Chapters 66, 69, 70 - Hinkle & Cheever: Brunner & Suddarth's and Chapter 49 - Maternal & Child Health Nursing

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." "You'll first regain use of your legs and then your arms." "It must be hard to accept the permanency of your paralysis."

"The paralysis caused by this disease is temporary." Page 2083

A client with Parkinson's disease asks the nurse what their treatment is supposed to do since the disease is progressive. What would be the nurse's best response? "Treatment aims at keeping you emotionally healthy by making you think you are doing something to fight this disease." "Treatment aims at keeping you independent as long as possible." "Treatment really doesn't matter; the disease is going to progress anyway." "Treatment for Parkinson's is only palliative; it keeps you comfortable."

"Treatment aims at keeping you independent as long as possible." Page 2103

A client experiences a seizure while hospitalized for appendicitis. During the postictal phase, the client is yelling and swings a closed fist at the nurse. Which is the appropriate action by the nurse? 1. Place the client in wrist restraints. 2. Reorient the client while gently holding their arms. 3. Apply oxygen via nasal cannula. 4. Administer lorazepam per orders.

2. Reorient the client while gently holding their arms. If the patient becomes agitated after a seizure (postictal), stay a distance away, but close enough to prevent injury until the patient is fully aware.

A nurse is providing education about migraine headaches to a community group. The cause of migraines has not been clearly demonstrated, but is related to vascular disturbances. A member of the group asks about familial tendencies. The nurse's correct reply will be which of the following? 1. "Only secondary migraine headaches show a familial tendency." 2. "There is a very weak familial tendency." 3. "No familial tendency has been demonstrated." 4. "There is a strong familial tendency."

4. "There is a strong familial tendency." The cause of migraine has not been clearly demonstrated, but it is primarily a vascular disturbance that has a strong familial tendency.

A patient with Parkinson Disease is experiencing weight loss due to difficulty chewing and swallowing. Which meal option below is the best for this patient? A. Scrambled eggs with a side of cottage cheese B. Grilled cheese with apple slices C. Baked chicken with bacon slices D. Tacos with refried beans

A. Scrambled eggs with a side of cottage cheese The patient should have a diet of soft foods that are easy to swallow and chew. Option A is the only option that meets that specification.

An 8-year-old girl is diagnosed as having tonic-clonic seizures. The nurse would want to teach her parents that: A) their daughter should maintain an active lifestyle. B) if their daughter shows symptoms of beginning a seizure, immediately give her medication. C) their daughter should carry a padded tongue blade with her at all times. D) their daughter should be kept quiet late in the day when she is most likely to have a seizure.

Ans: A Page: 1399 It is important for children with seizures to maintain as near normal a lifestyle as possible to maintain self-esteem and achievement. Most seizure medications must create a therapeutic level before they are effective.

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

Assessing respiratory effort Page 2081 Providing ventilatory assistance takes precedence in the immediate management of the patient with myasthenic crisis. Ongoing assessment for respiratory failure is essential. The nurse assesses the respiratory rate, depth, and breath sounds and monitors pulmonary function parameters (vital capacity and negative inspiratory force) to detect pulmonary problems before respiratory dysfunction progresses.

The nurse is ordered to administer Lorazepam to a patient experiencing status epilepticus. As a precautionary measure, the nurse will also have what reversal agent on standby? A. Narcan B. Flumazenil C. Calcium Chloride D. Idarucizumab

B. Flumazenil Flumazenil is the reversal agent for Lorazepam, which is a benzodiazepine.

Which finding below represents a positive Romberg Sign in a patient with multiple sclerosis? A. The patient report dark spots in the visual fields during the confrontation visual field test. B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth. C. The patient's sign and symptoms increase when expose to hot temperatures. D. The patient reports an electric shock feeling when the head and neck are moved downward.

B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth.

Which medications below can help treat muscle spasms in a patient with multiple sclerosis? Select all that apply: A. Propranolol B. Isoniazid C. Baclofen D. Diazepam E. Modafinil

C. Baclofen D. Diazepam These medications treat muscle spasms in patients with MS.

You're patient with Parkinson's Disease has been taking Carbidopa/Levodopa for several years. The patient reports that his signs and symptoms actually become worse before the next dose of medication is due. As the nurse, you know what medication can be prescribed with this medication to help decrease this for happening? A. Anticholinergic (Benztropine) B. Dopamine agonists (Ropinirole) C. COMT Inhibitor (Entacapone) D: Beta blockers (Metoprolol)

C. COMT Inhibitor (Entacapone) Entacapone "Comtan" (is a catechol-O-methyltransferase inhibitors) and is used with levodopa/carbidopa to prevent the "wearing off" of the drug before the next dose is due. It blocks the COMT enzyme that will break down the levodopa in the blood to allow it to last longer.

Neurons in the brain are tasked with handling and transmitting information. There are different types of neurons, such as excitatory and inhibitory. Excitatory neurons release the neurotransmitter _____________, while inhibitory neurons release the neurotransmitter ________________. A. GABA, glutamate B. Norepinephrine, GABA C. Glutamate, GABA D. Dopamine, glutamate

C. Glutamate, GABA Excitatory neurons release glutamate and inhibitory neurons release GABA

Your patient has entered the post ictus stage for seizures. The patient's seizure presented with an aura followed by body stiffening and then recurrent jerking. The patient had incontinence and bleeding in the mouth from injury to the tongue. What is an expected finding in this stage based on the type of seizure this patient experienced? A. Crying and anxiety B. Immediate return to baseline behavior C. Sleepy, headache, and soreness D. Unconsciousness

C. Sleepy, headache, and soreness Based on the findings during the seizure the patient experienced a tonic-clonic seizure. In the post ictus stage (after the seizure) the patient is expected to be sleepy (very tired), have soreness, and a headache. The nurse should let the patient sleep.

You're about to send a patient for a lumbar puncture to help rule out Guillain-Barré Syndrome. Before sending the patient you will have the patient? A. Clean the back with antiseptic B. Drink contrast dye C. Void D. Wash their hair

C. Void The patient will need to void and empty the bladder before going for a LP. This will help decrease the chances of the bladder becoming punctured during the procedure.

Which of the following outcomes would be most appropriate to include in the plan of care for a client diagnosed with a muscular dystrophy? Client demonstrates understanding of the need to adhere to medication therapy. Client participates in activities of daily living using adaptive devices. Client verbalizes understanding of the chronic nature of the disorder. Client describes the importance of diagnostic follow-up to evaluate the disorder.

Client participates in activities of daily living using adaptive devices. Page 2112

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

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

An 8-month-old boy is diagnosed as having cerebral palsy. During physical assessment, the nurse notes which abnormal finding that is common in this disease process? A) He cries when held in a ventral suspension position. B) He holds his back very straight when in a sitting position. C) He bears weight on both feet when held upright. D) He has a strong Moro reflex when startled.

D) He has a strong Moro reflex when startled. A Moro (startle) reflex typically fades by 5 to 6 months. Retained newborn reflexes are suggestive of cerebral palsy.

Which patient below is MOST at risk for developing a cholinergic crisis? A. A patient with myasthenia gravis is who is not receiving sufficient amounts of their anticholinesterase medication. B. A patient with myasthenia gravis who reports not taking the medication Pyridostigmine for 2 weeks. C. A patient with myasthenia gravis who is experiencing a respiratory infection and recently had left hip surgery. D. A patient with myasthenia gravis who reports taking too much of their anticholinesterase medication.

D. A patient with myasthenia gravis who reports taking too much of their anticholinesterase medication. Remember patients who experience a cholinergic crisis are most likely to because they've received too much of their anticholinesterase medications (example Pyridostigmine). However, on the other hand, patients who have received insufficient amount of their anticholinesterase medication or have experienced an illness/stress/surgery are most likely to experience a myasthenia crisis. Both conditions will lead to muscle weakness and respiratory failure but from different causes, which is why a Tensilon test is used to help differentiate between the two conditions.

A 7-year-old male patient is being evaluated for seizures. While in the child's room talking with the child's parents, you notice that the child appears to be daydreaming. You time this event to be 10 seconds. After 10 seconds, the child appropriately responds and doesn't recall the event. This is known as what type of seizure? A. Focal Impaired Awareness (complex partial) B. Atonic C. Tonic-clonic D. Absence

D. Absence This is an absence seizure and is most common in children. The hallmark of it is staring that appears to be like a daydreaming state. It is very short and the post ictus stage of this type of seizure is immediate.

As the home health nurse you are helping a patient with Parkinson's Disease get dressed. What item gathered by the patient to wear should NOT be worn? A. Velcro pants B. Pull over sweatshirt C. Non-slip socks D. Rubber sole shoes

D. Rubber sole shoes Rubber sole shoes can make walking difficulty, especially when the patient has a shuffling gait because these type of shoes tend to stick to the floor and can cause the patient to trip. It is best to wear low heel, smooth soles (not slick or hard).

A patient is exhibiting bradykinesia, rigidity, and tremors related to Parkinson's disease. The nurse understands that these symptoms are directly related to what decreased neurotransmitter level? Serotonin Dopamine Phenylalanine Acetylcholine

Dopamine Page 2101

Impaired balance and uncontrolled tremors of Parkinson's disease is correlated with which neurotransmitter? Glutamate Dopamine Serotonin Acetylcholine

Dopamine Page 2101

The nurse is completing an assessment on a client with myasthenia gravis. Which of the following historical recounting provides the most significant evidence regarding when the disorder began?

Drooping eyelids The initial manifestation of myasthenia gravis in 80% of patients involves the ocular muscles. Diplopia and ptosis (drooping of the eyelids) are common

A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following? Dyskinesia Bradykninesia Dysphonia Micrographia

Dyskinesia Page 2103

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding? Hypokinesia Dysphagia Micrographia Dysphonia

Dysphonia Page 2103

A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order: Doppler ultrasonography. electromyography (EMG). quantitative spectral phonoangiography. Doppler scanning.

Electromyography (EMG). Page 2111

True or False: A patient who is experiencing a tonic-clonic seizure is experiencing a focal (partial) seizure. True False

False A patient who is experiencing a tonic-clonic seizure is experiencing a GENERLAIZED seizure. This type of seizure affects both sides of the brain.

