Adaptive Quiz Week 7

A patient with a family history of Huntington's disease (HD) who underwent genetic testing has positive results. What can the nurse infer from this finding? Select all that apply. 1. There is no cure for this disease. 2. The onset of disease usually occurs between 30 and 50 years of age. 3. The patient will develop a progressive, degenerative brain disorder. 4. The patient would not be treated completely with the help of drugs. 5. The patient will be a carrier of the mutated gene, but will not develop the disease.

1, 2, 3- Correct Huntington's disease is an autosomal dominant disorder caused by a mutation in the HTT gene located on chromosome 4. Genetic testing, or DNA testing, is useful in diagnosing the disease but is not helpful in predicting the onset of symptoms. There is no cure for the disease. The onset of disease usually occurs between 30 and 50 years of age. Huntington's disease is a progressive, degenerative brain disorder. The symptoms of behavioral problems and movement disorder can be controlled with drugs. Negative test results would indicate that the person does not carry the mutated gene and will not develop the disease. Text Reference - p. 1440

Which extracranial disorder can cause seizures? 1. Migraine 2. Meningitis 3. Brain tumor 4. Hypertension

4- Correct Hypertension is an extracranial disorder that can cause seizures. Migraines fall into the category of intracranial disorders that are not associated with seizures. Brain tumors and meningitis are intracranial disorders that may cause seizures. Text Reference - p. 1419

Which degenerative neurologic disorder is characterized by a deficiency of γ-aminobutyric acid (GABA) and acetylcholine? 1. Myasthenia graves 2. Parkinson's disease 3. Lou Gehrig's disease 4. Huntington's disease

4- Correct The pathologic process of Huntington's disease involves a deficiency of the neurotransmitters γ-aminobutyric acid (GABA) and acetylcholine, which leads to the excessive release of dopamine. Myasthenia gravis occurs due to a decrease in the acetylcholine receptors because of an autoimmune process. In this disease, there is no deficiency of the neurotransmitters. The pathologic process of Parkinson's disease involves degeneration of dopamine-producing neurons, which leads to a deficiency of dopamine release. Lou Gehrig's disease involves degeneration of motor neurons in the brain and spinal cord and is not related to the deficiency of neurotransmitters. Text Reference - p. 1440

The nurse cares for a patient with suspected Parkinson's disease. What is an initial symptom of the disease? 1. Akinesia 2. Aspiration 3. Forgetfulness 4. Pill-rolling tremors

4- Correct Early symptoms of Parkinson's disease include coarse resting tremors of the fingers and thumb, also known as pill-rolling movements. Akinesia (complete or partial loss of muscle movement), aspiration, and mental deterioration occur later in the disease process. Text Reference - p. 1433

Which diet is used to control seizures in some patients? 1. A diet with low fats and low carbohydrates 2. A diet with low fats and high carbohydrates 3. A diet with high fats and low carbohydrates 4. A diet with high fats and high carbohydrates

The ketogenic diet is used to control seizures in some patients with epilepsy. It contains high fats and low carbohydrates. A diet with low fats and low carbohydrates is not considered a ketogenic diet. A ketogenic diet also does not contain low fats and high carbohydrates. Similarly, a diet with high fats and high carbohydrates is not a ketogenic diet. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 1424

Arrange the phases of a seizure chronologically. 1. The phase with a full seizure 2. The phase with signs that precede a seizure 3. The phase with recovery period after a seizure 4. The phase with a sensory warning of a seizure

1. The phase with signs that precede a seizure 2. The phase with a sensory warning of a seizure Incorrect 3. The phase with a full seizure 4. The phase with recovery period after a seizure A seizure progresses through several phases. The prodromal phase involves signs that precede a seizure. The aural phase has a sensory warning for the seizure. The ictal phase includes a full seizure. The postictal phase is the recovery period after the seizure. Text Reference - p. 1420

A patient with Parkinson's disease is prescribed sinemet. What side effects of the drug should the nurse monitor in the patient? Select all that apply. 1. Dizziness 2. Dyskinesia 3. Severe headache 4. Severe nausea and vomiting 5. Involuntary eye movements

2, 4, 5- Correct Sinemet is a combination of levodopa and carbidopa that is prescribed to patients suffering from parkinsonism. The drug has few side effects. These side effects include dyskinesia due to increased dopamine availability. Severe nausea and vomiting is another important side effect, because the dopaminergic pathway is the major pathway involved in emesis. Increased dopamine levels in the body many trigger the sensation of nausea and vomiting. Involuntary eye movements are due to the increased levels of the neurotransmitter dopamine in the body. Dizziness or fainting, due to orthostatic hypotension, is a side effect of the drug bromocriptine. A severe headache is also a side effect of bromocriptine. Test-Taking Tip: Reread the question if the answers do not seem to make sense, because you may have missed words such as not or except in the statement. Text Reference - p. 1435

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. 1. Tramadol 2. Prednisone 3. Azathioprine 4. Chlorzoxazone 5. Pyridostigmine

2,3,5- Correct Difficulty in swallowing, chewing, eye movement and facial mobility are the symptoms of myasthenia gravis. The most common drug therapies for this condition include anticholinesterase drugs, corticosteroids, and immunosuppressants. Corticosteroids, especially prednisone, are used to suppress the immune responses that are the main reason for such symptoms. Azathioprine is an immunomodulator used for immune suppression. Pyridostigmine is an example of an anticholinesterase that prolongs the action of acetylcholine at the neuromuscular junction. Tramadol is an opioid analgesic; it is contraindicated for patients with myasthenia gravis. Chlorzoxazone is an example of a muscle relaxant; it is contraindicated for patients with myasthenia gravis. Text Reference - p. 1438

The patient has a prescription for phenytoin 100 mg q8hr intravenous (IV). Available is a phenytoin injection containing 50 mg/mL. How many milliliters of solution should the nurse draw up for the dose? Fill in the blank using a whole number. ___ mL

2mL- Correct 100 mg ÷ 50 mg/mL = 2 mL Test-Taking Tip: Do not panic while taking an exam! Panic will only increase your anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume review of the question. Text Reference - p. 1422

A patient has been found to have amyotrophic lateral sclerosis. What classic symptom of the disorder does the nurse recognize? 1. Dysuria 2. Dyspnea 3. Dysphagia 4. Dysreflexia

3- Correct 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. Text Reference - p. 1439

Which type of seizure is characterized by "drop attacks"? 1. Tonic seizure 2. Clonic seizure 3. Atonic seizure 4. Myoclonic seizure

3- Correct A "drop attack" is defined as sudden fall without loss of consciousness. In atonic seizures, the patient suddenly falls down due to paroxysmal loss of muscle tone. In tonic and clonic seizures, there may be loss of consciousness and the patient may fall down. In a myoclonic seizure, the patient may fall to the ground due to excessive jerking of the extremities. Text Reference - p. 1421

