Med Surg - Chapter 43 - Care of Patients with Problems of the Central Nervous System: The Spinal Cord

Which drug type does the nurse expect to administer as part of the treatment plan for a patient with relapsing multiple sclerosis (MS)? 1 Antispasmodic 2 Immunomodulator 3 Calcium channel blocker 4 Penicillin-based antibiotic

2 Immunomodulator Immunomodulators such as interferon-beta, synthetic proteins like glatiramer acetate, and monoclonal antibodies such as natalizumab are among the current drug therapies recommended for early and continuous treatment of relapsing types of MS. Penicillin-based antibiotics are used in the treatment of bacterial infections. Calcium channel blockers are commonly used in patients with hypertension and other cardiovascular issues. Antispasmodics are used to suppress muscle spasms.

A patient diagnosed with multiple sclerosis is getting ready to be discharged home. What action is priority? 1 Suggest referral to a rehabilitation center first. 2 Ensure the patient has home adaptive equipment. 3 Assess the patient's home for hazards before discharge . 4 Ask the patient's family what assistance they plan to provide.

3 Assess the patient's home for hazards before discharge . Ensuring patient safety is the priority; the patient's home should be assessed prior to the patient being discharged. Recommending that the patient go to rehab first is not indicated. Ensuring that the patient has home adaptive equipment is important, but not the priority. Asking the family what assistance they plan to provide is important, but not the priority.

What is the nurse's priority action for a patient experiencing autonomic dysreflexia (AD)? 1 Catheterizing the patient 2 Implementing drug therapy 3 Raising the head of the bed 4 Adjusting the room temperature

3 Raising the head of the bed If a patient experiences AD, the nurse's priority action is to immediately raise the head of the bed to help reduce blood pressure. Following this, the nurse can determine the cause of AD and treat it promptly. For example, if the bladder is distended, the nurse may catheterize the patient to relieve urinary retention. The nurse should also notify the primary health care provider for drug therapy to quickly reduce blood pressure as indicated and adjust the room temperature and bed coverings as needed for patient comfort.

Which statement about multiple sclerosis (MS) is correct? 1 MS affects more men than women. 2 It usually occurs in people older than 50 years. 3 MS is seen more often in the warmer climates. 4 It occurs more frequently among whites than other races.

4 It occurs more frequently among whites than other races. MS affects people of all races but does tend to occur more frequently among whites. Women are affected twice as often as men. Though MS may occur in people over 50 years, it usually affects people between 20 and 40 years of age. There is a higher incidence in the colder climates of the Northeastern states, the Great Lakes, and Pacific Northwestern states, as well as Canada.

What should be included when providing discharge instructions to a patient recovering from an anterior cervical diskectomy and fusion (ACDF)? 1 Do not drive. 2 Restrict fluids. 3 Lift only less than 10 lbs. 4 Resume activities of daily living.

1 Do not drive. Care of the patient after an ACDF includes instructing the patient not to drive. Fluids do not need to be restricted. The patient should be instructed to perform no lifting. No strenuous activities should be performed, which may include those as part of the patient's normal activities of daily living.

What intervention is priority for a patient diagnosed with multiple sclerosis who is experiencing cognitive impairment? 1 Encourage the use of written lists. 2 Teach the use of a monthly calendar. 3 Teach about the use of antidepressants. 4 Discourage the use of electronic devices.

1 Encourage the use of written lists. The use of written lists can help reorient a patient. Monthly calendars are not recommended; daily calendars are. Teaching about antidepressants is not priority. Patients can use electronic devices for cues and reminders.

The nurse assessing a patient with multiple sclerosis (MS) is aware that although patients with this condition can expect a normal lifespan, they can develop a variety of complications. For which complications should the nurse evaluate the patient? Select all that apply. 1 Epilepsy 2 Cyanosis in extremities 3 Muscle stiffness or spasms 4 Paralysis, typically in the legs 5 Problems with bladder, bowel, or sexual functioning

1 Epilepsy 3 Muscle stiffness or spasms 4 Paralysis, typically in the legs 5 Problems with bladder, bowel, or sexual functioning Epilepsy; muscle stiffness or spasms; paralysis, typically in the legs; and bladder, bowel, or sexual dysfunction are all known complications of MS. Cyanosis in the extremities is not typical of MS.