True or False: Guillain-Barré Syndrome occurs when the body's immune system attacks the myelin sheath on the nerves in the central nervous system. True False

False Guillain-Barré Syndrome is an autoimmune neuro condition where the immune system attacks the nerves (myelin sheath) in the PERIPHERAL NERVOUS SYSTEM and cranial nerves. This condition does NOT occur in the central nervous system (CNS).

Which medication is the most effective agent in the treatment of Parkinson disease? Bromocriptine mesylate Benztropine Amantadine Levodopa

Levodopa Page 2103

When educating a patient about the use of antiseizure medication, what should the nurse inform the patient is a result of long-term use of the medication in women?

Osteoporosis

The nurse teaches the client with which disorder that the disease is due to decreased levels of dopamine in the basal ganglia of the brain? Huntington disease Multiple sclerosis Parkinson disease Creutzfeldt-Jakob disease

Parkinson disease Page 2101

A 55-year-old female client presents at the walk-in clinic complaining of feeling like a mask is on her face. While doing the initial assessment, the nurse notes the demonstration of a pill-rolling movement in the right hand and a stooped posture. Physical examination shows bradykinesia and a shuffling gait. What would the nurse suspect is the causative factor for these symptoms? Myesthenia gravis Huntington's disease Parkinson's disease Multiple sclerosis

Parkinson's disease Page 2102

Which of the following drugs may be used after a seizure to maintain a seizure-free state?

Phenobarbital Phenytoin and phenobarbital are given later to maintain a seizure-free state

The home health nurse is caring for a client with Parkinson's disease. The nurse understands that the purpose of adding selegiline with carbidopa-levodopa to the medication regime should result in which purpose? Prevents side effects from carbidopa-levodopa Slows the progression of the disease Replaces dopamine Relieves symptoms of dyskinesia

Slows the progression of the disease Page 2103 Selegiline (a Monomase-Oxidase Inhibitor) inhibits dopamine breakdown. To minimize adverse effects of levodopa over time, current practice includes delaying use of levodopa-containing drugs as long as possible, with the use of other drugs for symptom control in the interim. Selegiline may help people with Parkinson's disease by decreasing the dose of levodopa/carbidopa needed to control symptoms, stopping the effects of levodopa/carbidopa from wearing off between doses, and increasing the length of time that levodopa/carbidopa will continue to control symptoms.

The client presents to the walk-in clinic with fever, nuchal rigidity, and headache. Which of the following assessment findings would be most significant in the diagnosis of this client? 1. Change in level of consciousness 2. Vector bites 3. Seizures 4. Vomiting

2. Vector bites ????? why???? Answer is supposed to be on page 2070.

A patient with suspected Parkinsons disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor? A) When the patient is resting B) When the patient is ambulating C) When the patient is preparing his or her meal tray to eat D) When the patient is participating in occupational therapy

A) When the patient is resting The tremor is present while the patient is at rest; it increases when the patient is walking, concentrating, or feeling anxious. Resting tremor characteristically disappears with purposeful movement, but is evident when the extremities are motionless. Consequently, the nurse should assess for the presence of a tremor when the patient is not performing deliberate actions.

A physician orders a patient to take Benztropine (Cogentin). The patient has never taken this medication before and is due to take the first dose at 1000. What statement by the patient requires you to hold the dose and notify the physician? A. "I forgot to tell the doctor I take eye drops for my glaucoma." B. "I had a PET scan last week." C. "I take aspirin once day." D. "My hands are experiencing tremors at rest."

A. "I forgot to tell the doctor I take eye drops for my glaucoma." This medication is contraindicated for patients with glaucoma.

You're teaching a group of nursing students about Guillain-Barré Syndrome and how it can affect the autonomic nervous system. Which signs and symptoms verbalized by the students demonstrate they understood the autonomic involvement of this syndrome? Select all that apply: A. Altered body temperature regulation B. Inability to move facial muscles C. Cardiac dysrhythmias D. Orthostatic hypotension E. Bladder distension

A. Altered body temperature regulation C. Cardiac dysrhythmias D. Orthostatic hypotension E. Bladder distension All these are some signs and symptoms that can present in severe cases of GBS when the autonomic nervous system is involved.

A patient with Guillain-Barré Syndrome has a feeding tube for nutrition. Before starting the scheduled feeding, it is essential the nurse? Select all that apply: A. Assesses for bowel sounds B. Keeps the head of bed less than 30' degrees C. Checks for gastric residual D. Weighs the patient

A. Assess for bowel sounds C. Check for gastric residual Some patients who experience GBS will need a feeding tube because they are no longer able to swallow safely due to paralysis of the cranial nerves that help with swallowing. GBS can lead to a decrease in gastric motility and paralytic ileus. Therefore, before starting a scheduled feeding the nurse should always assess for bowel sounds and check gastric residual.

You're preparing to help the neurologist with conducting a Tensilon test. Which antidote will you have on hand in case of an emergency? A. Atropine B. Protamine sulfate C. Narcan D. Leucovorin

A. Atropine Atropine will help reverse the effects of the drug given during a Tensilon test, which is Edrophonium, in case an emergency arises. Edrophonium is a short-acting cholinergic drug, while atropine is an anticholinergic.

A patient with multiple sclerosis has issues with completely emptying the bladder. The physician orders the patient to take ___________, which will help with bladder emptying. A. Bethanechol B. Oxybutynin C. Avonex D. Amantadine

A. Bethanechol This medication is a cholinergic medication that will help with bladder emptying.

A patient is suspected of having multiple sclerosis. The neurologist orders various test. The patient's MRI results are back and show lesions on the cerebellum and optic nerve. What signs and symptoms below would correlate with this MRI finding in a patient with multiple sclerosis? A. Blurry vision B. Pain when moving eyes C. Dysarthria D. Balance and coordination issues E. "Pill rolling" of fingers and hands G. Heat intolerance H. Dark spots in vision I. Ptosis

A. Blurry vision B. Pain when moving eyes C. Dysarthria D. Balance and coordination issues H. Dark spots in vision If lesions are present on the optic nerves, optic neuritis can occurs which can lead to blurry vision, pain when moving the eyes, and dark spots in the vision. If cerebellar lesions are found, this can affect movement, speech, and some cognitive abilities. This would present as dysarthria (issues articulating words), and balance/coordination issues. "Pill rolling" of the fingers and hands is found in Parkinson's disease. Ptosis is common in myasthenia gravis, and heat intolerance in thyroid issues.

While providing discharge teaching to a patient prescribed Ropinirole (Requip), you make it priority to teach the patient about what side effect? A. Drowsiness B. Dry mouth C. Coughing D. Dark sweat or saliva

A. Drowsiness This medication is known to cause sudden drowsiness that can cause a person to randomly fall asleep. Therefore, it is PRIORITY to teach the patient to not take this medication when they be driving or operating machinery etc...to prevent injury.

Select all the signs and symptoms associated with cholinergic crisis: A. Miosis B. Dry mouth C. Blurred vision D. Constipation E. Muscle fasciculation F. Diarrhea and abdominal cramping G. Respiratory failure

A. Miosis C. Blurred vision E. Muscle fasciculation F. Diarrhea and abdominal cramping G. Respiratory failure

A patient diagnosed with myasthenia gravis has been hospitalized to receive plasmapheresis for a myasthenic exacerbation. The nurse knows that the course of treatment for plasmapheresis in a patient with myasthenia gravis is what? A) Every day for 1 week B) Determined by the patients response C) Alternate days for 10 days D) Determined by the patients weight

B) Determined by the patients response The typical course of plasmapheresis consists of daily or alternate-day treatment, and the number of treatments is determined by the patients response.

While assisting with a Tensilon test you will have what antidote on hand? A. Narcan B. Atropine C. Flumazenil D. Glucagon

B. Atropine Atropine is the antidote for Edrophonium, which is given during a Tensilon test.

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

C) Prepare to assist with intubation. For the patient with Guillain-Barr syndrome, mechanical ventilation is required if the vital capacity falls, making spontaneous breathing impossible and tissue oxygenation inadequate. Each of the other listed actions is likely insufficient to meet the patients oxygenation needs.

A nurse is admitting a patient with a severe migraine headache and a history of acute coronary syndrome. What migraine medication would the nurse question for this patient? A) Rizatriptan (Maxalt) B) Naratriptan (Amerge) C) Sumatriptan succinate (Imitrex) D) Zolmitriptan (Zomig)

C) Sumatriptan succinate (Imitrex) Triptans can cause chest pain and are contraindicated in patients with ischemic heart disease. Maxalt, Amerge and Zomig are triptans used in routine clinical use for treatment of migraine headaches.

The nurse caring for a patient diagnosed with Guillain-Barr syndrome is planning care with regard to the clinical manifestations associated this syndrome. The nurses communication with the patient should reflect the possibility of what sign or symptom of the disease? A) Intermittent hearing loss B) Tinnitus C) Tongue enlargement D) Vocal paralysis

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

You're examining a patient's health history and find that the patient experienced a cholinergic crisis last year. As the nurse you know that the most common cause of a cholinergic crisis is? A. Over usage of adrenergic blocker medications B. Stress C. Respiratory infections D. Overmedication of an anticholinesterase medication

D. Overmedication of an anticholinesterase medication The most common cause of a cholinergic crisis is overmedication of an anticholinesterase medication. However, on the other hand, the cause of a myasthenic crisis is NOT enough of an anticholinesterase medication or having a respiratory infection or experiencing stress of some type.

True or False: Parkinson's Disease most commonly affects patients in young adulthood, and there is currently no cure for the disease. True False

False The answer is FALSE. Parkinson's Disease most commonly affects patients in OLDER adulthood (60+), and there is currently no cure for the disease.

A client with meningitis has a history of seizures. Which activity should the nurse do while the client is actively seizing? 1. Place a cooling blanket beneath the client 2. Turn the client to the side during a seizure and do not restrain movements 3. Provide oxygen or anticonvulsants, whichever is available 4. Suction the client's mouth and pharynx

2. Turn the client to the side during a seizure and do not restrain movements

A nurse is monitoring a client with Guillain-Barré syndrome. The nurse should assess the client for which responses? Select all that apply. 1. seizure activity 2. respiratory distress 3. difficulty swallowing 4. increasing ICP

2. respiratory distress 3. difficulty swallowing

A patient has been diagnosed with myasthenia gravis. The nurse documents the initial and most common manifestation of: 1. Generalized fatigue. 2. Dysphoria. 3. Diplopia. 4. Facial muscle weakness.

