parkinson disease? A. Lately he seems to move far more slowly than he ever has in the past. B. He often complains that his joints are terribly stiff when he wakes up in the morning. C. He's forgotten the names of some people that we've known for years. D. He's losing weight even though he has a ravenous appetite.

ANS: A Rationale: Parkinson disease is characterized by bradykinesia. It does not manifest as memory loss, increased appetite, or joint stiffness.

The nurse is developing a plan of care for a client with Guillain-Barré syndrome. Which of the following interventions should the nurse prioritize for this client? A. Using the incentive spirometer as prescribed B. Maintaining the client on bed rest C. Providing aids to compensate for loss of vision D. Assessing frequently for loss of cognitive function

ANS: A Rationale: Respiratory function can be maximized with incentive spirometry and chest physiotherapy. Nursing interventions toward enhancing physical mobility should be utilized. Nursing interventions are aimed at preventing a deep vein thrombosis. Guillain-Barré syndrome does not affect cognitive function or vision.

The nurse caring for a client diagnosed with Parkinson disease has helped prepare a plan of care that would include which goal? A. Promoting effective communication B. Controlling diarrhea C. Preventing optic nerve damage D. Managing choreiform movements

ANS: A Rationale: The goals for the client may include improving functional mobility, maintaining independence in ADLs, achieving adequate bowel elimination, attaining and maintaining acceptable nutritional status, achieving effective communication, and developing positive coping mechanisms. Constipation would be more likely than diarrhea. Parkinson disease does not affect the optic nerve. Choreiform movements are related to Huntington's disease.

The clinic nurse caring for a client with Parkinson disease notes that the client has been taking levodopa and carbidopa (Sinemet) for 7 years. For what common side effect should the nurse assess this client? A. Pruritus B. Dyskinesia C. Lactose intolerance D. Diarrhea

ANS: B Rationale: Within 5 to 10 years of taking levodopa, most clients develop a response to the medication characterized by dyskinesia (abnormal involuntary movements). Another potential complication of long-term dopaminergic medication use is neuroleptic malignant syndrome characterized by severe rigidity, stupor, and hyperthermia. Side effects of long-term Sinemet therapy are not pruritus, lactose intolerance, or diarrhea.

A client with Parkinson disease is undergoing a swallowing assessment because the client has recently developed adventitious lung sounds. The client's nutritional needs should be met by what method? A. Total parenteral nutrition (TPN) B. Provision of a low-residue diet C. Semisolid food with thick liquids D. Minced foods and a fluid restriction

ANS: C Rationale: A semisolid diet with thick liquids is easier for a client with swallowing difficulties to consume than is a solid diet. Low-residue foods and fluid restriction are unnecessary and counterproductive to the client's nutritional status. The client's status does not warrant TPN until all other options have been ruled out.

A client with amyotrophic lateral sclerosis (ALS) is being visited by the home health nurse who is creating a care plan. Which of the following nursing diagnoses is most likely for a client with this condition? A. Chronic confusion B. Impaired urinary elimination C. Impaired verbal communication D. Bowel incontinence

ANS: C Rationale: Impaired communication is an appropriate nursing diagnosis; the voice in clients with ALS assumes a nasal sound and articulation becomes so disrupted that speech is unintelligible. Intellectual function is marginally impaired in clients with late ALS. Usually, the anal and bladder sphincters are intact because the spinal nerves that control muscles of the rectum and urinary bladder are not affected.

A client has been recently diagnosed with myasthenia gravis. Which is indicative of a person diagnosed with myasthenia gravis? A. Excessive serotonin activity in the brain B. Decreased dopamine activity in the brain C. Impairment of acetylcholine binding to muscle cells D. Defects in the expression of acetylcholine receptors

ANS: C Rationale: In myasthenia gravis, acetylcholine binding to muscle cells is impaired. A breakdown essentially occurs in the communication between nerves and muscles. This results in weakness of extremities and difficulties with speech and chewing. Many neurological disorders are due, at least in part, to an imbalance in neurotransmitters. Decreased dopamine activity in the brain is suggestive of Parkinson. Excessive or too much serotonin activity in the brain can cause a variety of mild to severe symptoms. Some of these include high blood pressure, shivering, confusion and/or high fever. Defects in the expression of acetylcholine receptors is more indicative of amyotrophic lateral sclerosis (ALS). ALS affects motor neurons directly.