The nurse is monitoring a patient with acute spinal cord injury (SCI). Which findings indicate a respiratory emergency? Select all that apply. 1 Stridor 2 Garbled speech 3 Increased urine output 4 Pulse oximetry less than 95% 5 Systolic blood pressure (SBP) less than 90 mm Hg 6 Mean arterial pressure (MAP) less than 65 mm Hg

1 Stridor 2 Garbled speech 4 Pulse oximetry less than 95% 5 Systolic blood pressure (SBP) less than 90 mm Hg 6 Mean arterial pressure (MAP) less than 65 mm Hg In the patient with acute SCI, stridor, garbled speech, pulse oximetry less than 95%, SBP less than 90 mm Hg, MAP less than 65 mm Hg, and decreased (not increased) urine output may indicate a respiratory emergency.

What term describes excessive inward curvature of the spine? 1 Lordosis 2 Scoliosis 3 Spinal shock 4 Spinal stenosis

1 Lordosis Lordosis is excessive inward curvature of the spine. Scoliosis is excessive sideways curvature of the spine. Spinal shock is a combination of areflexia/hyporeflexia and autonomic dysfunction following spinal cord injury. Spinal stenosis is back pain associated with narrowing of the spinal canal, nerve root canals, or intervertebral foramina.

Which assessment finding indicates that a patient with a T-2 spinal cord injury is developing a cardiovascular complication? 1 Temperature 90° F 2 Heart rate 68 and regular 3 Blood pressure 108/66 mm Hg 4 Respiratory rate 14 and unlabored

1 Temperature 90° F Cardiovascular dysfunction results from disruption of sympathetic fibers of the autonomic nervous system (ANS). The lack of sympathetic or hypothalamic control causes the patient to lose thermoregulatory functions. As a result, the body tends to assume the temperature of the environment. A body temperature of 90° F indicates a loss of thermoregulatory function. A heart rate of 68 and regular does not indicate bradycardia, which would occur from the loss of sympathetic input. A blood pressure of 108/66 mm Hg does not indicate hypotension, which would occur from the loss of sympathetic input. A respiratory rate of 14 and unlabored is within normal limits and does not indicate the development of a cardiovascular complication.

A patient diagnosed with multiple sclerosis has developed scotomas. What assessment finding is consistent with this finding? 1 Double vision 2 Intention tremors 3 Decreased peripheral vision 4 Involuntary eye movements

3 Decreased peripheral vision Scotomas are changes in peripheral vision. Double vision is diplopia. Intention tremors are not scotomas. Involuntary eye movements are nystagmus.

When providing teaching to a patient newly diagnosed with multiple sclerosis, the nurse informs the patient that the confirmation of the diagnosis is based on what finding? 1 Recent bloodwork 2 Physical assessment 3 Abnormal cerebrospinal fluid 4 Magnetic resonance imaging (MRI)

4 Magnetic resonance imaging (MRI) Magnetic resonance imaging (MRI) is the primary confirmative diagnostic tool in diagnosing multiple sclerosis. Blood work is not diagnostic for MS. Physical assessment and cerebrospinal fluid findings will rule out other causes and point toward a diagnosis of multiple sclerosis.

A nurse is planning a psychosocial assessment for a spinal cord injury (SCI) patient. How will the nurse assist the patient in identifying strategies to adjust to the disability? Select all that apply. 1 Help the patient set realistic goals and verbalize feelings. 2 Discourage sexuality- or intimacy-related questions from the patient. 3 Assess if the home environment can accommodate the patient's special needs. 4 Tell patient about the expected reactions of those outside the hospital environment. 5 Collaborate with the case manager for a review of the patient's insurance and financial status. 6 Answer all questions about prognosis and the potential for complete recovery truthfully.