3. Diplopia The initial manifestation of myasthenia gravis in 80% of patients involves the ocular muscles. Diplopia (double vision) and ptosis (drooping of the eyelids) are common

You're assessing your patient load for the patients who are at MOST risk for seizures. Select all the patients below that are at risk: A. A 32-year-old with a blood glucose of 20 mg/dL. B. A 63-year-old whose CT scan shows an ischemic stroke. C. A 72-year-old who is post opt day 5 from open heart surgery. D. A 16-year-old with bacterial meningitis. E. A 58-year-old experiencing ETOH withdrawal.

A. A 32-year-old with a blood glucose of 20 mg/dL. B. A 63-year-old whose CT scan shows an ischemic stroke. D. A 16-year-old with bacterial meningitis. E. A 58-year-old experiencing ETOH withdrawal. All the patients are at risk except option C. Remember all the risk factors: illness (especially CNS types like bacterial meningitis), fever, electrolyte/metabolic issues (low blood sugar, acidosis etc), ETOH (alcohol) withdraw, brain injury, STROKE, congenital brain defects, tumors etc.

A patient who is having a tonic-clonic seizure is prescribed Phenobarbital. During administration of this drug, it is important the nurse monitors for: A. Respiratory depression B. Hypertension C. Disseminated intravascular clotting D. Hypotension E. Fever

A. Respiratory depression D. Hypotension This medication stimulates the GABA receptors and helps with inhibitory neurotransmission. It can lead to respiratory depression and hypotension, therefore, it is very important the nurse monitors the patient for this.

Select all the signs and symptoms below that can present in myasthenia gravis: A. Respiratory failure B. Increased salivation C. Diplopia D. Ptosis E. Slurred speech F. Restlessness G. Mask-like appearance of looking sleepy H. Difficulty swallowing

A. Respiratory failure C. Diplopia D. Ptosis E. Slurred speech G. Mask-like appearance of looking sleepy H. Difficulty swallowing

Myasthenia gravis occurs when antibodies attack which receptor sites? Serotonin Dopamine Acetylcholine GABA

Acetylcholine Page 2079

The nurse is caring for an 82-year-old client diagnosed with cranial arteritis. What is the priority nursing intervention? Assess for weight loss. Administer corticosteroids as ordered. Document signs and symptoms of inflammation. Give acetaminophen per orders.

Administer corticosteroids as ordered. The medical management of cranial arteritis consists of early administration of a corticosteroid to prevent the possibility of loss of vision due to vascular occlusion or rupture of the involved artery.

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

Apply an eye patch to the right eye. The cranial nerves affecting vision may be affected by MS. An eye patch or a covered eyeglass lens may be used to block the visual impulses of one eye if the patient has diplopia.

Which phase of a migraine headache usually lasts less than an hour?

Aura The premonitory phase is experienced by more than 80% of adult migraine sufferers, with symptoms that occur hours to days before a migraine headache. In the postdrome phase, the pain gradually subsides, but patients may experience tiredness, weakness, cognitive difficulties, and mood changes for hours to days

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

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

The nurse is caring for a patient who is in status epilepticus. What medication does the nurse know may be given to halt the seizure immediately? A) Intravenous phenobarbital (Luminal) B) Intravenous diazepam (Valium) C) Oral lorazepam (Ativan) D) Oral phenytoin (Dilantin)

B) IV Diazepam (Valium) Medical management of status epilepticus includes IV diazepam (Valium) and IV lorazepam (Ativan) given slowly in an attempt to halt seizures immediately. Other medications (phenytoin, phenobarbital) are given later to maintain a seizure-free state. Oral medications are not given during status epilepticus.

__________________ happens due to excessive stimulation of the receptors at the neuromuscular junction by acetylcholine, which eventually leads to muscle weakness and respiratory failure. A. Myasthenic crisis B. Cholinergic crisis

B. Cholinergic crisis

An 8-year-old child, who is not responding to anti-seizure medications, is prescribed to start a ketogenic diet. This diet will include: A. High carbohydrates and high fat B. Low fat, high salt, and high carbohydrates C. High fat and low carbohydrates D. High glucose, high fat, and low carbohydrates

C. High fat and low carbohydrates This is a type of diet used in the pediatric population with epilepsy whose seizures cannot be controlled by medication. It is a high fat and low carb diet.

Which tests below can be ordered to help the physician diagnose Guillain-Barré Syndrome? Select all that apply: A. Edrophonium Test B. Sweat Test C. Lumbar puncture D. Electromyography E. Nerve Conduction Studies

C. Lumbar puncture D. Electromyography E. Nerve Conduction Studies These are the tests that can be ordered to help the MD determine if the patient is experiencing GBS.

The nurse is preparing to provide care for a patient diagnosed with myasthenia gravis. The nurse should know that the signs and symptoms of the disease are the result of what? A) Genetic dysfunction B) Upper and lower motor neuron lesions C) Decreased conduction of impulses in an upper motor neuron lesion D) A lower motor neuron lesion

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

The nurse is caring for a patient who has undergone supratentorial removal of a pituitary mass. What medication would the nurse expect to administer prophylactically to prevent seizures in this patient? A) Prednisone B) Dexamethasone C) Cafergot D) Phenytoin

D) Phenytoin Antiseizure medication (phenytoin, diazepam) is often prescribed prophylactically for patients who have undergone supratentorial craniotomy because of the high risk of seizures after this procedure. Prednisone and dexamethasone are steroids and do not prevent seizures. Cafergot is used in the treatment of migraines.

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

D) instruct the patient on daily muscle stretching/ A patient diagnosed with MS should be encouraged to increase the fiber in his or her diet and void 30 minutes after drinking to help train the bladder. The patient should participate in daily muscle stretching to help alleviate and relax muscle spasms.

13. When assisting a child while she is having a tonic-clonic seizure, it would be important to: A) place a tongue blade between the child's teeth. B) restrain the child from all movement. C) turn the child onto her back and observe her. D) protect the child from hitting her arms against furniture.

D) protect the child from hitting her arms against furniture. Page: 1397 In the hospital or home setting, keeping the child safe during a seizure is the highest priority.

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

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

True or False: Patients with multiple sclerosis have different signs and symptoms because this disease can affect various areas of the peripheral nervous system. True False

False Yes, patients with MS have different signs and symptoms because lesions can present at different locations in the CENTRAL NERVOUS SYSTEM....hence the brain and spinal cord (not the peripheral nervous system).

Select all the signs and symptoms associated with a myasthenic crisis: A. Pupil dilation B. Muscle fasciculation C. Miosis D. Bowel and bladder incontinence E. Negative gag or cough reflex F. Respiratory failure G. Bradycardia

A. Pupil dilation E. Negative gag or cough reflex F. Respiratory failure G. Bradycardia

A parent of a child diagnosed with seizures states, I've heard about a special diet that may control seizures, I think it's called ketogenic. What can you tell me about it?" Which are appropriate responses by the nurse? Select all that apply. A) "About 40% to 50% of children who follow the diet have really good results." B) "The diet consists of high fat foods." C) "Children are encouraged to eat a lot of breads and pasta on this diet." D) "Most families find this diet is easy to incorporate into their life." E) "Protein is limited in this diet."

Ans: A, B, E Page: 1397 Feedback: A ketogenic diet has been proven highly effective in 40% to 50% of the children who are started on it. The diet is high fat and low carbohydrate and protein. Bread and pasta are typically high in carbohydrates which is limited in this diet. This diet can be difficult for families to adhere to and incorporate into their lifestyle.

Your patient is scheduled for a lumbar puncture to help diagnose multiple sclerosis. The patient wants clarification about what will be found in the cerebrospinal fluid during the lumbar puncture to confirm the diagnosis of MS. You explain that ____________ will be present in the fluid if MS is present. A. high amounts of IgM B. oligoclonal bands C. low amounts of WBC D. oblong red blood cells and glucose

B. oligoclonal bands These specific proteins, oligoclonal bands, which are immunoglobulins will be found in the CSF. This demonstrates there is inflammation in the CNS and is a common finding in multiple sclerosis.

A patient has experienced a seizure in which she became rigid and then experienced alternating muscle relaxation and contraction. What type of seizure does the nurse recognize? A) Unclassified seizure B) Absence seizure C) Generalized seizure D) Focal seizure

C) Generalized seizure Generalized seizures often involve both hemispheres of the brain, causing both sides of the body to react. Intense rigidity of the entire body may occur, followed by alternating muscle relaxation and contraction (generalized tonicclonic contraction). This pattern of rigidity does not occur in patients who experience unclassified, absence, or focal seizures.

During assessment of a patient who has been taking Phenytoin (Dilantin) for seizure management for 3 years, the nurse notices one of the side effects that should be reported. What is that side effect? 1. Ataxia 2. Diplopia 3. Gingival hyperplasia 4. Alopecia

3. Gingival hyperplasia Gingival hyperplasia (swollen and tender gums) can be associated with long-term use of phenytoin

In planning care for a patient with an extrapyramidal disorder, the nurse recognizes that a major difference between Parkinson's disease and Huntington's disease is the development of ________ in clients with advanced Huntington's disease. 1. depression 2. muscle fasciculations 3. hallucinations and delusions 4. bradykinesia

3. hallucinations and delusions Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia. Hallucinations, delusions, and paranoid thinking may precede the appearance of disjointed movements.

The nurse is caring for a client hospitalized with a severe exacerbation of myasthenia gravis. When administering medications to this client, what is a priority nursing action? 1. Document medication given and dose. 2. Give client plenty of fluids with medications. 3. Assess client's reaction to new medication schedule. 4. Administer medications at exact intervals ordered.

4. Administer medications at exact intervals ordered. Maintenance of stable blood levels of anticholinesterase medications is imperative to stabilize muscle strength. Therefore, the anticholinesterase medications must be given on time. Any delay in administration of medications may exacerbate muscle weakness and make it impossible for the patient to take medications orally.

A spouse of a husband who has Parkinson's Disease explains to you that her husband experiences episodes while walking where he freezes and can't move. She asks what can be done to help with these types of episodes to prevent injury. Select all the options that are correct: A. Have the husband try to change direction of movement by moving in the opposite direction when the freeze ups occur. B. Use a cane with a laser point while walking. C. Have the husband try to push through the freeze ups. D. Encourage the husband to consciously lift the legs while walking (as with marching).

