Elsevier Adaptive Quizzing-Neurological Questions

A patient with systemic lupus erythematosus (SLE) is brought to the emergency room by ambulance after a grand mal seizure. The patient's family is visibly distraught, wondering if the patient is going to be diagnosed with another chronic medical disease. What is the nurse's best response? -"Seizures are caused by epilepsy; this is not related to SLE." -"Seizures are a common occurrence in SLE; this is nothing to worry about." -"Seizures are a common occurrence in SLE but can ideally be managed with oral medications." -"Seizures are extremely rare in patients with SLE; the patient will need a further workup to determine the cause of the seizure."

"Seizures are a common occurrence in SLE but can ideally be managed with oral medications."

The nurse is educating a student nurse about how metabolic disturbances cause seizures. Which statements made by the student nurse indicate effective learning? Select all that apply. "Seizures can be caused by a decrease in oxygen levels." "Seizures can be caused by an increase in pH of the blood." "Seizures can be caused by a decrease in pH of the blood." "Seizures can be caused by a decrease in blood glucose levels." "Seizures can be caused by an increase in blood glucose levels."

"Seizures can be caused by a decrease in oxygen levels." "Seizures can be caused by a decrease in pH of the blood." "Seizures can be caused by a decrease in blood glucose levels."

Which statement regarding cluster headaches is true? "The pain is unilateral." "The pain lasts for 4 to 72 hours." "The pain is associated with nausea." "The pain may switch to the anterior side."

"The pain is unilateral"

Which measure is a priority for a nurse to include in the plan of care for a patient who has multiple sclerosis? -Referring the patient for genetic counseling -Teaching the patient about medications used during acute exacerbations -Assisting the patient in identifying the factors that precipitate exacerbations -Instructing the patient in the proper technique for self-administration of an enema

-Assisting the patient in identifying the factors that precipitate exacerbations

A patient complains of difficulty with eye and eyelid movement, chewing, swallowing, speaking, and breathing. Which findings in the patient's diagnostic results would indicate the presence of myasthenia gravis? Select all that apply. -Alteration of one copy of gene in DNA test -Improved muscle contractibility during the Tensilon test -Presence of three signs of the classic triad: tremor, rigidity, and bradykinesia -Decreased response to repeated stimulation of hand muscles during EMG test -Increased immunoglobulin G levels in the cerebrospinal fluid during CSF analysis test

-Improved muscle contractibility during the Tensilon test -Decreased response to repeated stimulation of hand muscles during EMG test

Which criterion is included to establish that a patient has Parkinson's disease? Select all that apply. -Decreased serum dopamine levels. -Tumor present in the thymus gland. -Positive response to antiparkinsonian medications. -Magnetic resonance imaging (MRI) shows areas of plaque on cranial nerves. -Presence of two of the three classic features: rigidity, bradykinesia, and tremor.

-Positive response to antiparkinsonian medications. -Presence of two of the three classic features: rigidity, bradykinesia, and tremor.

A patient with a suspected neurologic disorder has weakness of the limbs, blurred vision, patchy blindness, and bowel and bladder dysfunction. Which clinical findings would support the diagnosis of multiple sclerosis? Select all that apply. -Presence of visual and auditory evoked potential -Presence of IgM antibodies in the cerebrospinal fluid -Presence of increased IgG antibodies in the cerebrospinal fluid -Presence of an altered copy of the HTT gene located on chromosome 4 -Presence of inflammation, tissue breakdown, and atropy of the spinal cord in the MRI

-Presence of visual and auditory evoked potential -Presence of increased IgG antibodies in the cerebrospinal fluid -Presence of inflammation, tissue breakdown, and atropy of the spinal cord in the MRI