A 33-year-old client presents at the clinic with reports of weakness, incoordination, dizziness, and loss of balance. The client is hospitalized and diagnosed with MS. What sign or symptom, revealed during the initial assessment, is typical of MS? A. Diplopia, history of increased fatigue, and decreased or absent deep tendon reflexes B. Flexor spasm, clonus, and negative Babinski reflex C. Blurred vision, intention tremor, and urinary hesitancy D. Hyperactive abdominal reflexes and history of unsteady gait and episodic paresthesia in both legs

ANS: C Rationale: Optic neuritis, leading to blurred vision, is a common early sign of MS, as is intention tremor (tremor when performing an activity). Nerve damage can cause urinary hesitancy. In MS, deep tendon reflexes are increased or hyperactive. A positive Babinski reflex is found in MS. Abdominal reflexes are absent with MS.

The critical care nurse is admitting a client in myasthenic crisis to the ICU. The nurse should prioritize what nursing action in the immediate care of this client? A. Suctioning secretions B. Facilitating ABG analysis C. Providing ventilatory assistance D. Administering tube feedings

ANS: C Rationale: Providing ventilatory assistance takes precedence in the immediate management of the client with myasthenic crisis. It may be necessary to suction secretions and/or provide tube feedings, but they are not the priority for this client. ABG analysis will be done, but this is also not the priority.

The nurse caring for a client in ICU diagnosed with Guillain-Barré syndrome should prioritize monitoring for what potential complication? A. Impaired skin integrity B. Cognitive deficits C. Hemorrhage D. Autonomic dysfunction

ANS: D Rationale: Based on the assessment data, potential complications that may develop include respiratory failure and autonomic dysfunction. Skin breakdown, decreased cognition, and hemorrhage are not complications of Guillain-Barré syndrome.

The nurse planning caring for a client diagnosed with Guillain-Barré syndrome. The nurse's communication with the client should reflect the possibility of which sign or symptom of the disease? A. Intermittent hearing loss B. Tinnitus C. Tongue enlargement D. Vocal paralysis

ANS: D Rationale: Guillain-Barré syndrome is a disorder of the vagus nerve. Clinical manifestations include vocal paralysis, dysphagia, and voice changes (temporary or permanent hoarseness). Hearing deficits, tinnitus, and tongue enlargement are not associated with this disease.

A client has just been diagnosed with Parkinson disease and the nurse is planning the client's subsequent care for the home setting. What nursing diagnosis should the nurse address when educating the client's family? A. Risk for infection B. Impaired spontaneous ventilation C. Unilateral neglect D. Risk for injury

ANS: D Rationale: Individuals with Parkinson disease face a significant risk for injury related to the effects of dyskinesia. Unilateral neglect is not characteristic of the disease, which affects both sides of the body. Parkinson disease does not directly constitute a risk for infection or impaired respiration.

The nurse is preparing to provide care for a client diagnosed with myasthenia gravis. The nurse should know that the signs and symptoms of the disease are the result of what issue? 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

ANS: D Rationale: Myasthenia gravis is characterized by a weakness of muscles, especially in the face and throat, caused by a lower neuron lesion at the myoneural junction. It is not a genetic disorder. A combined upper and lower neuron lesion generally occurs as a result of spinal injuries. A lesion involving cranial nerves and their axons in the spinal cord would cause decreased conduction of impulses at an upper motor neuron.

A middle-aged client has sought care from the primary provider and undergone diagnostic testing that has resulted in a diagnosis of MS. What sign or symptom is most likely to have prompted the client to seek care? A. Cognitive declines B. Personality changes C. Contractures D. Difficulty in coordination

ANS: D Rationale: The symptoms of MS most commonly reported are fatigue, depression, weakness, numbness, difficulty in coordination, loss of balance, spasticity, and pain. Cognitive changes and contractures usually occur later in the disease.

The nurse is caring for a patient with MS who is having spasticity in the lower extremities that decreases physical mobility. What interventions can the nurse provide to assist with relieving the spasms? Select all that apply. A. Assist with a rigorous exercise program to prevent contractures. B. Apply warm compresses to the affected areas. C. Allow the patient adequate time to perform exercises D. Have the patient take a hot tub bath to allow muscle relaxation. E. Demonstrate daily muscle stretching exercises.

B, C, E. Warm packs may be beneficial for relieving spasms, but hot baths should be avoided because of risk of burn injury secondary to sensory loss and increasing symptoms that may occur with elevation of the body temperature. Daily exercises for muscle stretching are prescribed to minimize joint contractures. The patient should not be hurried in any of these activities, because this often increases spasticity.

A client is hospitalized with Guillain-Barré syndrome. Which nursing assessment finding is most significant? A. Soft, nondistended abdomen B. Uneven, labored respirations C. Warm, dry skin D. Urine output of 40 ml/hour

B. A characteristic feature of Guillain-Barré syndrome is ascending weakness, which usually begins in the legs and progresses upward to the trunk, arms, and face. Respiratory muscle weakness, evidenced by uneven, labored respirations, is a particularly dangerous effect of this disease progression because it may lead to respiratory failure and death. Therefore, although warm, dry skin; urine output of 40 ml/hour; and a soft, nondistended abdomen are pertinent assessment data, those related to respiratory function and status are most significant.