A. Have the husband try to change direction of movement by moving in the opposite direction when the freeze ups occur. B. Use a cane with a laser point while walking. D. Encourage the husband to consciously lift the legs while walking (as with marching).

A patient is experiencing unexplained muscle weakness and respiratory failure. The neurologist conducts a Tensilon test to differentiate between myasthenic crisis or cholinergic crisis. During the test the patient experiences improved muscle strength. Based on this finding the patient has: A. Myasthenic Crisis B. Cholinergic Crisis C. Neither

A. Myasthenic Crisis During a Tensilon test the medication Edrophonium is given, which is an anticholinesterase medication. This will increase the availability of acetylcholine at the neuromuscular junction. If the patient had a cholinergic crisis the problem is not with the availability of acetylcholine, but because there is TOO MUCH of it at the receptor site. Therefore, during this test the patient would experience worsening of symptoms NOT improvement.

A school nurse is called to the playground where a 6-year-old girl has been found unresponsive and staring into space, according to the playground supervisor. How would the nurse document the girls activity in her chart at school? A) Generalized seizure B) Absence seizure C) Focal seizure D) Unclassified seizure

B) Absence seizure Staring episodes characterize an absence seizure, whereas focal seizures, generalized seizures, and unclassified seizures involve uncontrolled motor activity.

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

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

You're a home health nurse providing care to a patient with myasthenia gravis. Today you plan on helping the patient with bathing and exercising. When would be the best time to visit the patient to help these tasks? A. Mid-afternoon B. Morning C. Evening D. Before bedtime

B. Morning Patients with MG tend to have the best muscle strength in the morning after sleeping or resting rather than at the end of the day....the muscles are tired from being used and the muscle become weaker as the day progresses etc. Therefore any rigorous activities are best performed in the morning or after the patient has rested.

Myasthenia gravis occurs when antibodies attack the __________ receptors at the neuromuscular junction leading to ____________.* A. metabotropic; muscle weakness B. nicotinic acetylcholine; muscle weakness C. dopaminergic adrenergic; muscle contraction D. nicotinic adrenergic; muscle contraction

B. nicotinic acetylcholine; muscle weakness In myasthenia gravis, either the nicotinic acetylcholine receptors are attacked by antibodies created by the immune system (hence why this disease is considered autoimmune) or antibodies are inhibiting the function of muscle-specific kinase (which is a receptor tyrosine kinase that helps with maintaining and building the neuromuscular junction). Either way this leads to the neurotransmitter acetylcholine from being able to communicate with the muscle fiber to make it contract.

14. The nurse is caring for a 4-year-old with meningitis. A primary nursing goal would be to: A) increase stimulation opportunities to prevent coma. B) provide an opportunity for therapeutic play. C) reduce the pain related to nuchal rigidity. D) inspect the teeth for obvious caries.

C) reduce the pain related to nuchal rigidity. Page: 1391 Feedback: Irritation of the meninges causes pain on forward flexion of the neck.

The neurologist is conducting a Tensilon test (Edrophonium) at the bedside of a patient who is experiencing unexplained muscle weakness, double vision, difficulty breathing, and ptosis. Which findings after the administration of Edrophonium would represent the patient has myasthenia gravis? A. The patient experiences worsening of the muscle weakness. B. The patient experiences wheezing along with facial flushing. C. The patient reports a tingling sensation in the eyelids and sudden ringing in the ears. D. The patient experiences improved muscle strength.

D. The patient experiences improved muscle strength. During a Tensilon test Edrophonium is administered. This medication prevents the breakdown of acetylcholine, which will allow more of the neurotransmitter acetylcholine to be present at the neuromuscular junction....hence IMPROVING muscle strength IF myasthenia gravis is present. Therefore, if a patient with MG is given this medication they will have improved muscle strength.

True or False: Multiple Sclerosis tends to affect men more than women and occurs during the ages of 50-70 years. True False

False MS affects WOMEN more than men and shows up during the ages of 20-40 years.

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

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

A nurse is caring for client with late-stage Parkinson's disease. The client's plan of care includes a nursing diagnosis of "Potential for Injury." Which would not be included as a cause for this diagnosis? 1. uncontrolled movements 2. shuffling gait 3. rigidity 4. choreiform movements

4. choreiform movements Choreiform-movement: repetitive and rapid, jerky, involuntary movement that appears to be well-coordinated; often seen in Huntington's disease. Cardinal signs of PD: tremor, rigidity, bradykinesia/akinesia, postural instability (gait problems)

A patient is taking Rasagiline "Azilect" for treatment of Parkinson's Disease. What foods do the patient want to limit in their diet? Select all that apply: A. Liver B. Aged Cheese C. Sweetbread D. Beer E. Fermented foods F. Shellfish

B. Aged Cheese D. Beer E. Fermented foods Rasagiline "Azilect" is a MAO Inhibitor Type B (Monoamine Oxidase Inhibitor). The patient should avoid foods high in tyramine which can cause a hypertensive crisis. This includes: aged cheese, smoked/cured meats, fermented food, beer.

During your discharge teaching to a patient with multiple sclerosis, you educate the patient on how to avoid increasing symptoms and relapses. You tell the patient to avoid: A. Cold temperatures B. Infection C. Overexertion D. Salt F. Stress

B. Infection C. Overexertion F. Stress The patient should also avoid extreme heat, which can increase symptoms.

The nurse is caring for a client admitted with a diagnosis of septic meningitis. The nurse is aware that this infection is caused by which of the following? Lymphoma Bacteria Leukemia Virus

Bacteria Page 2065

A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is incorrect about this medication: A. It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication. B. Body fluids can turn a dark color and stain clothes. C. This medication is most commonly prescribed with a vitamin B6 supplement. D. Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain.

C. This medication is most commonly prescribed with a vitamin B6 supplement. All the other options are CORRECT about this medication. However, the patient should avoid foods and supplements high in vitamin B 6 because it decreases the effectiveness of this medication.

The causes of acquired seizures include what? (Mark all that apply.) 1. Hypernatremia 2. Metabolic and toxic conditions 3. Brain tumor 4. Cerebrovascular disease 5. Drug and alcohol withdrawal

4. Cerebrovascular disease 2. Metabolic and toxic conditions 3. Brain tumor 5. Drug and alcohol withdrawal Causes of seizures include: Cerebrovascular disease, Hypoxemia, Fever (childhood), Head injury, Hypertension, CNS infections, Metabolic and toxic conditions (kidney injury, hyponatremia, hypocalcemia, hypoglycemia, pesticide exposure), Brain tumor, Drug and alcohol withdrawal Allergies

A nurse is caring for a client with a history of severe migraines. The client has a medical history that includes asthma, gastroesophageal reflux disease, and three pregnancies. Which medication does the nurse anticipate the physician will order for the client's migraines? 1. Captopril (Coreg) 2. Metoprolol (Lopressor) 3. Amiodarone (Cordarone) 4. Verapamil (Calan)

4. Verapamil (Calan) I don't know why this is the answer. I would have picked Metoprolol based on this statement in the book: "most effective medications for migraine treatment include anticonvulsant agents (divalproex sodium [Depakote], valproate [Depacon], topiramate [Topamax]), beta-blockers (metoprolol [Lopressor], propranolol [Inderal], timolol [Blocadren]), and triptans (frovatriptan [Frova])"

_________________ happens due to minimal to no stimulation of the receptors at the neuromuscular junction site by acetylcholine because there is damage to the receptor sites, which leads to muscle weakness and respiratory failure. A. Myasthenic crisis B. Cholinergic crisis

A. Myasthenic crisis

You're caring for a patient with Parkinson's Disease that has tremors. Select the option that is INCORRECT about tremors experienced in this disease: A. The tremors are most likely to occur with purposeful movements. B. A common term used to describe the tremors in the hands and fingers is called "pill-rolling". C. Tremors are one of the most common signs and symptoms in Parkinson's Disease. D. Tremors in this disease can occur in the hands, fingers, arms, legs and even the lips and tongue.

A. The tremors are most likely to occur with purposeful movements. This option is the only one that is INCORRECT. Tremors in Parkinson's Disease tend to occurs at rest and will actually improve with movement.

A nurse is caring for a patient who experiences debilitating cluster headaches. The patient should be taught to take appropriate medications at what point in the course of the onset of a new headache? A) As soon as the patients pain becomes unbearable B) As soon as the patient senses the onset of symptoms C) Twenty to 30 minutes after the onset of symptoms D) When the patient senses his or her symptoms peaking

B) As soon as the patient senses the onset of symptoms A migraine or a cluster headache in the early phase requires abortive medication therapy instituted as soon as possible. Delaying medication administration would lead to unnecessary pain.

Any individual taking phenobarbital for a seizure disorder should be taught: A) to brush his or her teeth four times a day. B) never to discontinue the drug abruptly. C) never to go swimming. D) to avoid foods containing caffeine.

B) never to discontinue the drug abruptly. Page: 1395-1396 Feedback: Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.

You're developing discharge instructions to the parents of a child who experiences atonic seizures. What information below is important to include in the teaching? A. "This type of seizure is hard to detect because the child may appear like he or she is daydreaming." B. "Be sure your child wears a helmet daily." C. "It is common for the child to feel extremely tired after experiencing this type of seizure." D. "Avoid high fat and low carbohydrate diets."

B. "Be sure your child wears a helmet daily." This type of seizure leads to a sudden loss of muscle tone. The patient will go limp and fall, which when this happens the head is usually the first part of the body to hit the floor or an object nearby. It is important the child wears a helmet daily to protect their head from injury. Option A is a characteristic of an absence seizure. Option C is a characteristic of a tonic-clonic seizure during the post ictus stage. And option D is wrong because some patients benefit from this type of diet known as the ketogenic diet.

You're educating a patient about treatment options for Guillain-Barré Syndrome. Which statement by the patient requires you to re-educate the patient about treatment? A. "Treatments available for this syndrome do not cure the condition but helps speed up recovery time." B. "Plasmapheresis or immunoglobin therapies are treatment options available for this syndrome but are most effective when given within 4 weeks of the onset of symptoms." C. "When I start plasmapheresis treatment a machine will filter my blood to remove the antibodies from my plasma that are attacking the myelin sheath." D. "Immunoglobulin therapy is where IV immunoglobulin from a donor is given to a patient to stop the antibodies that are damaging the nerves.