A patient was brought to the hospital after a seizure episode. Which characteristic pattern explained by the patient's caregiver would be useful in diagnosing it as tonic-clonic seizure? -Stiffening of the body for 20 seconds, followed by jerking of the extremities for 40 seconds -Jerking of the extremities for 20 seconds, followed by stiffening of the body for 40 seconds -Stiffening of the body for 30 seconds, followed by jerking of the extremities for 10 seconds -Jerking of the extremities for 20 seconds, followed by stiffening of the body for 10 seconds

-Stiffening of the body for 20 seconds, followed by jerking of the extremities for 40 seconds

A patient with epilepsy who has been taking oral gabapentin was admitted to the emergency department in an unconscious state. The patient is experiencing seizures that are reoccurring in rapid succession. Which treatment option would be beneficial in alleviating the symptoms of the patient? Administer saline intravenously Administer dextrose intravenously Administer diazepam intravenously Administer gabapentin intravenously

Administer diazepam intravenously [rationale: Seizures that reoccur in rapid succession without the patient regaining consciousness are a characteristic feature of status epilepticus. It is a serious complication of epilepsy and occurs with any type of seizure. The most commonly used drug to treat status epilepticus is diazepam.]

A patient with Parkinson's disease has lost 35 pounds over two months. A swallowing study shows that the patient is able to swallow and does not aspirate. What suggestion should the nurse discuss with the patient and spouse to improve nutrition? -Allow adequate time for the patient to eat meals. -Administer prescribed carbidopa/levodopa with a protein drink. -Encourage the patient to eat at least every two hours while awake. -Include foods that are chewy so the patient builds up the jaw muscles.

Allow adequate time for the patient to eat meals.

What instructions should a nurse give to a patient who has focal seizures well controlled with phenytoin and who has mild gingival hyperplasia? Select all that apply. A. The drug should be changed immediately. B. Regular tooth brushing can limit hyperplasia. C. Gingival hyperplasia is not related to phenytoin. D. Surgical repair of gingival tissue will be required. E. Regular flossing can control gingival tissue growth.

B. Regular tooth brushing can limit hyperplasia E. Regular flossing can control gingival tissue growth

What part of the central nervous system is involved in migraine headaches? Cerebrum Spinal cord Cerebral cortex Medulla oblongata

Cerebral Cortex

The nurse visits a patient who is being treated with phenytoin for seizures. Which instruction is important to prevent precipitation of seizures in this patient? A. Notify the health care provider about unusual hair growth. B. Practice good dental hygiene to control gingival hyperplasia. C. Maintain a healthy lifestyle with regular exercise and nutritious diet. D. Do not stop the drug abruptly without consulting the health care provider.

D. Do not stop the drug abruptly without consulting the health care provider.

The nurse is reviewing the data of a pediatric patient who is admitted in the hospital. Which findings indicate that the patient is suffering from typical absence seizures? Select all that apply. Birth injury Daydreaming Hyperventilation Loss of consciousness Electroencephalogram (EEG) results

Day dreaming Hyperventilation ECG results

The nurse is caring for a patient with multiple sclerosis in remission. What information should the nurse include when teaching the patient about advantages of exercise for multiple sclerosis? Select all that apply. Decreases spasticity Increases coordination Helps to regain bladder control Delays the demyelination process Retrains unaffected muscles to substitute for impaired ones

Decreases spasticity Increases coordination Retrains unaffected muscles to substitute for impaired ones

A patient has been found to have amyotrophic lateral sclerosis. What classic symptom of the disorder does the nurse recognize? Dysuria Dyspnea Dysphagia Dysreflexia

Dysphagia [rationale: Weakness of the muscles of the legs that progresses to weakness in the upper extremities, dysarthria (difficulty in speech), and dysphagia (difficulty swallowing) are all classic symptoms of ALS. Although dyspnea and dysuria may be present in later stages of ALS, they are not considered classic symptoms of the disease. Dysreflexia is seen in patients with spinal cord injuries; it is a life-threatening, uninhibited response of the nervous system to a noxious stimuli and is not seen in ALS.]

