chapter 69- Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies

Bell palsy is a disorder of which cranial nerve? Trigeminal (V) Vestibulocochlear (VIII) Facial (VII) Vagus (X)

Facial (VII)-

A health care provider asks a nurse to assess a patient being evaluated for aseptic meningitis for a positive Brudzinski sign. Which of the following actions should the nurse take? Assess the patient's sensitivity to light. Support the patient's neck through normal range of motion and evaluate stiffness. Help the patient flex his neck and observe for flexion of the hips and knees. Flex the patient's thigh on his abdomen and assess the extension of the leg.

Help the patient flex his neck and observe for flexion of the hips and knees.

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

Magnetic resonance imaging- which can show the presence of plaques in the central nervous system

When caring for a client with trigeminal neuralgia, which intervention has the highest priority? Providing emotional support while the client adjusts to changes in his physical appearance Monitoring intake and output Assisting with ambulation Encouraging the client to bathe with care

Encouraging the client to bathe with care-

A client has a neurological defect and will be transferred to a nursing home because family members are unable to care for the client at home. While receiving a bed bath, the client yells at the nurse, "You don't know what you are doing!" What is the best reaction by the nurse? Accept the patient's behavior and do not take it personally. Request that the patient be cared for by another nurse. Discontinue the bath and resume it later. Explain that the client is getting good care.

Accept the patient's behavior and do not take it personally.

Which nursing intervention is appropriate for a client with double vision in the right eye due to MS? Apply an eye patch to the right eye. Exercise the right eye twice a day. Administer eye drops as needed. Place needed items on the right side.

Apply an eye patch to the right eye.

The nurse is caring for a client diagnosed with Guillain-Barre syndrome. His spouse asks about recovery rates. The nurse can correctly relate which of the following? Approximately 60% to 75% of clients recover completely. Only a very small percentage (5% to 8%) of clients recover completely. Usually 100% of clients recover completely. No one with Guillain-Barre syndrome recovers completely.

Approximately 60% to 75% of clients recover completely.

A patient suspected of having Guillain-Barré syndrome has had a lumbar puncture for cerebrospinal fluid (CSF) evaluation. When reviewing the laboratory results, what does the nurse find that is diagnostic for this disease? Glucose in the CSF Elevated protein levels in the CSF Red blood cells present in the CSF White blood cells in the CSF

Elevated protein levels in the CSF

Which is the most common cause of acute encephalitis in the United States? Western equine virus Herpes simplex virus West Nile virus St. Louis virus

Herpes simplex virus

A client has been brought to the ED with altered LOC, high fever, and a purpura rash on the lower extremities. The family states the client was reporting neck stiffness earlier in the day. What action should the nurse do first? Initiate isolation precautions. Ensure the family receives prophylaxis antibiotic treatment. Administer prescribed antibiotics. Apply a cooling blanket.

Initiate isolation precautions-

During the acute phase of a debilitating cerebrovascular accident, which nursing intervention is most helpful in promoting the rehabilitation of the client? Prevention of joint contractures Promotion of critical thinking ability Creation of a positive environment Use of adaptive equipment

Prevention of joint contractures- prevented through correct body positioning and by putting affected extremities through a full range of motion four or five times a day.

Which client goal, established by the nurse, is most important as the nurse plans care for a seizure client in the home setting? The client will take the seizure medication at the same time daily. The client will remain free of injury if a seizure does occur. The client will verbalize an understanding of feelings that preempt seizure activity. The client will post emergency numbers on the refrigerator for ease of obtaining.

The client will remain free of injury if a seizure does occur-

Which drug should be available to counteract the effect of edrophonium chloride? Prednisone Atropine Azathioprine Pyridostigmine bromide

atropine

The nurse is caring for a patient in the emergency department with an onset of pain related to trigeminal neuralgia. What subjective data stated by the patient does the nurse determine triggered the paroxysms of pain? "I was sitting at home watching television." "I was putting my shoes on." "I was brushing my teeth." "I was taking a bath."

"I was brushing my teeth."