B. "Plasmapheresis or immunoglobin therapies are treatment options available for this syndrome but are most effective when given within 4 weeks of the onset of symptoms." This statement is incorrect. Plasmapheresis and immunoglobin therapies are treatment options available for GBS, BUT they are only really effective when given within 2 weeks from the onset of symptoms (not 4 weeks).

During a Tensilon test the patient has worsening of muscle weakness. The nurse anticipates that the physician will give the following order? A. Administer Atropine along with an anticholinesterase medication. B. Administer Atropine and hold any further doses of Pyridostigmine. C. Administer Pyridostigmine and hold Atropine. D. Administer Edrophonium along with Atropine.

B. Administer Atropine and hold any further doses of Pyridostigmine. If a patient experiences worsening of muscle weakness during a Tensilon test the patient has cholinergic crisis. Therefore, the nurse could anticipate that the physician will order Atropine (to reverse the signs and symptoms...because remember this drug is the antidote for Edrophonium which is given during the test) and to HOLD any further doses of Pyridostigmine (this is an anticholinesterase drug).

You're providing teaching to a group of patients with myasthenia gravis. Which of the following is not a treatment option for this condition? A. Plasmapheresis B. Cholinesterase medications C. Thymectomy D. Corticosteroids

B. Cholinesterase medications These medications are not used to treat MG, but ANTIcholinesterase medications (like Pyridostigmine) are used to treat this condition.

While assessing a patient with Parkinson's Disease, you note the patient's arms slightly jerk as you passively move them toward the patient's body. This is known as: A. Lead Pipe Rigidity B. Cogwheel Rigidity C. Pronate Rigidity D. Flexor Rigidity

B. Cogwheel Rigidity This is known as cogwheel rigidity, and occurs when the arms are passively moved, which will cause them to jerk slightly.

You're patient is scheduled for an EEG (electroencephalogram). As the nurse you will: A. Keep the patient nothing by mouth. B. Hold seizure medications until after the test. C. Allow the patient to have coffee, milk, and juice only. D. Wash the patient's hair prior to the test. E. Administer a sedative prior to the test.

B. Hold seizure medications until after the test. D. Wash the patient's hair prior to the test. An EEG is a painless procedure that will assess the patient's brain activity (if a seizure occurs during the test this can allow the physician to determine what type of seizure it is). Therefore, the nurse would hold seizure medications (this can affect the test) and would NOT allow the patient to have caffeine like coffee or stimulant drugs (the patient can eat prior to the test just NO caffeine). The patient's hair should be cleaned prior to the test so the technician can apply the electrodes and get them to stick to the scalp easily. A sedative is not needed before this test.

A patient with a history of epilepsy is taking Phenytoin. The patient's morning labs are back, and the patient's Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will? A. Assess the patient for a rash B. Initiate seizure precautions C. Hold the next dose of Phenytoin D. Continue to monitor the patient

B. Initiate seizure precautions A normal Phenytoin level is 10 to 20 mcg/mL. The patient's level is low; therefore, the patient is at risk for seizures. The nurse should initiate seizure precautions. Remember a patient being under medicated is a trigger for developing a seizure.

You're developing a plan of care for a patient with multiple sclerosis who presents with Uhthoff's Sign. What interventions will you include in the patient's plan of care? Select all that apply: A. Avoid movements of the head and neck downward B. Keep room temperature cool C. Encourage patient to use warm packs and heating pads for symptoms D. Educate the patient on three ways to avoid overheating during exercise

B. Keep room temperature cool D. Educate the patient on three ways to avoid overheating during exercise Uhthoff's Sign is where when the patient experiences too much heat their symptoms increase and get worst. Therefore, it is important the patient stays cool and doesn't overheat (overheating can come from outside temperatures, exercise, emotional events etc.). The room should be cool and the patient should be encouraged to exercise but to avoid overheating.

Your patient is back from having a lumbar puncture. Select all the correct nursing interventions for this patient? A. Place the patient in lateral recumbent position. B. Keep the patient flat. C. Remind the patient to refrain from eating or drinking for 4 hours. D. Encourage the patient to consume liquids regularly.

B. Keep the patient flat. D. Encourage the patient to consume liquids regularly. The patient will need to stay flat after the procedure for a prescribed amount of time to prevent a headache, and the nurse will need to encourage the patient to drink fluids regularly to help replace the fluid lost during the lumbar puncture.

You're performing a head-to-toe assessment on a patient with multiple sclerosis. When you ask the patient to move the head and neck downward the patient reports an "electric shock" sensation that travels down the body. You would report your finding to the doctor that the patient is experiencing: A. Romberg's Sign B. Lhermitte's Sign C. Uhthoff's Sign D. Homan's Sign

B. Lhermitte's Sign This finding is known as Lhermitte's Sign.

You're providing free education to a local community group about the signs and symptoms of Parkinson's Disease. Select all the signs and symptoms a patient could experience with this disease: A. Increased Salivation B. Loss of smell C. Constipation D. Tremors with purposeful movement E. Shuffling of gait F. Freezing of extremities G. Euphoria H. Coordination issues

B. Loss of smell C. Constipation E. Shuffling of gait F. Freezing of extremities H. Coordination issues These are all signs and symptoms experienced with PD (they vary among patients). There is NOT increased salivation (although drooling occurs...this is due to the decreased ability to swallow). There are tremors at REST (not purposeful movement) along with depression rather the euphoria.

The patient's lumbar puncture results are back. Which finding below correlates with Guillain-Barré Syndrome? A. high glucose with normal white blood cells B. high protein with normal white blood cells C. high protein with low white blood cells D. low protein with high white blood cells

B. high protein with normal white blood cells

A patient with increased ICP has a ventriculostomy for monitoring ICP. The nurses most recent assessment reveals that the patient is now exhibiting nuchal rigidity and photophobia. The nurse would be correct in suspecting the presence of what complication? A) Encephalitis B) CSF leak C) Meningitis D) Catheter occlusion

C) Meningitis Complications of a ventriculostomy include ventricular infectious meningitis and problems with the monitoring system. Nuchal rigidity and photophobia are clinical manifestations of meningitis, but are not suggestive of encephalitis, a CSF leak, or an occluded catheter.

The nurse is providing care for a patient who is withdrawing from heavy alcohol use. The nurse and other members of the care team are present at the bedside when the patient has a seizure. In preparation for documenting this clinical event, the nurse should note which of the following? A) The ability of the patient to follow instructions during the seizure. B) The success or failure of the care team to physically restrain the patient. C) The patients ability to explain his seizure during the postictal period. D) The patients activities immediately prior to the seizure.

D) The patient's activities immediately prior to the seizure. Before and during a seizure, the nurse observes the circumstances before the seizure, including visual, auditory, or olfactory stimuli; tactile stimuli; emotional or psychological disturbances; sleep; and hyperventilation. Communication with the patient is not possible during a seizure and physical restraint is not attempted. The patients ability to explain the seizure is not clinically relevant.

A patient with a documented history of seizure disorder experiences a generalized seizure. What nursing action is most appropriate? A) Restrain the patient to prevent injury. B) Open the patients jaws to insert an oral airway. C) Place patient in high Fowlers position. D) Loosen the patients restrictive clothing.

D. Loosen the patient's restrictive clothing. An appropriate nursing intervention would include loosening any restrictive clothing on the patient. No attempt should be made to restrain the patient during the seizure because muscular contractions are strong and restraint can produce injury. Do not attempt to pry open jaws that are clenched in a spasm to insert anything. Broken teeth and injury to the lips and tongue may result from such an action. If possible, place the patient on one side with head flexed forward, which allows the tongue to fall forward and facilitates drainage of saliva and mucus.

Which assessment finding is most important in determining nursing care for a client with bacterial meningitis? Select all that apply. 1. Purpura of hands and feet 2. Low white blood cell (WBC) count 3. Pain and stiffness of the extremities 4. Cloudy cerebral spinal fluid 5. Low red blood cell (RBC) count 6. Low antidiuretic hormone (ADH) levels

4. Cloudy cerebral spinal fluid 1. Purpura of hands and feet Signs and Symptoms of Bacterial Meningitis: headache, fever, neck immobility (nuchal rigidity), Positve Kernig sign, Positive Brudzinski sign, photophobia, rash (ranges from petechial rash with purpuric lesions to large areas of ecchymosis), lethargy, unresponsiveness, coma

The nurse is called to attend to a patient having a seizure in the waiting area. What nursing care is provided for a patient who is experiencing a convulsive seizure? Select all that apply. 1. Providing for privacy 2. Restraining the patient to avoid self injury 3. Positioning the patient on his or her side with head flexed forward 4. Loosening constrictive clothing 5. Opening the patient's jaw and inserting a mouth gag

4. Loosening constrictive clothing 3. Positioning the patient on his or her side with head flexed forward 1. Providing for privacy Provide privacy Ease the patient to the floor Protect the head with a pad to prevent injury Loosen constrictive clothing and remove eyeglasses Push aside furniture that may injure patient during the seizure If the patient is in bed, remove pillows and raise side rails Do not attempt to pry open jaws that are clenched in a spasm or attempt to insert anything in the mouth during a seizure. Broken teeth and injury to the lips and tongue may result from such an action. Do not attempt to restrain the patient during the seizure, because muscular contractions are strong and restraint can produce injury Place the patient on one side with head flexed forward, which allows the tongue to fall forward and facilitates drainage of saliva and mucus If suction is available, use it if necessary to clear secretions.

The nurse is caring for a patient who is hospitalized with an exacerbation of MS. To ensure the patients safety, what nursing action should be performed? A) Ensure that suction apparatus is set up at the bedside. B) Pad the patients bed rails. C) Maintain bed rest whenever possible. D) Provide several small meals each day.

A) Ensure that suction apparatus is set up at the bedside. Because of the patients risk of aspiration, it is important to have a suction apparatus at hand. Bed rest should be generally be minimized, not maximized, and there is no need to pad the patients bed rails or to provide multiple small meals.

The nurse instructs the parents of a child with Guillain-Barré syndrome on care that will be needed once the child is discharged home. Which statement made by the parents indicates that teaching has been effective? A) "We need to be sure to change our child's body position at least twice a day." B) "Our child might experience weakness even after recovering from the illness." C) "It will take about 10 days for our child to be back normal and return to school." D) "This disease affects the heart and lungs, so our child will have limited ability going forward."