The caregivers of a patient with acute seizures ask the nurse what they should do if another episode of seizure occurs at home after discharge. What should the nurse tell them? Select all that apply. Ease the patient to the floor. Loosen constrictive clothes. Restrain the patient to a bed. Protect the patient from any injury. Bring the patient to the hospital immediately.

Ease the patient to the floor. Loosen constrictive clothes. Protect the patient from any injury.

The nurse teaches a patient newly diagnosed with migraine headaches about dietary restrictions aimed at headache prevention. During follow-up visits, the patient reports a recurrence of migraine attacks. Which action by the patient is responsible for this condition? Eating corn Eating cheese Eating soybeans Eating cucumbers

Eating cheese

A patient displays jerky muscle movements of the extremities and is incontinent of bowel and bladder. With what does the nurse recognize these clinical manifestations to be associated? Aura seizures Postictal seizures Generalized seizures Simple partial seizures

Generalized seizures [rationale: In a generalized, or grand mal, seizure the patient may experience incontinence along with jerking, or tonic-clonic, movements of the entire body. An aura is an individualized, subjective auditory, visual, olfactory, or taste hallucination that may precede a seizure. Postictal is the period of recovery after a seizure; it may be characterized by confusion and sedation. A simple partial seizure may be isolated to one side of the brain and remain partial or focal in nature, or it may spread to involve the entire brain, culminating in a generalized tonic-clonic seizure. Simple partial seizures generally do not involve loss of consciousness and rarely last more than one minute.]

A patient diagnosed with seizures is advised to take phenytoin. About which common side effects of phenytoin should the nurse inform the patient? Select all that apply. Hirsutism Neuropathy Weight gain Memory loss Gingival hyperplasia

Hirsutism Gingival hyperplasia

Which extracranial condition is associated with seizures? Migraine Meningitis Brain tumor Hypertension

Hypertension [rationale: Hypertension is an extracranial condition that is associated with seizures. Migraines, brain tumors, and meningitis are all intracranial conditions that can be associated with seizures.]

When performing a physical assessment of a patient with myasthenia gravis, what clinical manifestations is the nurse likely to find? Select all that apply. Muscle atrophy Abnormal reflexes Impaired facial mobility Difficulty in swallowing food Voice fading after a long conversation

Impaired facial mobility Difficulty in swallowing food Voice fading after a long conversation

The nurse performs a pull test on a patient with suspected Parkinson's disease. The nurse stands behind the patient and gives a tug backward on the shoulder. What would be the patient's reaction if he has Parkinson's disease? Lose balance and sit down Lose balance and fall forward Lose balance and fall backward Lose balance and become unconscious

Lose balance and fall backward

A patient complains of pain on one side of the head along with nausea, vomiting, and sensitivity to light. The primary health care provider prescribes corticosteroids. Which is the possible condition of the patient? Migraine Multiple sclerosis Cluster headache Parkinson's disease

Migraine

The patient with Parkinson's disease has a pulse oximetry reading of 72% but the patient is not displaying any other signs of decreased oxygenation. What most likely is contributing to the patient's low SpO 2 level? Motion Anemia Dark skin color Thick acrylic nails

Motion [rationale: Motion is the most likely cause of the low SpO 2 for this patient with Parkinson's disease. Anemia, dark skin color, and thick acrylic nails, as well as low perfusion, bright fluorescent lights, and intravascular dyes also may cause an inaccurate pulse oximetry result. There is no mention of these or any reason to suspect these in this question.]

A patient who has multiple sclerosis has received a prescription for a medication to alleviate the major symptoms of the disease. The nurse expects the medication to be in what drug classification? Antipsychotics Muscle relaxant Antihypertensive Narcotic analgesic

Muscle relaxant

A patient with myasthenia gravis is admitted to the hospital in respiratory failure and diagnosed with myasthenic crisis. Which of the factors in the patient's current life situation led to the development of this myasthenic crisis? Select all that apply. Omitted pyridostigmine previous day. Attended funeral of family member earlier in week. Took antibiotic prescribed for urinary tract infection. Diagnosed with urinary tract infection previous week. Continued taking prescribed corticosteroid every other day.