Myasthenia gravis occurs when antibodies attack which receptor sites? Serotonin Dopamine Acetylcholine Gamma-aminobutyric acid

Acetylcholine-

The nurse is performing an initial assessment on a client admitted with a possible brain abscess. Which of the following would the nurse most likely find? Headache that is worse in the morning Ptosis that is more pronounced at the end of the day Diplopia that is constant Nuchal rigidity

Headache that is worse in the morning

A client has been diagnosed with a frontal lobe brain abscess. Which nursing intervention is appropriate? Assess for facial weakness. Initiate seizure precautions. Assess visual acuity. Ensure that client takes nothing by mouth.

Initiate seizure precautions- frontal lobe brain abscess produces seizures, hemiparesis, and frontal headache

The nurse is evaluating the progression of a client in the home setting. Which activity of the hemiplegic client best indicates that the client is assuming independence? The client grasps the affected arm at the wrist and raises it. The client arranges a community service to deliver meals. The client ambulates with the assistance of one. The client uses a mechanical lift to climb steps.

The client grasps the affected arm at the wrist and raises it.

The primary arthropod vector in North America that transmits encephalitis is the tick. horse. mosquito. flea.

mosquito

A client admitted with meningitis is to receive Vancocin (vancomycin) 250 mg in 100 mL intravenously over 60 minutes twice a day. The IV tubing set is calibrated at 15 drops per/mL. At how many drops per minute will the nurse run this solution? Enter the correct number ONLY.

25: (100 mL/60 minutes) X 15 = 25.

A client who recently experienced a stroke tells the nurse that he has double vision. Which nursing intervention is most appropriate? Encourage the client to close his eyes. Alternatively patch one eye every 2 hours. Turn out the lights in the room. Instill artificial tears.

Alternatively patch one eye every 2 hours.

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

Assessing respiratory effort-client in myasthenic crisis has severe muscle weakness, including the muscles needed to support respiratory effort. Myasthenic crisis can lead to respiratory failure and death if not recognized earl

A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease? Ambenonium (Mytelase) Pyridostigmine (Mestinon) Edrophonium (Tensilon) Carbachol (Carboptic)

Edrophonium (Tensilon)- temporarily blocks the breakdown of acetylcholine, thus increasing acetylcholine level in the blood, and relieves weakness

Which is a component of the nursing management of the client with new variant Creutzfeldt-Jakob disease (vCJD)? Providing supportive care Initiating isolation procedures Preparing for organ donation Administering amphotericin B

Providing supportive care

A neurologic deficit is best defined as a deficit of the: central and peripheral nervous systems with decreased, impaired, or absent functioning. central nervous system that affects one body system. central nervous system with absent functioning. peripheral nervous system with decreased or impaired functioning.

central and peripheral nervous systems with decreased, impaired, or absent functioning-

The nurse is performing an initial assessment on a client with suspected Bell's palsy. Which of the following findings would the nurse be most focused on related to this medical diagnosis? Facial distortion and pain Hyporeflexia and weakness of the lower extremities Ptosis and diplopia Fatigue and depression

Facial distortion and pain-

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

Multiple sclerosis

A nurse is teaching a client with multiple sclerosis (MS). When teaching the client how to reduce fatigue, the nurse should tell the client to: take a hot bath. rest in an air-conditioned room. increase the dose of muscle relaxants. avoid naps during the day.

rest in an air-conditioned room.

A client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond? "The paralysis caused by this disease is temporary." "You'll be permanently paralyzed; however, you won't have any sensory loss." "It must be hard to accept the permanency of your paralysis." "You'll first regain use of your legs and then your arms."

"The paralysis caused by this disease is temporary."

The nurse is caring for a patient with GBS in the intensive care unit and is assessing the patient for autonomic dysfunction. What interventions should be provided in order to determine the presence of autonomic dysfunction? Assess the respiratory rate and oxygen saturation. Assess the blood pressure and heart rate. Assess the peripheral pulses. Listen to the bowel sounds.

Assess the blood pressure and heart rate.