B) "Our child might experience weakness even after recovering from the illness." Page: 1393-1394 Most children recover completely, without any residual effects of the syndrome; although, some may continue to have minor problems such as residual weakness. To prevent muscle contractures and effects of immobility, turning and repositioning every 2 hours is important in addition to passive range-of-motion exercises about every 4 hours. It will take longer than 10 days for the child to recover and return to school. This disease does not directly affect the heart and lungs. There should be minimal residual disability going forward.

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

C) In the morning, with frequent rest periods Procedures should be spaced to allow for rest in between. Procedures should be avoided before meals, or the patient may be too exhausted to eat. Procedures should be avoided near bedtime if possible.

You're educating a patient about the pathophysiology of myasthenia gravis. While explaining the involvement of the thymus gland, the patient asks you where the thymus gland is located. You state it is located? A. behind the thyroid gland B. within the adrenal glands C. behind the sternum in between the lungs D. anterior to the hypothalamus

C. behind the sternum in between the lungs The thymus is located anteriorly in the upper part of the chest behind the sternum in between the lungs.

An 8-year-old child is being treated for tonic-clonic seizures. What should the nurse emphasize when teaching the parents about this disorder? A) The child should maintain an active lifestyle. B) Immediately provide medication if a seizure begins. C) Have the child carry a padded tongue blade with her at all times. D) Ensure quiet time late in the day, when seizure activity is most likely to occur.

A) The child should maintain an active lifestyle. Page: 1399 As a rule, children with seizures should attend regular school and participate in physical education classes and active sports. Antiseizure medication is ineffective during a seizure because most medication needs to achieve a therapeutic level to be effective. Padded tongue blades are not used in people with a seizure disorder. There is no specific time of day when a seizure can occur.

The nurse is caring for a boy who has muscular dystrophy. When planning assistance with the patients ADLs, what goal should the nurse prioritize? A) Promoting the patients recovery from the disease B) Maximizing the patients level of function C) Ensuring the patients adherence to treatment D) Fostering the familys participation in care

B) Maximizing the patients level of function Priority for the care of the child with muscular dystrophy is the need to maximize the patients level of function. Family participation is also important, but should be guided by this goal. Adherence is not a central goal, even though it is highly beneficial, and the disease is not curable.

A school-aged girl with seizures is prescribed phenytoin sodium, 75 mg four times a day. An instruction the nurse would give her parents regarding this is: A) numbness of the fingers is common while taking this drug. B) their child will have to practice good tooth brushing. C) watching television while taking the drug may cause seizures. D) even small doses may cause noticeable dizziness.

B) their child will have to practice good tooth brushing. Page: 1390 A side effect of phenytoin sodium is hypertrophy of the gumline. Good tooth brushing helps prevent inflammation under the hypertrophied tissue.

A neurologic nurse is reviewing seizures with a group of staff nurses. How should this nurse best describe the cause of a seizure? A) Sudden electrolyte changes throughout the brain B) A dysrhythmia in the peripheral nervous system C) A dysrhythmia in the nerve cells in one section of the brain D) Sudden disruptions in the blood flow throughout the brain

C) A dysrhythmia in the nerve cells in one section of the brain The underlying cause of a seizure is an electrical disturbance (dysrhythmia) in the nerve cells in one section of the brain; these cells emit abnormal, recurring, uncontrolled electrical discharges. Seizures are not caused by changes in blood flow or electrolytes.

A patient with Parkinsons disease is experiencing episodes of constipation that are becoming increasingly frequent and severe. The patient states that he has been achieving relief for the past few weeks by using OTC laxatives. How should the nurse respond? A) Its important to drink plenty of fluids while youre taking laxatives. B) Make sure that you supplement your laxatives with a nutritious diet. C) Lets explore other options, because laxatives can have side effects and create dependency. D) You should ideally be using herbal remedies rather than medications to promote bowel function.

C) Lets explore other options, because laxatives can have side effects and create dependency. Laxatives should be avoided in patients with Parkinsons disease due to the risk of adverse effects and dependence. Herbal bowel remedies are not necessarily less risky.

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

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

A patient who was diagnosed with Parkinsons disease several months ago recently began treatment with levodopa-carbidopa. The patient and his family are excited that he has experienced significant symptom relief. The nurse should be aware of what implication of the patients medication regimen? A) The patient is in a honeymoon period when adverse effects oflevodopa-carbidopa are not yet evident. B) Benefits of levodopa-carbidopa do not peak until 6 to 9 months after the initiation of treatment. C) The patients temporary improvement in status is likely unrelated to levodopa-carbidopa. D) Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment.

D) Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment. The beneficial effects of levodopa therapy are most pronounced in the first year or two of treatment. Benefits begin to wane and adverse effects become more severe over time. However, a honeymoon period of treatment is not known.

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

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

Your patient is recovering from a myasthenic crisis and you are providing education to the patient about the causes of this condition. Which statement by the patient demonstrates they understood the teaching about how to prevent this condition? A. "I will make sure I don't take too much of my anticholinesterase medication because it can lead to this condition." B. "I will avoid milk products while taking Pyridostigmine because it increases the chances of toxicity." C. "I will avoid taking over-the-counter supplements that contain aconite." D. "I will avoid people who are sick with respiratory infections and be sure not to miss my scheduled doses of Pyridostigmine."

D. "I will avoid people who are sick with respiratory infections and be sure not to miss my scheduled doses of Pyridostigmine." Myasthenic crisis is caused by not enough anticholinesterase medication (pyridostigmine) or respiratory infection/stress etc. The other options are NOT causes of this condition.

A patient with MS has been admitted to the hospital following an acute exacerbation. When planning the patients care, the nurse addresses the need to enhance the patients bladder control. What aspect of nursing care is most likely to meet this goal? A) Establish a timed voiding schedule. B) Avoid foods that change the pH of urine. C) Perform intermittent catheterization q6h. D) Administer anticholinergic drugs as ordered.

A) Establish a timed voiding schedule. A timed voiding schedule addresses many of the challenges with urinary continence that face the patient with MS. Interventions should be implemented to prevent the need for catheterization and anticholinergics are not normally used.

The nurse caring for a patient diagnosed with Parkinsons disease has prepared a plan of care that would include what goal? A) Promoting effective communication B) Controlling diarrhea C) Preventing cognitive decline D) Managing choreiform movements

A) Promoting effectice communication The goals for the patient may include improving functional mobility, maintaining independence in ADLs, achieving adequate bowel elimination, attaining and maintaining acceptable nutritional status, achieving effective communication, and developing positive coping mechanisms. Constipation is more likely than diarrhea and cognition largely remains intact. Choreiform movements are related to Huntington disease.

You have a patient who has a brain tumor and is at risk for seizures. In the patient's plan of care you incorporate seizure precautions. Select below all the proper steps to take in initiating seizure precautions: A. Oxygen and suction at bedside B. Bed in highest position C. Remove all pillows from the patient's head D. Have restraints on stand-by E. Padded bed rails F. Remove restrictive objects or clothing from patient's body G. IV access

A. Oxygen and suction at bedside E. Padded bed rails F. Remove restrictive objects or clothing from patient's body G. IV access The bed needs to be in the LOWEST position possible, a pillow should be underneath the patient's head to protect it from injury, AVOID using restraints (this can cause musculoskeletal damage).

You're assessing a patient's health history for risk factors associated with developing Guillain-Barré Syndrome. Select all the risk factors below: A. Recent upper respiratory infection B. Patient's age: 3 years old C. Positive stool culture Campylobacter Jejuni D. Hyperthermia E. Epstein-Barr F. Diabetes G. Myasthenia Gravis

A. Recent upper respiratory infection C. Positive stool culture Campylobacter Jejuni E. Epstein-Barr Risk factors for developing Guillain-Barré Syndrome include: experiencing upper respiratory infection, GI infection (especially from Campylobacter Jejuni), Epstein-Barr infection, HIV/AIDS, vaccination (flu or swine flu) etc.

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

C) Semisolid food with thick liquids A semisolid diet with thick liquids is easier for a patient with swallowing difficulties to consume than is a solid diet. Low-residue foods and fluid restriction are unnecessary and counterproductive to the patients nutritional status. The patients status does not warrant TPN.

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

A) Guillain-Barr spares the Schwann cell, which allows for remyelination in the recovery phase of the disease. Myelin is a complex substance that covers nerves, providing insulation and speeding the conduction of impulses from the cell body to the dendrites. The cell that produces myelin in the peripheral nervous system is the Schwann cell. In Guillain-Barr syndrome, the Schwann cell is spared, allowing for remyelination in the recovery phase of the disease. The nurse should avoid downplaying the patients concerns by wholly deferring to the physician.

A patient is taking Phenytoin for treatment of seizures. Which statement by the patient requires you to re-educate the patient about this medication? A. "Every morning I take this medication with a full glass of milk with my breakfast." B. "I know it is important to have my drug levels checked regularly." C. "I will report a skin rash immediately to my doctor." D. "This medication can lower my body's ability to clot and fight infection."

A. "Every morning I take this medication with a full glass of milk with my breakfast." This medication should NOT be taken with milk products or antacids because it affects absorption. All the other options are correct.

You're educating a 25-year-old female about possible triggers for seizures. Which statement requires you to re-educate the patient about the triggers? A. "I'm at risk for seizure activity during my menstrual cycle." B. "I will limit my alcohol intake to 2 glasses of wine per day." C. "It's important I get plenty of sleep." D. "I will be sure to stay hydrated, especially during hot weather."

B. "I will limit my alcohol intake to 2 glasses of wine per day." The patient should avoid all alcohol because it can lead to a seizure. Hormone shifts (menstrual cycle, ovulation, pregnancy) sleep deprivation, and dehydration can lead to a seizure.

A patient with Parkinson's Disease has slow movements that affects their swallowing, facial expressions, and ability to coordinate movements. As the nurse you will document the patient has: A. Akinesia B. "Freeze up" tremors C. Bradykinesia D. Pill-rolling

C. Bradykinesia

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

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

An older adult has encouraged her husband to visit their primary care provider, stating that she is concerned that he may have Parkinsons disease. Which of the wifes descriptions of her husbands health and function is most suggestive of Parkinsons disease? A) Lately he seems to move far more slowly than he ever has in the past. B) He often complains that his joints are terribly stiff when he wakes up in the morning. C) Hes forgotten the names of some people that weve known for years. D) Hes losing weight even though he has a ravenous appetite.