Omitted pyridostigmine previous day. Attended funeral of family member earlier in week. Took antibiotic prescribed for urinary tract infection. Diagnosed with urinary tract infection previous week. [rationale: Exacerbations and crises can be precipitated by many factors including infection (patient's urinary tract infection), emotional stress (funeral of family member), reaction to medications (antibiotic prescribed for urinary tract infection), and inadequate anticholinesterase medications. Pyridostigmine is an anticholinesterase medication that prolongs acetylcholine present in the neuromuscular junction to improve muscle strength.]

Which neurodegenerative disorder is characterized by rigidity and bradykinesia? Multiple sclerosis Parkinson's disease Lou Gehrig's disease Huntington's disease

Parkinson's disease

A patient reports excessive daytime sleepiness. The nurse reviews the patient's medical record and notes a decreased dopamine level. The nurse expects that the patient will be diagnosed with what? Narcolepsy Jet lag disorder Alzheimer's disease Parkinson's disease

Parkinson's disease [rationale: Degeneration of dopamine neurons in the substantia nigra occurs in patients with Parkinson's disease; this leads to excessive daytime sleepiness. In narcolepsy syndrome, there is a decreased level of orexin. It results in an uncontrollable urge to sleep. Jet lag occurs when a person travels across multiple time zones. In the case of Alzheimer's disease, there is loss of cholinergic neurons in the basal forebrain, which causes sleep disturbances.]

Which patient will be at greater risk of sustaining a head injury according to the data given below? Patient A Patient B Patient C Patient D [refer to image attached]

Patient C [rationale: Patient C, who sustains no jerking and a sudden loss of muscle tone, may have atonic seizures. Because its onset is sudden, patients with atonic seizures are at a greater risk of head injury. Patient A, who experiences excessive jerking of the extremities and increased muscle tone, may have myoclonic seizures. Clonic seizures may be seen in patient B, who experiences a sudden loss of muscle tone, followed by limb jerking. Patient D, who has increased muscle tone and no jerks, may have tonic seizures.]

A patient with myasthenia gravis is concerned whether he or she will need a thymectomy. For which patients is thymectomy performed? Select all that apply. Patients with thymoma Patients with cholinergic crisis Patients with a positive Tensilon test Patients with purely ocular myasthenia gravis Patients between the ages of puberty and about 65 years

Patients with thymoma. Patients with purely ocular myasthenia gravis. Patients between the ages of puberty and about 65 years.

Which is the primary drug of choice for tonic-clonic seizures? Phenytoin Gabapentin Clonazepam Ethosuximide

Phenytoin

The nurse is caring for a patient with suspected Parkinson's disease. What is an initial symptom of the disease? Akinesia Aspiration Forgetfulness Pill-rolling tremors

Pill-rolling tremors

A patient diagnosed with myasthenia gravis reports difficulty in swallowing, chewing, eye movement, and facial mobility. Which drugs are most suitable for the patient? Select all that apply. Tramadol Prednisone Azathioprine Chlorzoxazone Pyridostigmine

Prednisone Azathioprine Pyridostigmine

What is the nursing action of highest priority to be taken with a patient who experiences a generalized tonic-clonic seizure? Restraining the arms and legs Controlling head movements Protecting the head and extremities Inserting a tongue blade between the teeth

Protecting the head and extremities

A patient has been diagnosed with amyotrophic lateral sclerosis (ALS). What nursing intervention is most important to help prevent a common cause of death for patients with ALS? Reduce fat intake Reduce the risk of aspiration Decrease injury related to falls Decrease pain secondary to muscle weakness

Reduce the risk of aspiration. [rationale: Reducing the risk of aspiration can help prevent respiratory infections that are a common cause of death from deteriorating muscle function.]