A client is experiencing muscle weakness and an ataxic gait. The client has a diagnosis of multiple sclerosis (MS). Based on these symptoms, the nurse formulates "Impaired physical mobility" as one of the nursing diagnoses applicable to the client. What nursing intervention should be most appropriate to address the nursing diagnosis? Use pressure-relieving devices when the client is in bed or in a wheelchair. Change body position every 2 hours. Help the client perform range-of-motion (ROM) exercises every 8 hours. Use a footboard and trochanter rolls.

Help the client perform range-of-motion (ROM) exercises every 8 hours.

Medical management of arthropod-borne virus (arboviral) encephalitis is aimed at preventing renal insufficiency. controlling seizures and increased intracranial pressure. maintaining hemodynamic stability and adequate cardiac output. preventing muscular atrophy.

controlling seizures and increased intracranial pressure

A client with herpes simplex virus (HSV) encephalitis is receiving acyclovir. To ensure early intervention, the nurse monitors laboratory values and urine output for which type of adverse reactions? Musculoskeletal Integumentary Hepatic Renal

renal

The client with herpes simplex virus (HSV) encephalitis is receiving acyclovir. The nurse monitors blood chemistry test results and urinary output for signs and symptoms of cardiac insufficiency. signs of relapse. signs of improvement in the patient's condition. renal complications related to acyclovir therapy.

renal complications related to acyclovir therapy.-

The parents of a client intubated due to the progression of Guillain-Barré syndrome ask whether their child will die. What is the best response by the nurse? "Don't worry; your child will be fine." "Once Guillain-Barré syndrome progresses to the diaphragm, survival decreases significantly." "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive." "It's too early to give a prognosis."

"There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive."

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

tensilon test- Edrophonium chloride (Tensilon) is an acetylcholinesterase inhibitor that stops the breakdown of acetylcholine. The drug is used because it has a rapid onset of 30 seconds and a short duration of 5 minutes. Immediate improvement in muscle strength after administration of this agent represents a positive test and usually confirms the diagnosis.

During a Tensilon test to determine if a patient has myasthenia gravis, the patient complains of cramping and becomes diaphoretic. Vital signs are BP 130/78, HR 42, and respiration 18. What intervention should the nurse prepare to do? Place the patient in the supine position. Administer diphenhydramine (Benadryl) for the allergic reaction. Administer atropine to control the side effects of edrophonium. Call the rapid response team because the patient is preparing to arrest.

Administer atropine to control the side effects of edrophonium.

Which well-recognized sign of meningitis is exhibited when the client's neck is flexed and flexion of the knees and hips is produced? Positive Kerning sign Photophobia Positive Brudzinski sign Nuchal rigidity

Positive Brudzinski sign- occurs when the client's neck is flexed (after ruling out cervical trauma or injury) and flexion of the knees and hips is produced

A patient with Bell's palsy says to the nurse, "It doesn't hurt anymore to touch my face. How am I going to get muscle tone back so I don't look like this anymore?" What interventions can the nurse suggest to the patient? Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone. Suggest applying cool compresses on the face several times a day to tighten the muscles. Inform the patient that the muscle function will return as soon as the virus dissipates. Tell the patient to smile every 4 hours.

Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone.

The nurse is assisting with administering a Tensilon test to a patient with ptosis. If the test is positive for myasthenia gravis, what outcome does the nurse know will occur? Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes. After administration of the medication, there will be no change in the status of the ptosis or facial weakness. The patient will have recovery of symptoms for at least 24 hours after the administration of the Tensilon. Eight hours after administration, the acetylcholinesterase begins to regenerate the available acetylcholine and will relieve symptoms.

Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes.

The nurse is administering the IV antiviral medication ganciclovir (Cytovene) to the patient with HSV-1 encephalitis. What is the best way for the nurse to administer the medication to avoid crystallization of the medication in the urine? Administer the medication rapidly over 15 minutes with 100 mL of normal saline. Dilute the medicine in 500 mL of lactated Ringer's solution. Administer via slow IV over 1 hour. Administer in a drip over 4 hours.

Administer via slow IV over 1 hour.

A client with myasthenia gravis is admitted with an exacerbation. The nurse is educating the client about plasmapheresis and explains this in which of the following statements? Antibodies are removed from the plasma. The thymus gland is removed. Immune globulin is given intravenously. Mestinon therapy is initiated.