A patient with hypertension reports paresthesia, tingling, and a pins and needles sensation. The patient was prescribed gabapentin. What is the possible diagnosis? 1. Stroke 2. Epilepsy 3. Status epilepticus 4. Restless legs syndrome (RLS)

Hypertension is the etiological factor of restless legs syndrome (RLS). Paresthesia, tingling, and a pins and needles sensation are clinical signs of RLS. Gabapentin can be used in all the neurologic disorders listed. A patient who sustains a stroke will present with one-sided weakness. This is not a symptom of RLS. Paresthesias, tingling, and a pins and needles sensation are not seen in epilepsy and status epilepticus. A patient with epilepsy may have jerking movements and muscle rigidity. A patient with status epilepticus can experience hypoxia and arrhythmias. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. Text Reference - p. 1427 Topics-

The patient with type 1 diabetes mellitus with hypoglycemia is having a seizure. Which medication should the nurse anticipate administering to stop the seizure? 1. Intravenous (IV) dextrose solution 2. IV diazepam 3. IV phenytoin 4. Oral carbamazepine

This patient's seizure is caused by low blood glucose, so IV dextrose solution should be given first to stop the seizure. IV diazepam, IV phenytoin, and oral carbamazepine would be used to treat seizures from other causes, such as head trauma, drugs, and infections. Text Reference - p. 1423

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. 1. "Seizures can be caused by a decrease pH of the blood." 2. "Seizures can be caused by a decrease in oxygen levels." 3. "Seizures can be caused by an increase pH of the blood." 4. "Seizures can be caused by a decrease in blood glucose levels." 5. "Seizures can be caused by an increase in blood glucose levels."

1, 2, 4- Correct Seizures are caused by metabolic disturbances such as acidosis and can occur due to a decrease in the blood pH. Hypoxia means that oxygen levels are decreased. Hypoxia is also a metabolic disturbance; therefore, hypoxia can lead to seizures. A decrease in blood glucose levels is known as hypoglycemia. Therefore acidosis, hypoxia, and hypoglycemia are the metabolic disturbances that cause seizures. Alkalosis, in which there is an increase in pH is not associated with seizures. Hyperglycemia, which is an increase in blood glucose levels, is also not associated with seizures. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 1419

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. 1.v"Seizures can be caused by a decrease pH of the blood." 2. "Seizures can be caused by a decrease in oxygen levels." 3. "Seizures can be caused by an increase pH of the blood." 4. "Seizures can be caused by a decrease in blood glucose levels." 5. "Seizures can be caused by an increase in blood glucose levels."

1, 2, 4- Correct Seizures are caused by metabolic disturbances such as acidosis and can occur due to a decrease in the blood pH. Hypoxia means that oxygen levels are decreased. Hypoxia is also a metabolic disturbance; therefore, hypoxia can lead to seizures. A decrease in blood glucose levels is known as hypoglycemia. Therefore acidosis, hypoxia, and hypoglycemia are the metabolic disturbances that cause seizures. Alkalosis, in which there is an increase in pH is not associated with seizures. Hyperglycemia, which is an increase in blood glucose levels, is also not associated with seizures. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation. Text Reference - p. 1419

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. 1. Ease the patient to the floor. 2. Loosen constrictive clothes. 3. Restrain the patient to a bed. 4. Protect the patient from any injury. 5. Bring the patient to the hospital immediately.

1, 2, 4- Correct During an acute seizure, the most important thing is to ease the patient to the floor, if seated, and loosen constrictive clothing. The patient should be protected from any potential injury. The chances of injury are higher if the patient is restrained. It is not necessary to bring the patient to the hospital immediately. Once the seizures have stopped and the patient becomes stable, then the patient can be brought to the hospital. Text Reference - p. 1426

The nurse is planning discharge teaching for a patient with myasthenia gravis. What instructions should the nurse include in the plan? Select all that apply. 1. Eat a balanced diet that can be easily chewed and swallowed. 2. Include liquid rather than solid foods in the diet. 3. Plan activities with periods of rest. 4. Practice hobbies such as playing golf. 5. Schedule drugs so that the peak effect of the drug is at mealtime.

1, 3, 5- Correct The discharge teaching should focus on the neurologic deficits and their effect on daily living. Teach the patient about a balanced diet that can easily be chewed and swallowed. Help the patient plan activities of daily living to avoid fatigue. Scheduling doses of drugs so that peak action is reached at mealtime may make eating less difficult. Semisolid foods may be easier to eat than solids or liquids. Arrange diversional activities that require little physical effort and match the patient's interests. Playing golf may be too exhausting. Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively. Text Reference - p. 1439

The nurse is managing the care of a patient with a seizure disorder who was admitted for status epilepticus. Which long-acting antiseizure medications would be effective for a patient with status epilepticus? Select all that apply. 1. Phenytoin 2. Diazepam 3. Lorazepam 4. Lamotrigdine 5. Phenobarbital

1, 4, 5- Correct Phenytoin, lamotrigine, and phenobarbital are the drugs with a long half-life that are used in treating status epilepticus. Diazepam and lorazepam are the rapid-acting drugs used in the treatment of status epilepticus. They have a short half-life. Text Reference - p. 1424

A patient with head trauma is admitted to the emergency department with continuous muscle contractions and loss of consciousness. Which drugs would be effective for treating this patient? Select all that apply. 1. Phenytoin 2. Zonisamide 3. Clonazepam 4. Ethosuximide 5. Carbamazepine

1, 5- Correct Tonic-clonic seizures are characterized by continuous muscle contractions and loss of consciousness. The primary drugs that are used to treat tonic-clonic seizures are phenytoin and carbamazepine. Zonisamide, clonazepam, and ethosuximide are the drugs used to treat absence and myoclonic seizures. Text Reference - p. 1423

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. 1. Ease the patient to the floor. 2. Loosen constrictive clothes. 3. Restrain the patient to a bed. 4. Protect the patient from any injury. 5. Bring the patient to the hospital immediately

1,2,4- Correct During an acute seizure, the most important thing is to ease the patient to the floor, if seated, and loosen constrictive clothing. The patient should be protected from any potential injury. The chances of injury are higher if the patient is restrained. It is not necessary to bring the patient to the hospital immediately. Once the seizures have stopped and the patient becomes stable, then the patient can be brought to the hospital. Text Reference - p. 1426

The nurse should instruct the patient on phenytoin to perform which action to prevent gingival hyperplasia? 1. Rinse with an oral antifungal solution twice per day. 2. Brush the teeth at least twice per day. 3. Visit a dentist annually. 4. Use a firm-bristle toothbrush.