1 Help the patient set realistic goals and verbalize feelings. 3 Assess if the home environment can accommodate the patient's special needs. 4 Tell patient about the expected reactions of those outside the hospital environment. 5 Collaborate with the case manager for a review of the patient's insurance and financial status. During the psychosocial assessment of an SCI patient, the nurse can help the patient set realistic goals and verbalize feelings about the injury and his or her future. The nurse should assess the home environment to ensure that it is free from hazards and can accommodate the patient's special needs. The patient should be told about expected reactions of those outside the hospital environment. Also, the nurse should collaborate with the case manager for a review of the patient's insurance and financial status to assist the patient and family in locating sources of funding if necessary. Questions related to sexuality and intimacy should be encouraged, not discouraged. The nurse should refer all questions about the prognosis and the potential for complete recovery to the health care provider as the timing and extent of recovery may be different for each patient.

A patient with a T6 spinal cord injury who is in the rehabilitation unit suddenly develops facial flushing and reports a severe headache. Blood pressure is elevated, and the heart rate is slow. Which action does the nurse take first? 1 Help the patient sit up. 2 Insert a straight catheter. 3 Check for fecal impaction. 4 Loosen the patient's clothing.

1 Help the patient sit up. The patient is experiencing autonomic dysreflexia, which can produce severe and rapidly occurring hypertension. Getting the patient to sit upright is the easiest and quickest action to take and has the most immediate chance of lowering blood pressure to the brain. Checking for fecal impaction, inserting a straight catheter, and loosening the clothing are important, but will not immediately reduce blood pressure.

Which assessment finding indicates the patient may have damage to the sacral spinal nerves? 1 Inability to void 2 Abdominal distention 3 Positive Babinski's reflex 4 Paresthesia of the fingers

1 Inability to void An inability to void may indicate damage to the sacral spinal nerves, which control the detrusor muscle of the bladder. Abdominal distention may occur due to the effects of anesthesia, but does not indicate sacral nerve damage. A positive Babinski's sign is indicative of nerve damage other than the sacral spinal nerve. Paresthesia of the fingers is not associated with damage to the spinal nerves.

A patient with multiple sclerosis will begin therapy with fingolimod. Which instruction does the nurse give the patient about this drug? 1 Monitor pulse daily. 2 Report symptoms of vertigo. 3 Report symptoms of flushing. 4 Monitor daily fingerstick blood sugar.

1 Monitor pulse daily. The patient should be taught to monitor the pulse daily as the medication can cause bradycardia, especially within the first 6 hours of taking it. The drug does not cause elevated blood sugar, so monitoring of blood sugar is not required. The drug does not cause vertigo or flushing.

Which factors contribute to back pain in the older adult? Select all that apply. 1 Osteoporosis 2 Spinal stenosis 3 Blood dyscrasias 4 Rheumatoid arthritis 5 Intervertebral disk degeneration

1 Osteoporosis 2 Spinal stenosis 3 Blood dyscrasias 5 Intervertebral disk degeneration Osteoporosis, spinal stenosis, blood dyscrasias, and intervertebral disk degeneration all contribute to back pain in the older adult. Osteoporosis can lead to painful vertebral fractures. Spinal stenosis narrows the spinal canal, placing painful pressure on the nerves. Blood dyscrasias inhibit the work of healthy blood on the spine. Intervertebral disk degeneration allows for unsupported vertebrae bones to painfully grind against each other. Osteoarthritis, not rheumatoid arthritis, contributes to painful bone deformity of the spine.

What medication may be used in a patient with multiple sclerosis who is experiencing erectile dysfunction? 1 Sildenafil 2 Methotrexate 3 Magnesium oxide 4 Methylprednisone

1 Sildenafil Sildenafil is a prostaglandin-5 inhibitor used for patients with sexual dysfunction. Methotrexate, methylprednisone, and magnesium oxide are not indicated for erectile dysfunction.

