Med Surg Exam 1

The nurse is teaching a client about starting glatiramer acetate. Which statement by the client indicates a need for further teaching? "I need to take this drug before breakfast at least once a week while I have weakness." "If I get flulike symptoms, which is not very likely, I'll take ibuprofen or acetaminophen." "I will avoid crowds and people who have infections because I'll be immunosuppressed." "I will rotate the site of the injections to prevent skin reactions from the drug."

"I need to take this drug before breakfast at least once a week while I have weakness." Because this drug is given parenterally, there is no need to take it with or without food. All of the other client statements are accurate and demonstrates client understanding. INCORRECT

A female client with newly diagnosed migraines is being discharged with a prescription for sumatriptan. Which statement by the client indicates an understanding of the nurse's discharge instructions? "Birth control is not needed while taking sumatriptan." "Sumatriptan can be taken as a last resort." "I will report any chest pain right away." "St. John's wort can also be taken to help my symptoms."

"I will report any chest pain right away."

The client is struggling with use of eating utensils. Which rehabilitation team member is brought in to help the client with this problem? A. Occupational therapist B. Physical therapist C. Activity therapist D. Physiatrist

A. Occupational therapist

The nurse is developing a teaching plan for a client with a history of low back pain. Which instructions does the nurse plan to include in teaching the client about preventing low back pain and injury? (Select all that apply.) Select all that apply. "When lifting something, the back should be straight and the knees bent." "Do not wear high-heeled shoes." "Standing for long periods of time will help to prevent low back pain." "Begin a regular exercise program to strengthen your back." "Keep weight within 50% of ideal body weight."

"When lifting something, the back should be straight and the knees bent." "Do not wear high-heeled shoes." "Begin a regular exercise program to strengthen your back."

Which client does the RN in the rehabilitation unit plan to assess first? A 63 year old who had a myocardial infarction (MI) and expresses anxiety about walking A 56 year old with a spinal cord injury and new-onset redness over the sacral area A 70 year old with a joint replacement who needs medication before exercising A 45 year old with multiple sclerosis (MS) reporting constipation

A 56 year old with a spinal cord injury and new-onset redness over the sacral area

A client in rehabilitation says, "This is too hard. My life will never be the same again!" What is the nurse's BEST response? A. "How did you handle challenges before you were injured?" B. "Why don't you try a relaxation exercise?" C. "Should I call a family member to help?" D. "You will be fine, don't worry so much."

A. "How did you handle challenges before you were injured?"

A client has been diagnosed with primary progressive multiple sclerosis (PPMS) and the nurse is providing education at the clinic. What statement by the client indicates the need for further teaching? A. "It's important I work out in the afternoon so my muscles are warmed up." B. "I can alternate wearing my eye patch between eyes for double vision." C. "I should keep my home clutter free so I don't fall." D. "I always keep my medications in the same place."

A. "It's important I work out in the afternoon so my muscles are warmed up." If a client has diplopia, wearing an eye patch and alternating it between eyes every few hours may relieve the symptoms. Keeping the home organized and clutter free will decrease the risk of falls. Keeping medications and other important belongings in the same place and maintaining a routine may help with memory deficits that may occur with MS.

A client with right-sided weakness is receiving antihypertensive medications. What does the RN communicate to the physical therapist (PT), who is planning to help the client walk? A. "Move the client from lying to standing slowly." B. "Monitor the client for weakness and fatigue during exercise." C. "Use a gait belt when ambulating the client." D. "Remind the client to use the left side to grip."

A. "Move the client from lying to standing slowly."

The nurse has been effectively using digital stimulation in older adult clients with constipation problems. For which client is this practice unsafe? A. A 70 year old with recently diagnosed atrial fibrillation B. A 68 year old with a long history of multiple sclerosis (MS) C. A 74 year old who is 4 months poststroke D. An 84 year old with progressive dementia and confusion

A. A 70 year old with recently diagnosed atrial fibrillation

A client with severe muscle spasticity has been prescribed tizanidine. The nurse instructs the client about which adverse effect of tizanidine? A. Drowsiness B. Hypertension C. Tachycardia D. Hirsutism

A. Drowsiness

The nurse administered a prescribed dose of natalizumab for a client who is diagnosed with multiple sclerosis. For what adverse drug event will the nurse assess as the priority for this client within the first hour after administration? A. Anaphylactic or allergic reaction B. Elevation of liver enzymes C. Infection D. Neurologic changes such as confusion

A. Anaphylactic or allergic reaction While all of these adverse drug events are associated with natalizumab, the one that can occur within the first hour after administration is anaphylaxis. Infection can also cause fatality if it becomes systemic or the client develops progressive multifocal leukoencephalopathy (PML) which can cause mental and other neurologic changes.