2- Correct To prevent gingival hyperplasia, the patient should brush twice per day with a soft-bristled toothbrush, and visit the dentist twice per year. An antifungal solution is not indicated for this condition. Text Reference - p. 1424

A patient with a family history of Huntington's disease suffers from a psychiatric disorder and is treated with sertraline and paroxetine. Tetrabenazine is added to the patient's prescription. Which assessment finding supports the addition of tetrabenazine to the prescription? 1. Chorea 2. Anxiety 3. Depression 4. Social withdrawal

1- Correct A patient with a family history of Huntington's disease has a 50 percent chance of inheriting the disease. The early stages of the disease are characterized by psychiatric symptoms. Movement disorders, such as chorea, characterized by abnormal and excessive involuntary movements of the face, the limbs, and the body, may appear at later stages of the disease. These are treated successfully with tetrabenazine. Anxiety can be managed with sertraline and paroxetine. Depression is a psychiatric symptom and can also be managed with sertraline and paroxetine. Social withdrawal is a psychiatric disorder symptom managed with sertraline and paroxetine, Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 1440

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? 1. Allow adequate time for the patient to eat meals. 2. Encourage the patient to eat at least every two hours while awake. 3. Administer prescribed carbidopa/levodopa with a protein drink. 4. Include foods that are chewy so the patient builds up the jaw muscles.

1- Correct Allowing adequate time for the patient to eat will limit frustration and improve overall intake. Six small feedings may improve intake, but eating every two hours would exhaust the patient. Absorption of levodopa is impaired by protein, so it is best to avoid large amounts of protein when carbidopa/levodopa is administered. Foods should be easily chewable to increase the overall intake. Text Reference - p. 14

Which drug helps to increase the bioavailability of levodopa in the brain by inhibiting the enzyme dopa-decarboxylase? 1. Carbidopa 2. Tolcapone 3. Rasagiline 4. Entacapone

1- Correct Carbidopa is a dopamine decarboxylase inhibitor. This enzyme breaks down the dopamine peripheral tissues before reaching the brain, decreasing the bioavailability of the drug. Levodapa is the dopamine precursor converted to dopamine in the basal ganglia. Carbidopa, when administered along with levodopa, increases the bioavailability of the drug in the brain. This prevents peripheral tissue breakdown of the drug by the enzyme dopa-decarboxylase. Tolacapone blocks the enzyme COMT that helps to increase the availability of drug levodopa. Rasagiline is a monoamine oxidase type B inhibitor that helps increase the half-life of the drug levodopa. Text Reference - p. 1435

The nurse recognizes that the intervention that is highest priority for a patient experiencing status epilepticus is administration of: 1. Diazepam IV 2. Phenytoin IV 3. Vecuronium IV 4. Ringers Lactate IV

1- Correct Diazepam given in an IV push is one of the drugs of choice for a patient experiencing status epilepticus. It is a rapid-acting benzodiazepine, but its action is of short duration and so the drug must be followed with a longer-acting anticonvulsant medication. Vecuronium is a paralyzing agent and is not used to treat status epilepticus. Phenytoin is a long-acting anticonvulsant medication commonly administered after a rapid-acting benzodiazepine (such as diazepam) to help stop a seizure and prevent further seizures. A patient experiencing extended episodes of status epilepticus may be at risk for dehydration, but IV fluids are not considered an immediate intervention. Text Reference - p. 1424

A patient with multiple sclerosis has an exacerbation of sensory deficits. Which nursing diagnostic statement should be assigned highest priority? 1. Risk for injury 2. Acute confusion 3. Fluid volume deficit 4. Ineffective thermoregulation

1- Correct 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. Text Reference - p. 1432

Which disease exhibits Lhermitte's sign as a clinical manifestation? 1. Multiple sclerosis 2. Myesthenia graves 3. Lou Gehrig's disease 4. Huntington's disease

1- Correct Lhermitte's sign is a transient sensory symptom manifested in the patients with multiple sclerosis. It is described as an electric shock radiating down the spine or into the limbs with flexion of the neck. Myasthenia gravis does not manifest as sensory loss. Lou Gehrig's disease, or amyotrophic lateral sclerosis, is a degenerative disorder or motor neurons and does not exhibit characteristics related to sensory loss. Huntington's disease is characterized by motor, cognitive, and psychiatric disorders but there is no sensory loss. Text Reference - p. 1429

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? 1. Stiffening of the body for 20 seconds, followed by jerking of the extremities for 40 seconds 2. Jerking of the extremities for 20 seconds, followed by stiffening of the body for 40 seconds 3. Stiffening of the body for 30 seconds, followed by jerking of the extremities for 10 seconds 4. Jerking of the extremities for 20 seconds, followed by stiffening of the body for 10 seconds

1- Correct Loss of consciousness, followed by stiffening of the body for 20 seconds (10 to 20 seconds) and jerking of the extremities for 40 seconds (30 to 40 seconds) are features of tonic-clonic seizures. Jerking of the extremities for 20 seconds, followed by stiffening of the body for 40 seconds may not be associated with tonic-clonic seizures. Stiffening of the body for 30 seconds, followed by jerking of the extremities for 10 seconds is unassociated with tonic-clonic seizures. Similarly, jerking of the extremities for 20 seconds, followed by stiffening of the body for 10 seconds is not associated with tonic-clonic seizures. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 1420

What questions should the nurse ask while assessing the functional health pattern in a patient who is suspected to have a seizure disorder? 1. "Do you have any alcohol history?" 2. "Do you have any headache or auras?" 3. "Do you have a history of head trauma?" 4. "Do you have a family history of epilepsy?"

2- Correct The nurse would ask questions about headache or aura when assessing the functional health pattern of a patient who is suspected to have a seizure disorder. Information about alcohol consumption history, head trauma, and family history of epilepsy is gathered from the patient to help find clues for a diagnosis. Text Reference - p. 1425

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? 1. Muscle relaxant 2. Antihypertensive 3. Narcotic analgesic 4. Antipsychotics

1- Correct Multiple sclerosis (MS) causes muscle spasticity as loss of the myelin sheath progresses. Muscle relaxants ease these spasms. Antihypertensives are not routinely used; hypertension is not related to MS. Narcotic analgesics are used to treat severe pain, which is usually not associated with MS. Antipsychotics are sometimes used in the treatment of Huntington's Disease, not MS. Text Reference - p. 1430

A patient with an aggressive form of multiple sclerosis is not responding to the drugs teriflunomide and dalfampridine. The patient is then prescribed natalizumab and mitoxantrone. The patient is later diagnosed with progressive multifocal leukoencephalopathy. Which medication in the patient's prescription might be responsible for this complication? 1. Natalizumab 2. Mitoxantrone 3. Teriflunomide 4. Dalfampridine

1- Correct Natalizumab and mitoxantrone are prescribed for patients with aggressive forms of multiple sclerosis who have inadequate response to other drugs. The major risk factor associated with the monoclonal antibody drug natalizumab is the potentially fatal viral infection of the brain known as multifocal leukoencephalopathy. The risk factors associated with mitoxantrone include cardiotoxicity, leukemia, and infertility. The risk factors associated with teriflunomide include serious liver disease and, because of its teratogenic effects, it is avoided during pregnancy. Dalfampridine precipitates seizures, a major risk factor associated of the drug. Text Reference - p. 1430