Which of the following neurotransmitters are deficient in myasthenia gravis? A. Dopamine B. Acetylcholine C. GABA D. Serotonin

B. A decrease in the amount of acetylcholine causes myasthenia gravis. A decrease of serotonin leads to depression. Parkinson's disease is caused by a depletion of dopamine. Decreased levels of GABA may cause seizures.

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. Fever and cough B. Muscle weakness and hyporeflexia of the lower extremities C. Ptosis and muscle weakness of upper extremities D. Hyporeflexia and skin rash

B. Guillain-Barre syndrome typically begins with muscle weakness and diminished reflexes of the lower extremities. Fever, skin rash, cough, and ptosis are not signs/symptoms associated with Guillain-Barre.

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. Mestinon therapy is initiated. B. Antibodies are removed from the plasma. C. The thymus gland is removed. D. Immune globulin is given intravenously.

B. Plasmapheresis is a technique in which antibodies are removed from plasma and the plasma is returned to the client. The other three choices are appropriate treatments for myasthenia gravis, but are not related to plasmapheresis.

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. You'll first regain use of your legs and then your arms. B. The paralysis caused by this disease is temporary. C. You'll be permanently paralyzed; however, you won't have any sensory loss. D. It must be hard to accept the permanency of your paralysis.

B. The nurse should inform the client that the paralysis that accompanies Guillain-Barré syndrome is only temporary. Return of motor function begins proximally and extends distally in the legs.

Which nursing intervention is the priority for a client in myasthenic crisis? A. Ensuring adequate nutritional support B. Preparing for plasmapheresis C. Assessing respiratory effort D. Administering intravenous immunoglobulin (IVIG) per orders

C. A client in myasthenic crisis has severe muscle weakness, including the muscles needed to support respiratory effort. Myasthenic crisis can lead to respiratory failure and death if not recognized early. Administering IVIG, preparing for plasmapheresis, and ensuring adequate nutritional support are important and appropriate interventions, but maintaining adequate respiratory status or support is the priority during the crisis.

Which of the following tests confirms the diagnosis of myasthenia gravis (MG)? A. Computed tomography (CT) scan B. Serum studies C. Tensilon test D. Electromyogram (EMG)

C. Edrophonium chloride (Tensilon) is an acetylcholinesterase inhibitor that stops the breakdown of acetylcholine. The drug is used because it has a rapid onset of 30 seconds and a short duration of 5 minutes. Immediate improvement in muscle strength after administration of this agent represents a positive test and usually confirms the diagnosis. The presence of acetylcholine receptor antibodies is identified in serum. Repetitive nerve stimulation demonstrates a decrease in successive action potentials. The thymus gland may be enlarged in MG, and a T scan of the mediastinum is performed to detect thymoma or hyperplasia of the thymus.

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

C. The survival rate of Guillain-Barré syndrome is approximately 90%. The client may make a full recovery or suffer from some residual deficits. Telling the parents not to worry dismisses their feelings and does not address their concerns. Progression of Guillain-Barré syndrome to the diaphragm does not significantly decrease the survival rate, but it does increase the chance of residual deficits. The family should be given information about Guillain-Barré syndrome and the generally favorable prognosis. With no prognosis offered, the parents are not having their concerns addressed.

A patient has been diagnosed with meningococcal meningitis at a community living home. When should prophylactic therapy begin for those who have had close contact with the patient? A. Within 72 hours after exposure B. Therapy is not necessary prophylactically and should only be used if the person develops symptoms. C. Within 48 hours after exposure D. Within 24 hours after exposure

D. People in close contact with patients with meningococcal meningitis should be treated with antimicrobial chemoprophylaxis using rifampin (Rifadin), ciprofloxacin hydrochloride (Cipro), or ceftriaxone sodium (Rocephin). Therapy should be started within 24 hours after exposure because a delay in the initiation of therapy limits the effectiveness of the prophylaxis.

The diagnosis of multiple sclerosis is based on which test? A. Evoked potential studies B. Neuropsychological testing C. CSF electrophoresis D. Magnetic resonance imaging

D. The diagnosis of MS is based on the presence of multiple plaques in the central nervous system observed with magnetic resonance imaging. Electrophoresis of CSF identifies the presence of oligoclonal banding. Evoked potential studies can help define the extent of the disease process and monitor changes. Neuropsychological testing may be indicated to assess cognitive impairment.