A client with a T6 spinal cord injury who is on the rehabilitation unit suddenly develops facial flushing and reports a severe headache. Blood pressure is elevated, and the heart rate is slow. Which action does the nurse take first? A. Help the client sit up. B. Check for fecal impaction. C. Loosen the client's clothing. D. Insert a straight catheter.

A. Help the client sit up.

The nurse is planning health teaching for a client starting on donepezil for Alzheimer disease (AD). For which side effect will the nurse teach the family to monitor? A. Low pulse rate B. Elevated body temperature C. Low oxygen saturation D. High blood pressure

A. Low pulse rate

The nurse is caring for a client with a spinal cord injury resulting from a diving accident, who has a halo fixator and an indwelling urinary catheter in place. The nurse notes that the blood pressure is elevated and that the client is reporting a severe headache. The nurse anticipates that the primary health care provider will prescribe which medication? A. Nifedipine B. Dopamine hydrochloride C. Ziconotide D. Methylprednisolone

A. Nifedipine The nurse anticipates that the primary health care provider will prescribe nifedipine or nitrates for a spinal cord injury client who has an elevated blood pressure and severe headache. This client is experiencing autonomic dysreflexia (AD). If AD is not treated, a hemorrhagic stroke can occur

A client is admitted with a spinal cord injury at the seventh cervical vertebra secondary to a gunshot wound. Which nursing intervention is the priority for the client at this time? A. Positioning the client to maximize ventilation potential B. Taking vital signs every 2 hours C. Inserting an indwelling urinary catheter D. Monitoring the client's nutritional status

A. Positioning the client to maximize ventilation potential

The nurse is administering the intake assessment for a newly admitted client with a history of seizures. The client suddenly begins to seize. What does the nurse do next? A. Positions the client on the side. B. Restrains the client. C. Forces a tongue blade in the mouth. D. Documents the length and time of the seizure.

A. Positions the client on the side.

The nurse is caring for a client with early stage (stage 1) Alzheimer disease (AD). Which nursing action is most appropriate when caring for this client? A. Provide a structured environment. B. Use validation therapy. C. Give a cholinesterase inhibitor. D. Refer the client to the social worker.

A. Provide a structured environment.

A client with lower motor neuron spinal cord dysfunction has not voided, and a bladder scan shows 700 mL of urine in the bladder. Using the client's bladder training plan, what action does the staff RN advise a new graduate nurse to take first with this client? A. Remind the client to try the Valsalva maneuver. B. Insert a straight catheter to empty the bladder. C. Reassess the client's bladder volume in 2 hours. D. Administer a dose of oxybutynin chloride (Ditropan).

A. Remind the client to try the Valsalva maneuver.

The nurse is caring for a client in a bowel retraining program. Which nursing actions will facilitate consistent defecation patterns? (Select all that apply.) Use digital stimulation inserting the finger into the anus for one minute. Administer bisacodyl suppository daily. Administer the bisacodyl suppository after the client eats a meal. Encourage consumption of a high-fiber diet. Insert the bisacodyl suppository just inside the anal sphincter.

Administer the bisacodyl suppository after the client eats a meal. Encourage consumption of a high-fiber diet.

The nurse is caring for a client who is diagnosed with middle stage (moderate) Alzheimer disease. What assessment findings would the nurse expect? (Select all that apply.) . Agnosia Mild impaired cognition Sleeping problems Seizures Wandering Psychoses

Agnosia Sleeping problems Seizures Wandering Psychoses

The nurse is caring for a client who sustained a complete cervical spinal cord injury and is at risk for autonomic dysreflexia. Which assessment findings would the nurse anticipate if this complication occurs? (Select all that apply.) Select all that apply. Goose bumps above and/or below the injury level Sudden and severe hypertension Severe throbbing headache Profuse sweating above the injury level Nasal congestion and blurred vision Facial and skin flushing

All

The nurse is in the room while the assistive personnel (AP) is providing incontinence care to a client. Which action by the AP would require the nurse to intervene? (Select all that apply.) Select all that apply. Allowing the client to remain in the same position. Applying moisture barrier cream to the perineal area. Using soap and water to clean soiled areas on the perineum. Rubbing areas on the sacrum that are slightly red. Drying the sacral area carefully with a towel. Placing a bed pillow between the client's knees.