Which drug overdose may lead to paradoxic intoxication in a patient with parkinsonism? 1. Levodopa 2. Biperiden 3. Trihexyphenidyl 4. Diphenhydramine

1- Correct Paradoxic intoxication is the aggravation, rather than relief, of symptoms. This condition is mainly due to the excessive use of dopaminergic drugs such as levodopa. Biperiden is an anticholinergic drug that blocks the cholinergic receptors and maintains the balance between dopaminergic and cholinergic activity. Trihexyphenidyl is an example of an anticholinergic drug that does not aggravate the symptoms of the disease with overuse. Diphenhydramine is an antihistamine, that has anticholinergic effects. It does not lead to paradoxic intoxication in a patient with Parkinsonism when the drug is overdosed. Text Reference - p. 1435

Which is the primary drug of choice for tonic-clonic seizures? 1. Phenytoin 2. Gabapentin 3. Clonazepam 4. Ethosuximide

1- Correct Phenytoin is the primary drug of choice for tonic-clonic seizures. Gabapentin is an alternative drug for tonic-clonic, absence, and myoclonic seizures. Clonazepam is the preferred drug for absence and myoclonic seizures. Ethosuximide is the primary drug used for absence and myoclonic seizures. Text Reference - p. 1423

A patient with a history of epilepsy experienced gingival enlargement. Which drug may be causing it? 1. Phenytoin 2. Gabapentin 3. Clonazepam 4. Valproic acid

1- Correct Phenytoin, gabapentin, clonazepam, valproic acid, and carbamazepine are the drugs used in treating epilepsy. Gingival enlargement is a common side effect of phenytoin; therefore, a patient with epilepsy who is using phenytoin may experience gingival enlargement. Gabapentin, clonazepam, and valproic acid do not cause gingival enlargement. Text Reference - p. 1424

A patient with a seizure disorder failed to respond to drug therapy. Resection of epileptogenic tissue is performed. What could be the possible diagnosis? 1. Focal seizures 2. Atonic seizures 3. Myoclonic seizures 4. Tonic-clonic seizures

1- Correct Surgical intervention is most appropriate for patients who do not respond to drug therapy. Resection of epileptogenic tissue is advised for patients who are suspected to have focal seizures. Atonic, myoclonic, and tonic-clonic seizures are included under generalized seizures. If generalized seizures do not respond to drug therapy, sectioning of the corpus callosum is performed. Text Reference - p. 1424

A patient was just diagnosed with Huntington's disease. The patient's adult child is upset about the diagnosis. How can the nurse best help the patient's child? 1. Provide emotional and psychologic support. 2. Encourage him or her to get diagnostic genetic testing done. 3. Tell him the cognitive deterioration will be treated with counseling. 4. Tell him the chorea and psychiatric disorders can be treated with haloperidol (Haldol).

1- Correct The patient's child will first need emotional and psychologic support. He or she should be taught about diagnostic genetic testing for him- or herself, but should decide with a genetic counselor if and when he or she wants this done. The treatment plan for the father will be determined depending on the father's needs. Text Reference - p. 1440

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? 1. β-interferon 2. Natalizumab 3. Mitoxantrone 4. Dalfampridine

1- Correct β-interferon is an immunomodualtor prescribed in the initial treatment of multiple sclerosis. It is known to cause flu-like symptoms, depression, and suicidal ideations. Natalizumab is prescribed for patients with active and aggressive forms of multiple sclerosis. This drug is not part of initial treatment and the major risk factor associated with this drug therapy is progressive multifocal leukoencephalopathy. Mitoxantrone is also prescribed for patients with active and aggressive forms of multiple sclerosis, not in the initial treatment. The risk factors associated with this drug are cardiotoxicity, leukemia, and infertility. Dalfampridine is prescribed to improve walking speed. Text Reference - p. 1430

Which autoimmune disease is characterized by a decreased number of acetylcholine receptors in the neuromuscular junction? 1. Multiple sclerosis 2. Myasthenia graves 3. Lou Gehrig's disease 4. Huntington's disease

2- Correct Myasthenia gravis is an autoimmune disease of the neuromuscular junction. This occurs due to an attack of antibodies on the acetylcholine receptors, which results in a decreased number of receptor sites at the neuromuscular junction. Multiple sclerosis is a chronic progressive degenerative disorder of the central nervous system due to demyelination of the nerve fibers. Lou Gehrig's disease is a rare, progressive neurologic disorder that involves degeneration of motor neurons in the brain and spinal cord. It is not an autoimmune disease of the neuromuscular junction. Huntington's disease is a genetically transmitted autosomal dominant disorder, not an autoimmune disease of the neuromuscular junction. Text Reference - p. 1437

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. 1 . The drug should be changed immediately. 2 . Regular flossing can control gingival tissue growth. 3 . Surgical repair of gingival tissue will be required. 4 . Regular tooth brushing can limit hyperplasia. 5 . Gingival hyperplasia is not related to phenytoin.

2, 4- Correct Gingival hyperplasia is a common side effect of phenytoin. The nurse should instruct the patient to maintain good dental hygiene with regular tooth brushing and flossing. Regular flossing not only helps in maintaining good dental hygiene but also helps control gingival tissue growth. Similarly, regular brushing, besides being generally good for dental health, also helps limit gingival hyperplasia. Mild gingival hyperplasia does not require the drug to be replaced. Surgical intervention would be required only if the gingival hyperplasia were extensive, which is not the case with this patient. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress. Text Reference - p. 1424

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. 1. Alteration of one copy of gene in DNA test 2. Improved muscle contractibility during the Tensilon test 3. Presence of three signs of the classic triad: tremor, rigidity and bradykinesia 4. Decreased response to repeated stimulation of hand muscles during EMG test 5. Increased immunoglobulin G levels in the cerebrospinal fluid during CSF analysis test

2, 4- Correct Patients with myasthenia gravis experience improved muscle contractibility after intravenous administration of the anticholinesterase agent edrophonium chloride. This test aids in diagnosis of myasthenia gravis. EMG testing may show a decreased response to repeated stimulation of muscles in the hands, which would indicate muscle fatigue. Single-fiber EMG is a confirmative test for myasthenia gravis. The alteration of one copy of a gene in a DNA test is a diagnostic test for Huntington's disease, a genetically transmitted autosomal dominant disorder. The presence of three signs of the classic triad of tremor, rigidity, and bradykinesia, is a confirmed diagnostic test for Parkinson's disease. Increased immunoglobulin G levels in the cerebrospinal fluid during CSF analysis test confirms multiple sclerosis, not myasthenia gravis. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. Text Reference - p. 1438

A patient with restless legs syndrome (RLS) failed to respond to gabapentin, which was prescribed earlier. What would be the drug of choice? 1. Carbidopa 2. Oxycodone 3. Pramipexole 4. Phenobarbital

2- Correct A patient with restless legs syndrome (RLS) may have severe symptoms that are not relieved by gabapentin. In such cases, low doses of opioids like oxycodone are prescribed. Carbidopa, a dopamine precursor, is used to increase the amount of dopamine in the brain. This drug may not relieve the severe symptoms of RLS. Pramipexole, a dopamine agonist is also used to increase the dopamine amount. Like carbidopa, this drug also may not relieve the severe symptoms of RLS. Phenobarbital is not used to treat RLS. Text Reference - p. 1427

A patient developed seizures after a head injury and informs the nurse he or she feels like there has been a loss of control over life since the seizures. Initially, what is the most appropriate response by the nurse? 1. "With medications and your health care provider's assistance, I am sure you will be able to achieve your life goals." 2. "Tell me about what you would like to do and how the seizures affect you." 3. "New treatments come out every year, so don't give up." 4. "You are young and can still heal from the injury. It has only been a few months."