Which condition involves complete but temporary loss of motor, sensory, reflex, and autonomic function? 1 Spinal shock 2 Spinal tumor 3 Neurogenic shock 4 Penetrating trauma

1 Spinal shock Spinal shock occurs when the cord immediately responds to the injury. Patients with spinal shock have complete but temporary loss of motor, sensory, reflex, and autonomic function. Spinal cord tumor causes ischemia and infarction. Neurogenic shock causes hypoperfusion due to severe cord injury. Penetrating trauma causes local damage to the spinal cord.

Which intervention does the nurse include in education for the patient to prevent low back pain and injury? 1 Stop smoking. 2 Wear high-heeled shoes. 3 Keep weight more than 20% above ideal. 4 Avoid activity like swimming and walking.

1 Stop smoking. Smoking should be stopped to prevent low back pain and injury. Smoking causes vertebral disk degeneration and narrows the vessels that supply blood to the spine. High-heeled shoes are discouraged to promote proper body alignment. Weight should be within 10% of ideal body weight to reduce the impact of excess weight on the spine. Exercise is encouraged to prevent low back pain and injury, and swimming and walking are good activities to encourage.

The nurse assesses a 30-year-old patient diagnosed with multiple sclerosis (MS). Which symptom does the nurse expect to find? 1 Vision changes 2 Flaccid muscles 3 Tremors at rest 4 Absent deep tendon reflexes

1 Vision changes Vision changes, such as diplopia, nystagmus, and blurred vision, are symptoms of MS. Affected muscles are spastic, not flaccid. Tremors at rest are not characteristic of MS. Deep tendon reflexes may be hyperactive, not absent.

The nurse provides care for a patient admitted with multiple sclerosis (MS). Which symptoms does the nurse expect to find when assessing the patient? Select all that apply. 1 Vision loss 2 Difficulty walking 3 Long-term memory loss 4 Numbness in extremities 5 Urinary bladder dysfunction

1 Vision loss 2 Difficulty walking 4 Numbness in extremities 5 Urinary bladder dysfunction Symptoms of MS depend on which nerves are affected. Loss of visual acuity and visual fields can occur with MS. Difficulty walking can occur if the motor nerves to muscles are affected. Numbness occurs when the nerves that carry sensations are affected. Bladder dysfunction occurs due to spinal cord involvement. Memory loss is not usually reported with MS.

Which activity instructions are indicated for a patient four to six weeks after back surgery? Select all that apply. 1 Walk daily. 2 Restrict driving. 3 Limit lifting to 10 lb. 4 Increase stair climbing. 5 Avoid twisting at the waist.

1 Walk daily. 2 Restrict driving. 5 Avoid twisting at the waist. Instructions after back surgery include walking daily, restricting driving, and avoiding twisting and bending at the waist to protect the surgical site and promote patient safety. The patient would be instructed to limit stair climbing to protect impact on the surgical site, and lifting is limited to 5 lb or less to reduce strain.

Which patient statement indicates that self-care for a halo fixation device has been effective? 1 "I will sleep without a pillow." 2 "I will not drive until the device is removed." 3 "I will restrict my fluid intake to 1 liter per day." 4 "I will apply corn starch under the vest every day."

2 "I will not drive until the device is removed." The patient with a halo fixation device should not drive because the device impairs vision. A small pillow should be used for comfort and to prevent unnecessary pressure. Fluids should not be restricted because it could lead to dehydration and contribute to constipation. Powders should be used sparingly under the vest.

The nurse is teaching a patient newly diagnosed with multiple sclerosis (MS). Which statement by the patient indicates a correct understanding of the pathophysiology of the disease? 1 "I will die early." 2 "Parts of my nervous system have plaques." 3 "I will have gradual deterioration with no healthy times." 4 "This was caused by getting too many x-rays as a child."

2 "Parts of my nervous system have plaques." MS is characterized by an inflammatory response that results in diffuse random or patchy areas of plaque in the white matter of the central nervous system. The patient with MS has no decrease in life expectancy. Frequent times of remission are common in patients with MS. There is no known cause for MS.