Allowing the client to remain in the same position. Rubbing areas on the sacrum that are slightly red.

A rehabilitation nurse is teaching the client with a spastic bladder to perform intermittent catheterizations. Which client statement indicates the need for further education? A. "Before I catheterize myself, I will try to urinate." B. "I will catch myself at 9 a.m. and 9 p.m." C. "I will use the Valsalva and Credé maneuvers before trying to urinate." D. "You can teach my son to help me with the catheterizations."

B. "I will catch myself at 9 a.m. and 9 p.m."

The nurse is providing instructions to a client with a cervical spinal cord injury about caring for the halo fixator device. The nurse plans to include which instructions? A. "Avoid using a pillow under the head while sleeping." B. "Begin driving 1 week after discharge." C. "Keep straws available for drinking fluids." C. "Swimming is recommended to keep active."

C. "Keep straws available for drinking fluids." The instructions the nurse include for a client with a halo device is to keep straws available for drinking fluids. The halo device makes it difficult to bring a cup or a glass to the mouth.

Which is the most effective way for a college student to minimize the risk for bacterial meningitis? A. Avoid large crowds. B. Get the meningococcal vaccine. C. Take a high dose vitamin C daily. D. Take prophylactic antibiotics.

B. Get the meningococcal vaccine. The most effective way for a college student to minimize the risk for bacterial meningitis is to get the meningococcal vaccine. Individual's ages 16 to 21 years have the highest rates of meningococcal infection and need to be immunized against the virus.

The nurse is providing medication instructions for a client for whom phenytoin has been ordered for treatment of epilepsy. The nurse instructs the client to avoid which beverage? A. Grape juice B. Grapefruit juice C. Apple juice D. Prune juice

B. Grapefruit juice The nurse instructs the client taking phenytoin for epilepsy to avoid taking grapefruit juice. Some citrus fruits and juices, like grapefruit juice, can interfere with the metabolism of phenytoin potentially leading to an increased blood level and toxicity.

A client with Parkinson disease (PD) is being discharged home with his wife. To ensure success with the management plan, which discharge action is most effective? A. Telling his wife what the client needs B. Involving the client and his wife in developing a plan of care C. Writing up a detailed plan of care according to standards D. Setting up visitations by a home health nurse

B. Involving the client and his wife in developing a plan of care

The nurse is teaching a client, newly diagnosed with migraines, about trigger control. Which statement made by the client demonstrates good understanding of the teaching plan? A. "I need to use fake sugar in my coffee." B. "I can still eat Chinese food." C. "I should not miss any meals." D. "It is okay to drink a few wine coolers."

C. "I should not miss any meals."

The nurse is caring for a client diagnosed with vascular dementia. The nurse recognizes that which health problem is associated with this type of dementia? A. Epilepsy B. Stroke C. Meningitis D. Migraines

B. Stroke Vascular dementia is typically caused by strokes or other cranial vascular disease. The exact cause of Alzheimer disease is not known.

The nurse is collaborating with the rehabilitation therapist to improve mobility skills for a client with a complete high-level spinal cord injury. Which technique is appropriate for this client? A. Use of a mechanical lift to get the client out of bed B. Use of a sliding board (slider) to transfer from bed to a chair C. Use of parallel bars to facilitate ambulation D. Use of a walker to promote balance and prevent muscle atrophy

B. Use of a sliding board (slider) to transfer from bed to a chair The client who has a complete high-level, or cervical, spinal cord injury is tetraplegic (quadriplegic) meaning that he or she does not have control over any extremity. The client has shoulder movement allowing the client to use a sliding board as a "bridge" between the bed and chair.

A client has received preoperative teaching from the nurse for a microdiskectomy. Which statement by the client indicates a correct understanding of the nurse's instruction? A. "I'll need to wear special stockings after the procedure." B. "I can go home 48 hours after the procedure." C. "I can go home the day of the procedure." D. "I'll have a drain in place after the procedure."