2- Correct Asking the patient what he or she would like to do and how seizures affect him or her is correct because it addresses the patient's concerns. Telling the patient he or she will achieve his or her life goals, that the patient will still heal because he or she is young and that new treatments are available are not correct statements to make because they do not address the patient's concern over losing control of his or her life. Text Reference - p. 1426

The registered nurse supervises a student nurse providing care to a patient with Huntington's disease (HD). Which action of the student nurse needs correction? 1. Providing more fluid diet to the patient 2. Providing a low-calorie diet not more than 2000 calories/day 3. Providing palliative care is the only option for collaborative care 4. Providing comfortable environment by maintaining physical safety

2- Correct Choreic movements are the clinical manifestations of Huntington's disease. So, caloric requirements can be as high as 4000 to 5000 calories/day to maintain a patient's body weight. Alternate sources of nutrition may be indicated as the disease progresses. Providing a fluid diet may help the patient to swallow more easily and prevent complications such as aspiration. There is no cure for HD, so the collaborative care would be palliative. Physical safety of the patient and care-giver should be maintained by providing a comfortable environment. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Text Reference - p. 1440

What should be the immediate nursing intervention provided to a patient with hypoglycemia who is suspected to have had a seizure? 1. Intravenous administration of saline 2. Intravenous administration of dextrose 3. Intravenous administration of diazepam 4. Intravenous administration of gabapentin

2- Correct Hypoglycemia can cause tonic-clonic seizures in some patients. In such cases, the underlying cause is treated first, followed by the administration of antiseizure drugs if necessary. Therefore, dextrose should be administered immediately to reverse the hypoglycemia. Intravenous administration of saline is advised to correct fluid and electrolyte imbalance in patients who are dehydrated. IV diazepam is given to patients with status epilepticus. If the symptoms do not subside after treating the underlying cause of a seizure, oral administration of gabapentin may be necessary. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there usually is no pattern to the answers. Text Reference - p. 1419

Which medication prescribed for neurologic disorders can lead to paradoxic intoxication? 1. Multiple sclerosis 2. Parkinson's disease 3. Huntington's disease 4. Myasthenia gravis

2- Correct Paradoxic intoxication involves the aggravation, rather than relief, of symptoms, after using a drug. Dopaminergic drugs, prescribed for parkinsonism, may cause paradoxic intoxication after prolonged use. Drug therapy for multiple sclerosis includes immunomodulators or corticosteroids, and other drugs that help reduce the symptoms. Drug therapy for Huntington's disease includes managing the symptoms of chorea and cognitive and psychiatric disorders. These drugs help reduce the symptoms but do not cause paradoxic intoxication. Drug therapy for myasthenia gravis includes using anticholinergics, corticosteroids, and immunosuppressive agents that decrease symptoms but do not cause paradoxic intoxication. Text Reference - p. 1435

Which neurodegenerative disorder is characterized by rigidity and bradykinesia? 1. Multiple sclerosis 2. Parkinson's disease 3. Lou Gehrig's disease 4. Huntington's disease

2- Correct Parkinson's disease is a chronic, progressive neurodegenerative disorder characterized by an increased muscle tone (known as rigidity), slowness in the initiation and execution of movement (known as bradykinesia), tremors, and gait disturbances. Multiple sclerosis is a chronic progressive degenerative disorder of the central nervous system characterized by progressive, chronic demyelination of nerve fibers of the spinal cord and brain. Lou Gehrig's disease is a rare progressive neurologic disorder that involves degeneration of motor neurons in the spinal cord and brain. It is characterized by limb weakness, dysarthria, and dysphagia. Huntington's disease is a genetically transmitted, autosomal dominant disorder characterized by chorea movements, and cognitive and psychiatric disorders. Text Reference - p. 1432

Which disease is characterized by a degeneration of dopamine-producing neurons and decreased levels of dopamine? 1. Multiple sclerosis 2. Parkinson's disease 3. Lou Gehrig's disease 4. Huntington's disease

2- Correct Parkinson's disease is characterized by a lack of dopamine, because of the degeneration of dopamine-producing neurons; this disrupts the normal balance between acetylcholine and dopamine in the brain. Multiple sclerosis is due to the demyelination of the nerve fibers of the brain and spinal cord. Characteristics of this disease are not associated with a deficiency of neurotransmitters. Lou Gehrig's disease is a rare progressive neurologic disorder that involves the degeneration of motor neurons in the brain and spinal cord, not the degeneration of neurons producing dopamine. Huntington's disease involves a deficiency of the neurotransmitters acetylcholine and γ-aminobutyric acid. This disease is characterized by increased levels of dopamine. Text Reference - p. 1432

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? 1. Reduce fat intake 2. Reduce the risk of aspiration 3. Decrease injury related to falls 4. Decrease pain secondary to muscle weakness

2- Correct Reducing the risk of aspiration can help prevent respiratory infections that are a common cause of death from deteriorating muscle function. Reducing fat intake may reduce cardiovascular disease, but this is not a common cause of death for patients with ALS. Decreasing injury related to falls and decreasing pain secondary to muscle weakness are important nursing interventions for patients with ALS, but are unrelated to causes of death for these patients. Text Reference - p. 1439

A nurse reviews the medical history with a patient and learns that the patient was diagnosed with restless legs syndrome. Based on this fact, which question should the nurse also ask? 1. "Do you experience calf pain after walking a block?" 2. "Are you able to sleep well and feel rested?" 3. "Do you experience episodes where you are unable to move one leg?" 4. "When exposed to cold do your legs turn pale, then blue, and become painful?"