A) Lately he seems to move far more slowly than he ever has in the past. Parkinsons disease is characterized by bradykinesia. It does not manifest as memory loss, increased appetite, or joint stiffness.

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

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

A hospital patient has experienced a seizure. In the immediate recovery period, what action best protects the patients safety? A) Place the patient in a side-lying position. B) Pad the patients bed rails. C) Administer antianxiety medications as ordered. D) Reassure the patient and family members.

A) Place the patient in a side-lying position. To prevent complications, the patient is placed in the side-lying position to facilitate drainage of oral secretions. Suctioning is performed, if needed, to maintain a patent airway and prevent aspiration. None of the other listed actions promotes safety during the immediate recovery period.

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

A) Possible nursing home placement C) Increasing disability D) Becoming a burden on the family Elderly patients with MS are particularly concerned about increasing disability, family burden, marital concern, and the possible future need for nursing home care. Older adults with MS are not noted to have particular concerns regarding the pain of therapy or loss of appetite.

A patient with a new diagnosis of amyotrophic lateral sclerosis (ALS) is overwhelmed by his diagnosis and the known complications of the disease. How can the patient best make known his wishes for care as his disease progresses? A) Prepare an advance directive. B) Designate a most responsible physician (MRP) early in the course of the disease. C) Collaborate with representatives from the Amyotrophic Lateral Sclerosis Association. D) Ensure that witnesses are present when he provides instruction.

A) Prepare an advance directive. Patients with ALS are encouraged to complete an advance directive or living will to preserve their autonomy in decision making. None of the other listed actions constitutes a legally binding statement of end-of-life care.

The nurse is caring for an 8-month-old baby diagnosed with spastic cerebral palsy. Which assessment finding supports this medical diagnosis? A) The child has a strong Moro reflex when startled. B) The child bears weight on both feet when held upright. C) The child cries when held in a ventral suspension position. D) The child holds the back very straight when in a sitting position.

A) The child has a strong Moro reflex when startled. Page: 1388 Spasticity is excessive tone in the voluntary muscles that results in loss of upper motor neurons. A child with spastic cerebral palsy has hypertonic muscles, abnormal clonus, exaggeration of deep tendon reflexes, abnormal reflexes such as a positive Babinski reflex, and continuation of neonatal reflexes, such as the tonic neck reflex, well past the age at which these usually disappear. If infants with this disorder are held in a ventral suspension position, they arch their backs and extend their arms and legs abnormally. They tend to assume a "scissors gait" because tight adductor thigh muscles cause their legs to cross when held upright. This involvement may be so severe it leads to a subluxated hip. Posture when in a sitting position is not remarkable for this health problem.

An infant is diagnosed as having cerebral palsy. When planning care, which would the nurse stress to the parents? A) Their child probably will benefit from early schooling to increase ability for self-care. B) Administering an anti-acetylcholinergic drug to decrease muscle spasms is crucial. C) The parent should be tested during future pregnancies to predict similar involvement. D) The infant's disease will cause progressive brain cell degeneration with age.

A) Their child probably will benefit from early schooling to increase ability for self-care. Page: 1390 Cerebral palsy is not a progressive disorder. It cannot be predicted by pregnancy studies. Early schooling gives the child a "head start."

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

A) Using the incentive spirometer as prescribed Respiratory function can be maximized with incentive spirometry and chest physiotherapy. Nursing interventions toward enhancing physical mobility should be utilized. Nursing interventions are aimed at preventing a deep vein thrombosis. Guillain-Barr syndrome does not affect cognitive function or vision.

An adult patient has sought care for the treatment of headaches that have become increasingly severe and frequent over the past several months. Which of the following questions addresses potential etiological factors? Select all that apply. A) Are you exposed to any toxins or chemicals at work? B) How would you describe your ability to cope with stress? C) What medications are you currently taking? D) When was the last time you were hospitalized? E) Does anyone else in your family struggle with headaches?

A, B, C, E Headaches are multifactorial, and may involve medications, exposure to toxins, family history, and stress. Hospitalization is an unlikely contributor to headaches.

You're assessing a patient who recently experienced a focal type seizure (partial seizure). As the nurse, you know that which statement by the patient indicates the patient may have experienced a focal impaired awareness (complex partial) seizure? A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this." B. "I remember having vision changes, but it didn't last long." C. "I woke up on the floor with my mouth bleeding." D. "After the seizure I was very sleepy, and I had a headache for several hours."

A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this." The patient will experience an alternation in consciousness (hence the name focal IMPAIRED awareness) AND will perform an action without knowing they are doing it called automatism like lip-smacking, rubbing the hands together etc. With a focal onset AWARE seizure (also called partial simple seizure) the patient is aware and will remember what happens (like vision changes etc.).

A clinic nurse is caring for a patient diagnosed with migraine headaches. During the patient teaching session, the patient questions the nurse regarding alcohol consumption. What would the nurse be correct in telling the patient about the effects of alcohol? A) Alcohol causes hormone fluctuations. B) Alcohol causes vasodilation of the blood vessels. C) Alcohol has an excitatory effect on the CNS. D) Alcohol diminishes endorphins in the brain.

B) Alcohol causes vasodilation of the blood vessels. Alcohol causes vasodilation of the blood vessels and may exacerbate migraine headaches. Alcohol has a depressant effect on the CNS. Alcohol does not cause hormone fluctuations, nor does it decrease endorphins (morphine-like substances produced by the body) in the brain.

A 69-year-old patient is brought to the ED by ambulance because a family member found him lying on the floor disoriented and lethargic. The physician suspects bacterial meningitis and admits the patient to the ICU. The nurse knows that risk factors for an unfavorable outcome include what? Select all that apply. A) Blood pressure greater than 140/90 mm Hg B) Heart rate greater than 120 bpm C) Older age D) Low Glasgow Coma Scale E) Lack of previous immunizations

B) Heart rate greater than 120 bpm C) Older age D) Low Glasgow Coma Scale Risks for an unfavorable outcome of meningitis include older age, a heart rate greater than 120 beats/minute, low Glasgow Coma Scale score, cranial nerve palsies, and a positive Gram stain 1 hour after presentation to the hospital. A BP greater than 140/90 mm Hg is indicative of hypertension, but is not necessarily related to poor outcomes related to meningitis. Immunizations are not normally relevant to the course of the disease.

A patient with possible bacterial meningitis is admitted to the ICU. What assessment finding would the nurse expect for a patient with this diagnosis? A) Pain upon ankle dorsiflexion of the foot B) Neck flexion produces flexion of knees and hips C) Inability to stand with eyes closed and arms extended without swaying D) Numbness and tingling in the lower extremities

B) Neck flexion produces flexion of knees and hips Clinical manifestations of bacterial meningitis include a positive Brudzinskis sign. Neck flexion producing flexion of knees and hips correlates with a positive Brudzinskis sign. Positive Homans sign (pain upon dorsiflexion of the foot) and negative Rombergs sign (inability to stand with eyes closed and arms extended) are not expected assessment findings for the patient with bacterial meningitis. Peripheral neuropathy manifests as numbness and tingling in the lower extremities. Again, this would not be an initial assessment to rule out bacterial meningitis.

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

B) Position the patient upright during feeding. Correct, upright positioning is necessary to prevent aspiration in the patient with dysphagia. There is no need for a low-residue diet and suctioning should not be performed unless there is an apparent need.

A male patient presents to the clinic complaining of a headache. The nurse notes that the patient is guarding his neck and tells the nurse that he has stiffness in the neck area. The nurse suspects the patient may have meningitis. What is another well-recognized sign of this infection? A) Negative Brudzinskis sign B) Positive Kernigs sign C) Hyperpatellar reflex D) Sluggish pupil reaction

B) Positive Kernigs sign Meningeal irritation results in a number of well-recognized signs commonly seen in meningitis, such as a positive Kernigs sign, a positive Brudzinskis sign, and photophobia. Hyperpatellar reflex and a sluggish pupil reaction are not commonly recognized signs of meningitis.

The nurse is planning care for a preschool-age child diagnosed with meningitis. What should the nurse identify as a priority goal for this patient's care? A) Inspect the teeth for obvious caries. B) Reduce the pain related to nuchal rigidity. C) Provide an opportunity for therapeutic play. D) Increase stimulation opportunities to prevent coma.

B) Reduce the pain related to nuchal rigidity. Page: 1391-1392 Meningitis is an infection of the cerebral meninges. Pathologic organisms spread to the meninges. Once organisms enter the meningeal space, they multiply rapidly and then spread throughout the CSF to invade brain tissue through the meningeal folds, which extend down into the brain itself. A child with meningitis usually has an upper respiratory tract infection prior to the development of meningitis. Then the child will become increasingly irritable because of an intense headache with sharp pain when bending the head forward. Reducing the pain caused by neck pain would be the priority goal for this patient's care. Inspecting the teeth, providing opportunities for play, and increasing stimulation would not be priority goals for this patient.

The nurse is planning care for a preschool-aged child with spastic cerebral palsy. Which nursing diagnosis should the nurse identify to guide care for this patient's musculoskeletal status? A) Risk for self-care deficit related to impaired mobility B) Risk for disuse syndrome related to spasticity of muscle groups C) Impaired verbal communication related to neurologic impairment D) Risk for delayed growth and development related to activity restriction

B) Risk for disuse syndrome related to spasticity of muscle groups Page: 1389 Children with cerebral palsy need promotion of any function that is not already impaired to prevent further loss of function and allow them to master the highest level of self-care. Learning to be ambulatory is an important part of self-care because it pays a large role in determining how independent the child can become. Walking can be difficult for the child to master because of lack of muscle coordination. Preventing contractures is also important to maintain motor function. Risk for self-care deficit focuses on self-care measures such as dressing, toothbrushing, bathing, and toileting, so the child can not only gain self-esteem by accomplishing these tasks but also achieve optimal independence. Impaired verbal communication addresses focuses on speech and not necessary the entire musculoskeletal status. The risk for delayed growth and development focuses on the child's potential inability to pursue stimulating activities and surroundings because of not being fully mobile.