C. "I can go home the day of the procedure." " A microdiskectomy is considered minimally invasive surgery (MIS) and does not typically require an inclient hospital stay.

The home health nurse is checking in on a client with dementia and the client's spouse. The spouse confides to the nurse, "I am so tired and worn out." What is the nurse's best response? A. "Establishing goals and a daily plan can help." B. "Can't you take care of your spouse?" C. "Make sure you take some time off and take care of yourself." D. "That's not a very nice thing to say."

C. "Make sure you take some time off and take care of yourself." The nurse's best response to the spouse of the client with dementia is to encourage the wife to take some time off to take care of herself. This response is supportive and reminds the spouse that he or she cannot care for the client when exhausted.

A client with possible multiple sclerosis asks the nurse to explain why she has to have a visual evoked response (VER) test. What statement by the nurse is correct about this diagnostic test? A. "A group of electrodes will be placed on your scalp so to see how your eyes react." B. "You will have to lie very still in a tube for the magnetic imaging of your head and neck." C. "This test will help determine how well the nerves in your eyes transmit a signal." D. "A contrast medium will be used to visualize any changes in your brain."

C. "This test will help determine how well the nerves in your eyes transmit a signal."

A client has just received a bisacodyl suppository. How soon after administration does the nurse expect results to be evident? A. 5 to 10 minutes B. 10 to 15 minutes C. 15 to 30 minutes D. 30 to 45 minutes

C. 15 to 30 minutes

The nurse is assessing a client who was diagnosed with Alzheimer disease (AD) and notes the client has difficulty finding the correct words at times during conversation. What communication alteration would the nurse document? A. Aphasia B. Apraxia C. Anomia D. Agnosia

C. Anomia Anomia is the inability to find words for objects, places, and events, and is a common assessment finding in clients with early AD. Aphasia is a general problem with speaking, understanding, to both. Apraxia is the inability to use an object correctly and agnosia, a later AD finding, is a lack of sensory comprehension.

The nurse is reviewing the history of a client who has been prescribed topiramate for prevention of migraines. The nurse plans to contact the primary health care provider if the client has which condition? A. Diabetes mellitus B. Hypothyroidism C. Bipolar disorder D. Glaucoma

C. Bipolar disorder

The medical-surgical nurse is coordinating transfer from acute care to community-based care for a client who requires rehabilitation. Which interprofessional team members will be the primary decision makers in this transition? A. Medical-surgical nurses B. Rehabilitation nurses C. Client and family D. Case managers

C. Client and family

The nurse is caring for a client who is diagnosed with bacterial meningitis. Which assessment finding would be an immediate concern for the nurse? A. Severe unrelenting headaches B. Photophobia during the day C. Periodic nystagmus D. Decreased level of consciousness

D. Decreased level of consciousness

Following a fall, a 62-year-old client is admitted to the rehabilitation unit with a broken collarbone and a full leg brace. What transfer technique will the nurse use for this client? A. Cane-assisted transfer B. Bear-hug technique C. Mechanical lift D. Slide board

C. Mechanical lift

Which intervention does the rehabilitation nurse delegate to assistive personnel (AP) who is caring for a 70-year-old client with right-sided weakness following a stroke? A. Arrange for family members to participate in planning for discharge. B. Teach the client to use an extended shoehorn when putting on shoes. C. Reinforce the client's placing the right arm in the sleeve first when dressing. D. Determine whether the client's passive range-of-motion (ROM) exercises should be increased

C. Reinforce the client's placing the right arm in the sleeve first when dressing.

To prevent the leading cause of death for clients with spinal cord injury, collaboration with which component of the primary health care team is a nursing priority? A. Nutritional therapy B. Physical therapy C. Respiratory therapy D. Occupational therapy

C. Respiratory therapy To help prevent death for a client with spinal cord injury, collaboration with the respiratory therapy team is a priority. A client with a cervical spinal cord injury is at risk for breathing problems including pneumonia and aspiration, resulting from the interruption of spinal innervation to the respiratory muscles.