Antibodies are removed from the plasma- Plasmapheresis is a technique in which antibodies are removed from plasma and the plasma is returned to the client

A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide (Mestinon) on time. The nurse gets busy and does not administer the medication until after breakfast. What outcome will the patient have related to this late dose? The muscles will become fatigued and the patient will not be able to chew food or swallow pills. There should not be a problem, since the medication was only delayed by about 2 hours. The patient will go into cardiac arrest. The patient will require a double dose prior to lunch.

The muscles will become fatigued and the patient will not be able to chew food or swallow pills.

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

Uneven, labored respirations-characteristic feature of Guillain-Barré syndrome is ascending weakness, which usually begins in the legs and progresses upward to the trunk, arms, and face. Respiratory muscle weakness, evidenced by uneven, labored respirations

A client with Guillain-Barre syndrome cannot swallow and has a paralytic ileus; the nurse is administering parenteral nutrition intravenously. The nurse is careful to assess which of the following related to intake of nutrients? Gag reflex and bowel sounds Condition of skin Respiratory status Urinary output and capillary refill

Gag reflex and bowel sounds-

Which condition is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain? Multiple sclerosis Creutzfeldt-Jakob disease Parkinson disease Huntington disease

Creutzfeldt-Jakob disease- causes severe dementia and myoclonus

The nurse is performing an initial nursing assessment on a client with possible Guillain-Barre syndrome. Which of the following findings would be most consistent with this diagnosis? Muscle weakness and hyporeflexia of the lower extremities Fever and cough Hyporeflexia and skin rash Ptosis and muscle weakness of upper extremities

Muscle weakness and hyporeflexia of the lower extremities

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

Demonstrate daily muscle stretching exercises. Apply warm compresses to the affected areas. Allow the patient adequate time to perform exercises

The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe? Diplopia and ptosis Numbness Patchy blindness Loss of proprioception

Diplopia and ptosis

The nurse is planning care for a client with Guillain-Barre syndrome. The priority client outcome would be which of the following? Maintains effective respirations and airway clearance Shows increasing mobility Receives adequate nutrition and hydration Demonstrates recovery of speech

Maintains effective respirations and airway clearance

Which of the following is the first-line therapy for myasthenia gravis (MG)? Pyridostigmine bromide (Mestinon) Deltasone (Prednisone) Azathioprine (Imuran) Lioresal (Baclofen)

Pyridostigmine bromide (Mestinon)-anticholinesterase medication, is the first-line therapy in MG. It provides symptomatic relief by inhibiting the breakdown of acetylcholine and increasing the relative concentration of available acetylcholine at the neuromuscular junction

A client with respiratory complications of multiple sclerosis (MS) is admitted to the medical-surgical unit. Which equipment is most important for the nurse to keep at the client's bedside? Sphygmomanometer Padded tongue blade Nasal cannula and oxygen Suction machine with catheters

Suction machine with catheters-MS weakens the respiratory muscles and impairs swallowing, putting the client at risk for aspiration. To ensure a patent oral airway, the nurse should keep a suction machine and suction catheters at the bedside

While caring for clients who have suffered neurologic deficits from causes such as cerebrovascular accident and closed head injury, an important nursing goal that motivates nurses to offer the best care possible is preventing: complications. falls. choking. infection.

complications

A client with fungal encephalitis receiving amphotericin B reports fever, chills, and body aches. The nurse knows that these symptoms- indicate renal toxicity and a worsening condition. are primarily associated with infection with Coccidioides immitis and Aspergillus. indicate the need for immediate blood and cerebral spinal fluid (CSF) cultures. may be controlled by the administration of diphenhydramine and acetaminophen approximately 30 minutes before administration of the amphotericin.

may be controlled by the administration of diphenhydramine and acetaminophen approximately 30 minutes before administration of the amphotericin.

A client is receiving baclofen for management of symptoms associated with multiple sclerosis. The nurse evaluates the effectiveness of this medication by assessing which of the following? Sleep pattern Mood and affect Appetite Muscle spasms

muscle spasms-

The most common cause of cholinergic crisis includes which of the following?

overmedication