The nurse is caring for a patient diagnosed with Parkinsons disease. The patient is having increasing problems with rising from the sitting to the standing position. What should the nurse suggest to the patient to use that will aid in getting from the sitting to the standing position as well as aid in improving bowel elimination? A) Use of a bedpan B) Use of a raised toilet seat C) Sitting quietly on the toilet every 2 hours D) Following the outlined bowel program

B) Use of a raised toilet seat A raised toilet seat is useful, because the patient has difficulty in moving from a standing to a sitting position. A handicapped toilet is not high enough and will not aid in improving bowel elimination. Sitting quietly on the toilet every 2 hours will not aid in getting from the sitting to standing position; neither will following the outlined bowel program.

While completing a health history on a patient who has recently experienced a seizure, the nurse would assess for what characteristic associated with the postictal state? A) Epileptic cry B) Confusion C) Urinary incontinence D) Body rigidity

B). Confusion In the postictal state (after the seizure), the patient is often confused and hard to arouse and may sleep for hours. The epileptic cry occurs from the simultaneous contractions of the diaphragm and chest muscles that occur during the seizure. Urinary incontinence and intense rigidity of the entire body are followed by alternating muscle relaxation and contraction (generalized tonicclonic contraction) during the seizure.

You're providing diet education to a patient with Parkinson's Disease. Which statement below demonstrates the patient understood your teaching? Select all that apply: A. "I will limit foods high in fiber like fruits and vegetables in my diet." B. "I will be sure to drink 2 Liter of fluid per day." C. "It is very common for me to experience diarrhea with this disease." D. "I will avoid taking Carbidopa/Levodopa with a protein rich meal."

B. "I will be sure to drink 2 Liter of fluid per day." D. "I will avoid taking Carbidopa/Levodopa with a protein rich meal." Constipation (not diarrhea) is a common symptom with Parkinson's Disease. Therefore, the patient should be vigilant about preventing constipation by EATING foods high in fiber like fruits/vegetable and drinking 2 L of fluid per day (unless contraindicated). In addition, diet teaching should be included with the medication Carbidopa/Levodopa. The patient should NOT take this medication with a protein rich meal because levodopa competes with protein in the small intestine (hence decreasing it absorption).

Select all the TRUE statements about the pathophysiology of multiple sclerosis: A. "The dendrites on the neuron are overstimulated leading to the destruction of the axon." B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon." C. "This disease affects the insulating structure found on the neuron in the central nervous system." D. "The dopaminergic neurons in the part of the brain called substantia nigra have started to die."

B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon." C. "This disease affects the insulating structure found on the neuron in the central nervous system." In multiple sclerosis the myelin sheath (which is the insulating and protective structure made up of Schwann cells that protects the axon) is damaged. MS affects the CNS (central nervous system) and when the myelin sheath becomes damaged it leads to a decrease in nerve transmission.

A 25 year-old presents to the ER with unexplained paralysis from the hips downward. The patient explains that a few days ago her feet were feeling weird and she had trouble walking and now she is unable to move her lower extremities. The patient reports suffering an illness about 2 weeks ago, but has no other health history. The physician suspects Guillain-Barré Syndrome and orders some diagnostic tests. Which finding below during your assessment requires immediate nursing action? A. The patient reports a headache. B. The patient has a weak cough. C. The patient has absent reflexes in the lower extremities. D. The patient reports paresthesia in the upper extremities.

B. The patient has a weak cough. The patient's signs and symptoms in this scenario are typical with Guillain-Barré Syndrome. The syndrome tends to start in the lower extremities (with paresthesia that will progress to paralysis) and migrate upward. The respiratory system can be affected leading to respiratory failure. Therefore, the nurse should assess for any signs and symptoms that the respiratory system may be compromised (ex: weak cough, shortness of breath, dyspnea...patient says it is hard to breath etc.). The nurse should immediately report this to the MD because the patient may need mechanical ventilation. Absent reflexes is common in GBS and paresthesia can extend to the upper extremities as the syndrome progresses. A headache is not common.

The school nurse is observing a child in the classroom. The child is speaking and then suddenly stops and stares for about 5 seconds and then continues speaking. The nurse charts this as what type of seizure? A) Tonic-clonic B) Febrile C) Absence D) Partial (focal) seizures

C) Absence In absence seizures, a child will have a staring spell that lasts for a few seconds. Tonic-clonic seizures consist of all body muscles rapidly contract and relax. Febrile seizures are associated with a rapid rise in body temperature and follows the tonic-clonic pattern. Partial (focal) seizures originate from a specific brain area. The seizure movement will be localized to a certain part of the body.

A patient who has been on long-term phenytoin (Dilantin) therapy is admitted to the unit. In light of the adverse of effects of this medication, the nurse should prioritize which of the following in the patients plan of care? A) Monitoring of pulse oximetry B) Administration of a low-protein diet C) Administration of thorough oral hygiene D) Fluid restriction as ordered

C) Administration of thorough oral hygiene Gingival hyperplasia (swollen and tender gums) can be associated with long-term phenytoin (Dilantin) use. Thorough oral hygiene should be provided consistently and encouraged after discharge. Fluid and protein restriction are contraindicated and there is no particular need for constant oxygen saturation monitoring.

The nurse is caring for a child who is having a seizure. What is the appropriate action by the nurse? A) Attempt to place oxygen on the child so they don't become cyanotic. B) Hold the child's arms and legs still so they aren't injured. C) Attempt to turn the child on their side to prevent aspiration. D) Place a bite block or oral airway into the child's mouth to prevent biting of the tongue.

C) Attempt to turn the child on their side to prevent aspiration. Page: 1399 Safety measures include turning the child on their side or abdomen with their head turned to the side to prevent aspiration. Slight cyanosis may be noted but administration of oxygen is not needed due to the short time of the tonic clonic stage. Do not attempt to restrain or place objects into the child's mouth. These actions may further injure the child.

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

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

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

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

A nurse is collaborating with the interdisciplinary team to help manage a patients recurrent headaches. What aspect of the patients health history should the nurse identify as a potential contributor to the patients headaches? A) The patient leads a sedentary lifestyle. B) The patient takes vitamin D and calcium supplements. C) The patient takes vasodilators for the treatment of angina. D) The patient has a pattern of weight loss followed by weight gain.

C) The patient takes vasodilators for the treatment of angina. Vasodilators are known to contribute to headaches. Weight fluctuations, sedentary lifestyle, and vitamin supplements are not known to have this effect.

A patient with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take Pyridostigmine. At what time should you administer this medication so the patient will have the maximum benefit of this medication? A. As soon as possible B. 1 hour after the patient has eaten (at 1300) C. 1 hour before the patient eats (at 1100) D. at 1200 right before the patient eats

C. 1 hour before the patient eats (at 1100) Pyridostigmine is an anticholinesterase medication that will help improve muscle strength. It is important the patient has maximum muscle strength while eating for the chewing and swallowing process. Therefore, the medication should be given 1 hour before the patient eats because this medication peaks (has the maximum effect) at approximately 1 hour after administration. How does the medication improve muscle strength? It does this by preventing the breakdown of acetylcholine. Remember the nicotinic acetylcholine receptors are damaged and the patient needs as much acetylcholine as possible to prevent muscle weakness. Therefore, this medication will allow more acetylcholine to be used...hence improving muscle strength.

Which meal option would be the most appropriate for a patient with myasthenia gravis? A. Roasted potatoes and cubed steak B. Hamburger with baked fries C. Clam chowder with mashed potatoes D. Fresh veggie tray with sliced cheese cubes

C. Clam chowder with mashed potatoes Patients with MG have weak muscles and this can include the muscles that are used for chewing and swallowing. The patient should choose meal options that require the least amount of chewing and that are easy to swallow. Option C is a thick type of soup and the mashed potatoes are soft....both are very easy to eat and swallow compared to the other options.

A patient is receiving Interferon Beta for treatment of multiple sclerosis. As the nurse you will stress the importance of? A. Physical exercise to improve fatigue B. Low fat diet C. Hand hygiene and avoiding infection D. Reporting ideation of suicide

C. Hand hygiene and avoiding infection Interferon Beta decreases the number of relapses of symptoms in MS patients by decreasing the immune system response, but it lowers the white blood cells count. Hence, there is a risk of infection. It is very important the nurse stresses the importance of hand hygiene and avoiding infection.

Keeping the previous question in mind, the patient is now experiencing characteristics of a tonic-clonic seizure. The seizure started at 1402 and it is now 1408, and the patient is still experiencing a seizure. The nurse should? A. Continue to monitor the patient B. Suction the patient C. Initiate the emergency response system D. Restrain the patient to prevent further injury

C. Initiate the emergency response system Tonic-clonic seizures should last about 1-3 minutes. If the seizure lasts MORE than 5 minutes, the patient needs medical treatment FAST to stop the seizure....this is known as status epilepticus.

Your patient has a history of epilepsy. While helping the patient to the restroom, the patient reports having this feeling of déjà vu and seeing spots in their visual field. Your next nursing action is to? A. Continue assisting the patient to the restroom and let them sit down. B. Initiate the emergency response system. C. Lay the patient down on their side with a pillow underneath the head. D. Assess the patient's medication history.

C. Lay the patient down on their side with a pillow underneath the head. The patient is reporting signs and symptoms of an aura (this is a warning sign before a seizure event). Lay the patient down on their side with a pillow underneath the head and remove any restrictive clothing. Also, time the seizure. If the seizure lasts more than 5 minutes or if the patient starts to have seizures back-to-back activate the emergency response system.

As the nurse you know that Parkinson's Disease tends to affect the _____________ of the midbrain, which leads to the depletion of the neurotransmitter ________________. A. red nucleus, acetylcholine B. leminisci, norepinephrine C. substantia nigra, dopamine D. tectum nigra, dopamine

C. substantia nigra, dopamine

During nursing report you learn that the patient you will be caring for has Guillain-Barré Syndrome. As the nurse you know that this disease tends to present with: A. signs and symptoms that are unilateral and descending that start in the lower extremities B. signs and symptoms that are symmetrical and ascending that start in the upper extremities C. signs and symptoms that are asymmetrical and ascending that start in the lower extremities D. signs and symptoms that are symmetrical and ascending that start in the lower extremities

D. signs and symptoms that are symmetrical and ascending that start in the lower extremities GBS signs and symptoms will most likely start in the lower extremities (ex: feet), be symmetrical, and will gradually spread upward (ascending) to the head. There are various forms of Guillain-Barré Syndrome. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common type in the U.S. and this is how this syndrome tends to present.