A family member of a client with a recent spinal cord injury asks the nurse, "Can you please tell me what the real prognosis for recovery is? I don't feel like I'm getting a straight answer." What would be the appropriate response for the nurse? A. "Only time will tell, but hopefully the client will be able to care for yourself." B. "Every injury is different, and it is too soon to have any real answers right now." C. "The Health Insurance Portability and Accountability Act requires that I obtain the client's permission first." D. "Please request a meeting with the primary health care provider. I can help set that up."

D. "Please request a meeting with the primary health care provider. I can help set that up."

A recently injured client who is paraplegic is in rehabilitation. Which client comment indicates that he or she is adapting to new self-care activities? A. "I don't want to do this today." B. "My dog can do this—why can't I do it too?" C. "I am so tired today, I want to rest." D. "This isn't working; I need to try something else."

D. "This isn't working; I need to try something else."

A client visits the clinic with a migraine and is lying in a darkened room with a wet cloth on the head after receiving treatment. What action would the nurse take next? A. Turn on the lights for a neurologic assessment. B. Assess the client's vital signs. C. Remove the cloth because it can harbor microorganisms. D. Allow the client to remain undisturbed.

D. Allow the client to remain undisturbed.

A client returns to the neurosurgical floor after undergoing a traditional anterior cervical diskectomy and fusion (ACDF). What is the nurse's first action? A. Check the client's ability to void. B. Administer pain medication. C. Assist with ambulation. D. Assess airway and breathing.

D. Assess airway and breathing.

A client is admitted with bacterial meningitis. Which nursing intervention is the highest priority for this client? A. Strict monitoring of hourly intake and output B. Decreasing environmental stimuli C. Managing pain through drug and nondrug methods D. Assessing neurologic status at least every 2 to 4 hours

D. Assessing neurologic status at least every 2 to 4 hours

A client is admitted into the emergency department (ED) with frontal-temporal pain, preceded by a visual disturbance. The client is upset and thinks it is a stroke. What health problem does the nurse suspect may be occurring? A. West Nile virus B. Stroke C. Meningitis D. Classic migraine

D. Classic migraine

An 80-year-old client has limited mobility following a stroke. Which nursing intervention will help prevent skin breakdown? A. Applying moist packs to the skin every shift B. Decreasing calories consumed; avoiding weight gain C. Turning and repositioning at least every 4 hours D. Ensuring the client's skin remains dry and clean

D. Ensuring the client's skin remains dry and clean

A client admitted with cerebral edema suddenly begins to have a seizure while the nurse is in the room. What would the nurse do first? A. Administer phenytoin. B. Draw the client's blood. C. Start an intravenous (IV) line. D. Establish an airway.

D. Establish an airway.

A client with right-sided hemiplegia is in a rehabilitation unit. Which nursing intervention is effective in promoting the client's independence? A. Assisting the client with all of his or her activities of daily living (ADLs) B. Sending the client to a long-term care facility C. Telling the client to do the "best" that he or she can do D. Instructing the client step-by-step on how to put on his or her robe

D. Instructing the client step-by-step on how to put on his or her robe

Which nursing intervention is best for preventing complications of immobility when caring for a client with spinal cord injury? A. Special pressure-relief devices B. Frequent ambulation C. Encouraging nutrition D. Regular turning and repositioning

D. Regular turning and repositioning Regular turning and repositioning are the best way to prevent complications of immobility in clients with spinal cord problems.

A client has been hospitalized with a non-life-threatening C-spine neck injury. The interprofessional rehabilitation team has worked with the client who is quadriplegic for 4 months. Which outcome indicates that the team's efforts are effective? A. Personal care is performed with help from the family. B. Mobility requires multiple assistive devices. C. Constipation now occurs only 3 days a week. D. Skin is intact, with no evidence of skin impairment.

D. Skin is intact, with no evidence of skin impairment.

The nurse is reinforcing the physical therapist's teaching on gait training for a client who had a total knee replacement 6 weeks ago. Which ambulatory aid does the nurse expect the client to be using? A. Walker with rollers B. Crutches C. Walker with a built-in seat D. Straight cane

D. Straight cane A straight cane is the most likely ambulatory aid for a client who is 6 weeks postsurgery from a knee replacement. The client should be weight bearing, with some assistance, on the affected leg.