2- Correct Restless legs syndrome is a condition in which patients experience paresthesias, including numbness, tingling, pain, and restlessness in one or both legs. The condition occurs commonly at night, interferes with the patient's ability to sleep, and contributes to daytime fatigue. Asking whether the patient sleeps well and feels rested is appropriate. Calf pain that occurs with walking is termed intermittent claudication and is a symptom of peripheral vascular disease. A temporary episode of paralysis describes a transient ischemic attack (TIA), a precursor to a stroke. Raynaud's disease occurs in persons with connective tissue conditions and involves vasospasms in response to cold. The legs become pale, then cyanotic and often reddened post vasospasm. The episodes are painful. Text Reference - p. 1427

The nurse is managing the care of a patient with status epilepticus. Which assessment would be inappropriate, once the event has subsided? 1. Oxygenation 2. Apical heart rate 3. Oral body temperature 4. Respiratory rate and pattern

2- Correct Status epilepticus is one of the complications of all types of seizures. Tachycardia is the clinical sign of tonic-clonic seizures, so the nurse need not focus on the apical heart rate. However, the nurse may monitor the heart rate to check for any improvement of the patient's overall health. Hypoxia, hyperthermia, and ventilatory insufficiency may be caused by status epilepticus. Therefore, the nurse should assess the patient's oxygenation level, oral body temperature, and respiratory rate and pattern. Text Reference - p. 1422

Which characteristic of a patient's recent seizure is consistent with a focal seizure? 1. The patient lost consciousness during the seizure. 2. The seizure involved lip smacking and repetitive movements. 3. The patient fell to the ground and became stiff for 20 seconds. 4. The etiology of the seizure involved both sides of the patient's brain.

2- Correct The most common complex focal seizure involves lip smacking and automatisms (repetitive movements that may not be appropriate). Loss of consciousness, bilateral brain involvement, and a tonic phase are associated with generalized seizure activity. Text Reference - p. 1421

A nurse is educating a group of people in a community center about restless legs syndrome (RLS). Which risk factor included in the presentation would be inappropriate? 1. Pregnancy 2. Liver failure 3. Hypertension 4. Iron deficiency

2- Correct The nurse should include information about the conditions that cause restless legs syndrome (RLS), and liver failure is not associated with it. The conditions associated with RLS include pregnancy, hypertension, and iron deficiency. Pregnancy and anemia (iron deficiency) can worsen the symptoms. Text Reference - p. 1427

A patient with parkinsonism on a dopamine agonist medication reports severe nausea and vomiting. After receiving the antiemetic, the patient lost consciousness due to a sudden drop in blood pressure. Which antiemetic drug interaction is responsible for the patient's condition? 1. Ondansetron and amantadine 2. Ondansetron and apomorphine 3. Trimethobenzamide and amantadine 4. Trimethobenzamide and apomorphine

2- Correct When the dopamine agonist apomorphine is administered alone, it causes severe nausea and vomiting. Apomorphine, when administered along with antiemetics such as ondansetron, leads to very low blood pressure and loss of consciousness. Amantadine does not have any drug-drug interactions with antiemetics such as ondansetron. Amantadine would not cause any side effects such as nausea and vomiting; therefore co-administration with an antiemetic such as trimethobenzamide is not required. Trimethobenzamide is the preferred antiemetic to be co-administered with apomorphine, because it causes nausea and vomiting when taken alone. Text Reference - p. 1435

A patient, whose parent died from Huntington's disease, is discussing the condition and genetic testing with a nurse. Which of the patient's statements needs to be corrected by the nurse? 1. Offspring of persons with Huntington's disease have a 50% risk to develop it. 2. Currently there is no effective treatment or cure for Huntington's disease. 3. Positive genetic testing indicates at what age the symptoms of the disease will occur. 4. Positive genetic testing indicates the patient eventually will develop the disease.

3- Correct A positive genetic testing does not tell the patient at what age symptoms of the disease will appear. Continuous and excessive involuntary movements will occur. Onset of the disease occurs between the ages of 30 and 50 years. Offspring have a 50 percent risk of developing the disease, because it is an autosomal dominant transmission. If the patient has the gene, eventually the symptoms of the disease will occur. Test-Taking Tip: Come to your test prep with a positive attitude about yourself, your nursing knowledge, and your test-taking abilities. A positive attitude is achieved through self-confidence gained by effective study. This means (a) answering questions (assessment), (b) organizing study time (planning), (c) reading and further study (implementation), and (d) answering questions (evaluation). Text Reference - p. 1440

A patient is prescribed carbamazepine for a new-onset seizure disorder. The nurse is educating the patient about this drug. What teaching comment by the nurse is most accurate? 1. This medication is given to treat absence and myloclonic seizures. 2. Don't be concerned if any visual disturbances occur while taking this medication. 3. Do not take this medication with grapefruit. 4. The goal of this medication is to cure your condition and prevent any more seizures.

3- Correct Grapefruit inhibits the activity of the gastrointestinal enzyme that breaks down this medication so that more of the drug is in the body, and sometimes dangerously high amounts can enter the bloodstream. Carbamazepine is given to treat generalized tonic-clonic and partial seizures. Patients are instructed to report any type of visual abnormalities. Antiseizure drugs do not cure the condition but help to prevent seizures with a minimum of side effects. Text Reference - p. 1496

Which type of drug is prescribed to patients with parkinsonism with a condition such as hypomobility? 1. Ropinirole 2. Pamiprexole 3. Apomorphine 4. Bromocriptine

3- Correct Hypomobility is a condition that occurs towards the end of the dosing interval of standard medication in patients with parkinsonism. Drugs such as apomorphine, a dopamine agonist, block the reuptake of dopamine into the presynaptic neurons and stimulate the postsynaptic dopamine receptors. Carbidopa and entacapone block the COMT enzyme. Ropinirole, pamiprexole, and bromocriptine are classified as dopamine receptor agonists that act by stimulating the dopamine receptors. These dopamine receptor agonists are not used during hypomobility. Text Reference - p. 1435

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? 1. Aura seizures 2. Postictal seizures 3. Generalized seizures 4. Simple partial seizures

3- Correct 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. Text Reference - p. 1420

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? 1. Atonic seizure 2. Myoclonic seizure 3. Subclinical seizure 4. Tonic-clonic seizure

3- Correct 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. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 1422

A patient is diagnosed with multiple sclerosis (MS) and is prescribed interferon. What should the nurse include in medication teaching? 1. The medication should be taken before meals on an empty stomach. 2. The medication is given during exacerbation of symptoms to promote remission. 3. The medication often causes patients to experience flu-like symptoms. 4. The medication alters carbohydrate metabolism and elevates serum glucose levels.

3- Correct Interferon is an immunomodulator medication that treats the disease process and prevents relapses. The medication often causes flu-like symptoms, achiness, and headache, which are treated effectively with mild analgesics such as acetaminophen or ibuprofen. The medication is administered subcutaneously every other day. Exacerbations of MS are treated with corticosteroid medications. Corticosteroids alter carbohydrate metabolism and elevate serum glucose levels. Text Reference - p. 1430

A patient with a diagnosis of Parkinson's disease (PD) has been admitted recently to a long-term care facility. Which action should the health care team take to promote adequate nutrition for this patient? 1. Provide multivitamins with each meal. 2. Provide a diet that is low in complex carbohydrates and high in protein. 3. Provide small, frequent meals throughout the day that are easy to chew and swallow. 4. Provide the patient with a minced or pureed diet that is high in potassium and low in sodium.