A patient with multiple sclerosis has an exacerbation of sensory deficits. Which nursing diagnostic statement should be assigned highest priority? Risk for injury Acute confusion Fluid volume deficit Ineffective thermoregulation

Risk for injury [rationale: In multiple sclerosis, one side is usually affected more than the other. Therefore the gait is unsteady, so the risk for falls is increased. Acute confusion may be a manifestation experienced by some patients later in the multiple sclerosis disease process. Deficient fluid volume and ineffective thermoregulation are not generally affected by multiple sclerosis. Visual disturbances and muscle spasticity may also contribute to the risk for injury.]

The nurse is teaching home care measures to the caregiver of a patient with seizures. Which action made by the patient's caregiver during an acute seizure episode indicates the need for additional teaching? Turning the patient to the side Loosening the patient's tight clothing Easing the patient to the floor, if seated Sending the patient to hospital immediately after a single seizure

Sending the patient to hospital immediately after a single seizure

Which characteristic feature is exclusively seen in a complex focal seizure? Jerking of the limbs Smacking of the lips Loss of consciousness Increased muscle tone

Smacking of the lips [rationale: Smacking of the lips is the characteristic feature seen only in complex focal seizures. Jerking of the limbs, loss of consciousness, and increased muscle tone are seen in all other types of seizures. Sometimes focal seizures may spread across the entire brain and culminate in a generalized tonic-clonic seizure. This results in symptoms such as jerking of the limbs, loss of consciousness, increased muscle tone, and lip smacking]

Which type of seizure lasts longer than five minutes and occurs in rapid succession without return to consciousness between seizures? Epilepsy Tonic seizure Absence seizure Status epilepticus

Status epilepticus

A patient with head trauma is being sedated and is on a ventilator in the intensive care unit. What type of seizure might this patient experience? Atonic seizure Myoclonic seizure Subclinical seizure Tonic-clonic seizure

Subclinical seizure [rationale: In subclinical seizures, the sedated patient experiences seizures, but external signs are not visible due to the sedative medication. In atonic seizures, the external signs like paroxysmal loss of muscle tone are visible. In myoclonic seizures, sudden and excessive jerks in the body are observed. In tonic-clonic seizures, the skin feels warm and cyanosis is visible.]

Which drug is used as a first line therapy for severe migraines? Propanolol Topiramate Sumatriptan Amitriptyline

Sumatriptan

When taking the history of a patient with a migraine headache, what features of a migraine headache is the patient likely to report? Select all that apply. The headache is usually unilateral. The headache is preceded by an aura. The headache is sharp and stabbing in nature. The headache lasts from a few minutes to three hours. The headache is usually triggered by certain foods, such as chocolate.

The headache is usually unilateral. The headache is preceded by an aura. The headache is usually triggered by certain foods, such as chocolate.

The nurse is caring for a patient who suddenly loses consciousness and then stiffens for about 15 seconds, followed by jerking of the extremities. How does the nurse document this occurrence in the medical record? Focal seizure Tonic-clonic seizure Psychogenic seizure Typical absence seizure

Tonic-clonic seizures

What nursing intervention would be beneficial to a patient with a severe migraine? Playing loud music Changing the bed linen Turning off the lights in the room Giving warm compresses on the neck

Turning off the lights in the room

What seizure disorder typically occurs in children and rarely continues beyond adolescence? Focal seizures Tonic-clonic seizures Psychogenic seizures Typical absence seizures

Typical absence seizures

The nurse assesses a patient for signs of petit mal, or absence, seizures. What is the classic sign of this seizure disorder? Dizziness Intense anxiety Stiffening of the body Vacant facial expression

Vacant facial expression

A patient being treated for multiple sclerosis complains of flu-like symptoms and reports feeling depressed. The patient also reports having frequent thoughts of committing suicide. Which drug in the patient's prescription may be responsible for these symptoms? β-interferon Natalizumab Mitoxantrone Dalfampridine

β-interferon