Conus Medullaris Syndrome

Incomplete spinal cord injury that is less likely to cause paralysis than other sp cord injuries. Symptoms: scree back pain. Strange or jarring sensations in the back, such as buzzing, tingling, numbness

The nurse is teaching a client starting on fingolimod to treat multiple sclerosis about the drug's possible side and adverse effects. Which effects will the nurse include in the teaching? (Select all that apply.) Select all that apply. Infection Hypertension Diarrhea Tachycardia Facial flushing Nausea/vomiting

Infection Diarrhea Facial flushing Nausea/vomiting

The nurse is teaching a class on safe patient handling and mobility. What will the nurse include? (Select all that apply.) Select all that apply. Place the bed at hip level when providing direct care. Attempt to lift with a team prior to using client-handling equipment. Keep the client directly in front of your body while providing care. Maintain a wide, stable base with your feet prior to lifting. Place the client 1 foot away from your body prior to lifting.

Keep the client directly in front of your body while providing care. Maintain a wide, stable base with your feet prior to lifting.

Central Cord Syndrome

Most common form of incomplete spinal cord injury Impairment In the arms and hands and to a lesser extent in the legs. brains ability to send and receive signals to and from parts of the body below the site if injury is reduced but not entirely blocked.

A client with Parkinson disease (PD) reports having auditory hallucinations. What drug would the nurse anticipate may be prescribed for the client? Ubrogepant Pimavanserin Phenytoin Levodopa

Pimavanserin Pimavanserin is a drug that is used when clients with PD have hallucinations. Phenytoin is used to manage seizures and ubrogepant is used for clients who have migraine headaches. Levodopa, usually in combination with carbidopa, is a commonly used drug for most clients at some time for their PD.

What roles does the rehabilitation nurse have in the functioning of the rehabilitation team? (Select all that apply.) Select all that apply. Plans continuity of care for discharge. Coordinates rehabilitation team activities. Coordinates holistic care. Develops the client's fine motor skills. Retrains clients with swallowing challenges.

Plans continuity of care for discharge. Coordinates rehabilitation team activities. Coordinates holistic care.

The hospital nurse is assigned to establish a rehabilitation milieu on the unit. What elements will the nurse include? (Select all that apply.) Select all that apply. Protecting clients from embarrassment (e.g., bowel training) Making the inpatient unit a more homelike environment Allowing time for clients to practice self-management skills Keeping to a structured hospital schedule (e.g., medication administration) Carefully monitoring fluid and dietary intake Encouraging clients and providing emotional support

Protecting clients from embarrassment (e.g., bowel training) Making the inpatient unit a more homelike environment Allowing time for clients to practice self-management skills Encouraging clients and providing emotional support

A client has been admitted with new-onset status epilepticus. Which seizure precautions would the nurse implement? (Select all that apply.) Select all that apply. Suction equipment at the bedside Continuous sedation Intravenous (IV) access Bite block at the bedside Side rails raised

Side rails raised Seizure precautions the nurse institutes for an admitted client with new-onset status epilepticus include IV access, suctioning equipment at the bedside, and raised side rails. IV access is needed to administer medications. Suctioning equipment must be available to suction secretions and facilitate an open airway during a seizure. Raised, padded side rails may be used to protect the client from falling out of bed during a seizure.

A client receiving propranolol as preventive therapy for migraine headaches is experiencing side effects after taking the drug. Which side effect is of greatest concern to the nurse? Warm sensation Tingling feelings Slow heart rate Dry mouth

Slow heart rate

The nurse is caring for a client who has Parkinson disease (PD). What assessment findings would the nurse expect? (Select all that apply.) Stooped posture Masklike facial expression Drooling at times Shuffled gait Dysarthria Muscle rigidity

all

Cauda Equina Syndrome

compression of lower spinal cord (risk of paralysis in legs). Rare disorder that's is usually a surgical emergency. Fast tx to prevent lasting damage leading to incontinence and paralysis in legs

Anterior cord syndrome

incomplete cord syndrome Affects the anterior 2/3 of the spinal cord, resetting in motor paralysis below the level of lesion as well as the loss of pain and temperature at and below the level of the lesion. Sensations of touch position and vibration INTACT

Brown-Sequard Syndrome

rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.

What diagnostic test is used to differentiate a cholinergic crisis from a myasthenic crisis? electrophysiologic studies repetitive nerve stimulation tensilon challenge testing CSF protein level

tensilon challenge testing