3- Correct Nutritional support is a priority in the care of individuals with PD. Such patients may benefit from meals that are smaller and more frequent than normal and that are easy to chew and swallow. Multivitamins are not necessary at each meal, and vitamin intake, along with protein intake, must be monitored to prevent contraindications with medications. It is likely premature to introduce a minced or pureed diet and a low-carbohydrate diet is not indicated. Test-Taking Tip: The night before the examination you may wish to review some key concepts that you believe need additional time, but then relax and get a good night's sleep. Remember to set your alarm, allowing yourself plenty of time to dress comfortably (preferably in layers, depending on the weather), have a good breakfast, and arrive at the testing site at least 15 to 30 minutes early. Text Reference - p. 1436

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? 1. Notify the health care provider about unusual hair growth. 2. Practice good dental hygiene to control gingival hyperplasia. 3. Do not stop the drug abruptly without consulting the health care provider. 4. Maintain a healthy lifestyle with regular exercise and nutritious diet.

3- Correct Phenytoin is an antiseizure drug. Abrupt withdrawal of the drug after long-term use may precipitate seizures; therefore, the patient should not stop the drug without consulting the health care provider. Unusual hair growth and gingival hyperplasia are side effects of antiseizure drugs and are not relevant in preventing precipitation of seizures. Maintaining a healthy lifestyle is a general measure to keep healthy and may not contribute to prevention of precipitation of seizures. Text Reference - p. 1424

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? 1. Administer saline intravenously 2. Administer dextrose intravenously 3. Administer diazepam intravenously 4. Administer gabapentin intravenously

3- Correct 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. Saline is administered to patients with severe dehydration and electrolyte imbalance. Dextrose is given if the patient has seizures due to hypoglycemia. Gabapentin is given to treat generalized seizures. Text Reference - p. 1422

What is the nursing action of highest priority to be taken with a patient who experiences a generalized tonic/clonic seizure? 1. Restraining the arms and legs 2. Controlling head movements 3. Protecting the head and extremities 4. Inserting a tongue blade between the teeth

3- Correct Staying with the patient to provide protection of the head and extremities is the most important nursing care activity for a patient experiencing a generalized tonic/clonic seizure. Attempting to restrain or control the jerking movement of the head and extremities during a seizure may cause further injury and even fracture bones. Body parts should not be restrained or controlled. Use of a tongue blade is not acceptable in current practice because it is difficult to insert once the seizure begins and the patient may bite through the tongue blade and aspirate. Text Reference - p. 1423

A patient with systemic lupus erythematosus presents to the emergency room with warm skin and pallor. The nurse observes that the patient is lethargic and has an altered level of consciousness. What seizure phase is this patient most likely experiencing? 1. Tonic phase 2. Clonic phase 3. Postictal phase 4. Hypertonic phase

3- Correct Systemic lupus erythematosus can lead to tonic-clonic seizures. Warm skin and pallor are the clinical signs of tonic-clonic seizures. Tonic-clonic seizures progress through several phases. Lethargy and altered level of consciousness are seen in the postictal phase, so the probable phase of this patient's stroke is the postictal phase. In the tonic phase, continuous muscle contraction is observed. Rigidity and relaxation in rapid succession are observed in the clonic phase. Extreme muscle rigidity is seen in the hypertonic phase, which lasts for 5 to 15 seconds. Text Reference - p. 1423

hich measure is a priority for a nurse to include in the plan of care for a patient who has multiple sclerosis? 1. Referring the patient for genetic counseling 2. Teaching the patient about medications used during acute exacerbations 3. Assisting the patient in identifying the factors that precipitate exacerbations 4. Instructing the patient in the proper technique for self-administration of an enema

3- Correct The cause of multiple sclerosis is unknown, although fatigue, stress, or events such as pregnancy or acute illness can bring on an exacerbation. Identifying and avoiding such activities or factors may prevent exacerbations. Multiple sclerosis does not have a genetic link. Teaching the patient about medications and the proper technique for the self-administration of an enema is important but not as high of a priority as preventing exacerbations of the disease and complications. Text Reference - p. 1429

Which measure is a priority for a nurse to include in the plan of care for a patient who has multiple sclerosis? 1. Referring the patient for genetic counseling 2. Teaching the patient about medications used during acute exacerbations 3. Assisting the patient in identifying the factors that precipitate exacerbations 4. Instructing the patient in the proper technique for self-administration of an enema

3- Correct The cause of multiple sclerosis is unknown, although fatigue, stress, or events such as pregnancy or acute illness can bring on an exacerbation. Identifying and avoiding such activities or factors may prevent exacerbations. Multiple sclerosis does not have a genetic link. Teaching the patient about medications and the proper technique for the self-administration of an enema is important but not as high of a priority as preventing exacerbations of the disease and complications. Text Reference - p. 1429 Topics

Which nerve is represented as [CN]V? 1. Facial nerve 2. Vagus nerve 3. Cranial nerve 4. Glossopharyngeal nerve

3- Correct The cranial nerve is represented as [CN]V. The facial nerve is represented as [CN]VII. The vagus nerve is represented as [CN]X. The glossopharyngeal nerve is represented as [CN]IX). Text Reference - p. 1413

Which nursing diagnosis is likely to be a priority in the care of a patient with myasthenia gravis (MG)? 1. Acute confusion 2. Bowel incontinence 3. Activity intolerance 4. Disturbed sleep pattern

3- Correct The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG, and although sleep disturbance is likely, activity intolerance is usually of primary concern. Test-Taking Tip: Being prepared reduces your stress or tension level and helps you maintain a positive attitude. Text Reference - p. 1439

The patient with epilepsy is due for a dose of carbamazepine. The serum carbamazepine level today is 18 mcg/mL. What is the priority nursing action? 1. Give the scheduled dose immediately to maintain the therapeutic level. 2. Ask the laboratory to draw a new level to check for error in measurement. 3. Withhold the dose and telephone the health care provider with the result. 4. Telephone the health care provider to obtain a prescription for an increased dose.

3- Correct The therapeutic range for the serum carbamazepine is 4 to 12 mcg /mL. The patient's result is higher than the normal range and places the patient at risk for toxicity. The nurse should hold the dose of medication and immediately notify the health care provider. There is no reason to repeat the drug level. Text Reference - p. 1422

A patient with a history of epilepsy is in the postanesthesia recovery unit (PACU) after surgery under local anesthesia. The patient has a tonic-clonic seizure that lasts two minutes. Which action should the nurse take while the patient is having the seizure? 1. Restrain the patient to prevent injury. 2. Administer 50 grams of dextrose intravenously. 3. Reorient the patient to place and time. 4. Ensure the patient has a patent airway.

4- Correct During a tonic-clonic seizure the patient becomes unconscious, has generalized stiffening (tonic phase), and then jerking (clonic phase). The most important nursing intervention is to maintain the patient's open airway. Suctioning equipment should be available. The patient should not be restrained but protected from injury. Intravenous dextrose is not indicated, because the patient is not noted to be hypoglycemic. Reorientation is not done with the patient unconscious during the seizure. Text Reference - p. 1426

The nurse is teaching safety measures to a patient with seizure disorder who has a history of diabetes mellitus. Which statement made by the patient shows ineffective learning? 1. "I will get adequate sleep." 2. "I will refrain from drinking alcohol." 3. "I will wear a helmet while riding a bike." 4. "I will refrain from doing physical exercises."

4- Correct Good general health habits are helpful for patients who have a seizure disorder. Patients with a seizure disorder should exercise regularly. Loss of sleep is one of the factors which may aggravate the condition of the patient with a seizure disorder. Therefore, adequate sleep is very important for these patients. Alcohol consumption can cause liver damage. Patients with a seizure disorder should refrain from drinking alcohol in order to prevent aggravation of this condition. Patients with seizure disorders are more prone to accidents. Therefore, wearing a helmet will reduce the risk of head injury. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. Text Reference - p. 1425

Which degenerative neurologic disorder is an example of a genetically transmitted, autosomal dominant disorder? 1. Multiple sclerosis 2. Myasthenia graves 3. Lou Gehrig's disease 4. Huntington's disease

4- Correct Huntington's disease is a genetically transmitted, autosomal dominant disorder. The offspring of a person with this disease have a 50 percent risk of inheriting it. Multiple sclerosis is a chronic progressive degenerative disorder of the central nervous system, not an autosomal dominant disorder. Demyelination of the nerve fibers of the brain and spinal cord is the principle characteristic of the disease. Myasthenia gravis is an autoimmune disease of the neuromuscular junction and is not an autosomal dominant disorder. Lou Gehrig's disease is a rare, progressive neurologic disorder that involves the degeneration of motor neurons in the brain and spinal cord. This is not an autosomal dominant disorder. Text Reference - p. 1440

Which degenerative neurologic disorder is an example of a genetically transmitted, autosomal dominant disorder? 1. Multiple sclerosis 2. Myasthenia gravis 3. Lou Gehrig's disease 4. Huntington's disease

4- Correct Huntington's disease is a genetically transmitted, autosomal dominant disorder. The offspring of a person with this disease have a 50 percent risk of inheriting it. Multiple sclerosis is a chronic progressive degenerative disorder of the central nervous system, not an autosomal dominant disorder. Demyelination of the nerve fibers of the brain and spinal cord is the principle characteristic of the disease. Myasthenia gravis is an autoimmune disease of the neuromuscular junction and is not an autosomal dominant disorder. Lou Gehrig's disease is a rare, progressive neurologic disorder that involves the degeneration of motor neurons in the brain and spinal cord. This is not an autosomal dominant disorder. Text Reference - p. 1440 Topics

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? 1. Turning the patient to the side 2. Loosening the patient's tight clothing 3. Easing the patient to the floor, if seated 4. Sending the patient to hospital immediately after a single seizure

4- Correct It is not necessary to send a patient immediately to the hospital after a seizure unless the seizure is prolonged or another seizure immediately follows. The caregiver should turn the patient to his or her side in order to protect the patient from injury. Loosening any restrictive clothing of the patient will ensure a patent airway. Similarly, easing the patient to the floor if he or she is seated will help to protect the patient from injuries. Text Reference - p. 1426

What is the major complication associated with myasthenic crisis? 1. Speech alteration 2. Difficulty chewing 3. Impaired facial mobility 4. Respiratory insufficiency

4- Correct Myasthenic crisis is the acute exacerbation of myasthenia gravis. This is a life-threatening condition that occurs when the muscles that control breathing and swallowing become too weak to perform their functions. The clinical manifestations of myasthenia gravis include speech alteration due to muscle weakness related to speech. However, this is not a major complication associated with myasthenic crisis. Difficulty in chewing is due to the weakness of muscles related to chewing but is not a major complication associated with myasthenic crisis. Impaired facial mobility and expression are the clinical manifestations of myasthenia gravis due to the weakness of facial muscles but are not a major complication associated with myasthenic crisis. Text Reference - p. 1438

Which type of multiple sclerosis is characterized by a relapsing-remitting initial course followed by disease with or without relapses? 1. Relapsing-remitting 2. Primary-progressive 3. Progressive-relapsing 4. Secondary-progressive

4- Correct Secondary-progressive multiple sclerosis has a relapsing-remitting course that later becomes steadily progressive, with or without occasional relapses, minor remissions, and plateaus. Relapsing-remitting multiple sclerosis involves developing and resolving symptoms over a few weeks to months before the patient returns to the baseline. Primary-progressive multiple sclerosis involves steady and gradual neurologic dysfunction without remittance of the symptoms. Progressive-relapsing multiple sclerosis involves frequent relapses with a partial recovery, without the patient returning to the baseline. Text Reference - p. 1429

The nurse assesses a patient for signs of petit mal, or absence, seizures. What is the classic sign of this seizure disorder? 1. Dizziness 2. Intense anxiety 3. Stiffening of the body 4. Vacant facial expression

4- Correct The patient experiencing a petit mal or absence seizure displays a sudden vacant look and usually stares straight ahead. This type of seizure often goes unnoticed by the patient and others. Dizziness and intense anxiety are not commonly associated with petit mal seizures. Stiffening of the body is the tonic phase and is associated with a tonic-clonic seizure, not an absence seizure. Text Reference - p. 1420 Topics

A patient with a suspected seizure failed to respond to drug therapy and reports unusual sensations and hallucinations. What could be the effective surgical treatment? 1. Hemispherectomy 2. Vagal nerve stimulation 3. Sectioning of corpus callous 4. Resection of epileptogenic tissue

4- Correct Unusual sensations and hallucinations are the clinical signs of simple focal seizures. Surgery is advised when the patient does not respond to drug therapy. Resection of epileptogenic tissue is the effective surgical treatment in focal seizures. A hemispherectomy is performed in patients who have multifocal epilepsy, associated with hemiplegia. When surgery is not feasible, vagal nerve stimulation is performed. Sectioning of corpus callosum is an appropriate surgical therapy for generalized seizures. Text Reference - p. 1421

Arrange the steps of vagal nerve stimulation chronologically. 1. Occurrence of seizure is prevented. 2. An electrode is implanted surgically. 3. The electrode is activated by a magnet. 4. The electrode delivers the electrical impulse.

Correct: 1. An electrode is implanted surgically. 2. The electrode is activated by a magnet. 3. The electrode delivers the electrical impulse. 4. Occurrence of seizure is prevented. Vagal nerve stimulation is used when surgery is not feasible to treat seizures. In this process, an electrode is implanted in the neck. A magnet can activate this electrode, which delivers the electrical impulse and prevents the seizure from occurring. Test-Taking Tip: In this question type, you are asked to prioritize (put in order) the options presented. For example, you might be asked the steps of performing an action or skill such as those involved in medication administration. Text Reference - p. 1424