Herniation of a disc occurs most commonly in which area of the spine? 1 At the sacrum 2 Between L4 and L5 3 Between C3 and C4 4 Between T6 and T7

2 Between L4 and L5 Herniated discs occur most often between the L4 and L5. They can occur at any place in the spine, but the fourth and fifth lumbar are the most common site.

The nurse provides care for a patient admitted with multiple sclerosis (MS). Which medications does the nurse expect will be ordered for the patient? Select all that apply. 1 Antibiotics 2 Cholinergics 3 Stool softeners 4 Muscle relaxants 5 Glucocorticoids

2 Cholinergics 3 Stool softeners 4 Muscle relaxants 5 Glucocorticoids Cholinergics are used to treat bladder dysfunction for MS patients. Stool softeners are commonly used to treat bowel dysfunction that accompanies MS. Muscle relaxants reduce stiffness and spasms for MS patients. Glucocorticoids are steroids used to treat relapses of MS. Antibiotics are not routinely used to treat MS symptoms.

Which risk factors would the nurse educate a patient about in regards to risk for multiple sclerosis (MS)? Select all that apply. 1 Male gender 2 Family history 3 Age 20 to 50 years 4 Asian and African descent 5 History of Epstein-Barr virus

2 Family history 3 Age 20 to 50 years 5 History of Epstein-Barr virus If a parent or sibling has had MS, the patient is at higher risk of developing the disease. MS can occur at any age, but most commonly affects people between the ages of 20 to 50 years. A variety of viruses, including Epstein-Barr, have been linked to MS. Women are about twice as likely as men to develop MS. White people, particularly those of Northern European descent, are at the highest risk of developing MS. People of Asian, African, or Native American descent have the lowest risk.

What does the nurse prioritize when caring for a patient diagnosed with multiple sclerosis who is experiencing hypalgesia? 1 Pain 2 Injury risk 3 Lack of tolerance for activity 4 Reduced capacity for self-care

2 Injury risk A patient with multiple sclerosis who has hypalgesia has decreased sensitivity to pain, which increases the risk of injury. Pain is not as high a priority as injury risk. Reduced capacity for self-care is important but not priority. Likewise, lack of tolerance for activity is important but not priority.

What would be the appropriate nursing intervention for delusions occurring with ziconotide? 1 Assuring the patient that the symptoms are normal 2 Instructing the patient to stop taking the drug immediately 3 Instructing the patient to decrease the dosage of the drug 4 Asking the patient to begin taking haloperidol along with ziconotide

2 Instructing the patient to stop taking the drug immediately Delusions are a symptom of psychosis and may worsen if taking ziconotide continues, so the nurse should instruct the patient to stop taking the drug immediately. Decreasing the dosage of the drug may not be enough to ease the symptoms of psychosis. Symptoms of psychosis are not normal. The patient should only start other medication at the discretion of the health care provider.

The nurse understands that which statement is true of back pain? 1 Acute back pain continues for more than 12 weeks. 2 Low back pain is the leading cause of work disability. 3 The most common area for back pain is the thoracic spine. 4 Subsequent episodes of back pain tend to decrease in severity.

2 Low back pain is the leading cause of work disability. Low back pain is the leading cause of work disability and a significant burden of disease in the United States. Acute back pain lasts less than two weeks, while chronic back pain continues for 12 weeks or more. The most common areas for back pain are the cervical and lumbar spine where there is the most movement. Back pain can be recurrent with subsequent episodes generally increasing in severity.

What teaching is priority for a patient taking dalfampridine? 1 Monitoring pulse 2 Observing for seizure activity 3 Observing for signs of bleeding 4 Reporting of visual disturbances

2 Observing for seizure activity Dalfampridine has been shown to improve the ability of patients with multiple sclerosis to walk; however, it has a high incidence of seizures. There's no indication to check the pulse while on this medication. It does not carry the risk of bleeding. Dalfampridine does not increase the risk of visual disturbances.

What is the symptom of a lateral herniation of the nucleus pulposus in an intervertebral disk of fifth and sixth cervical vertebrae? 1 Pain in the leg 2 Pain in the neck 3 Pain in the abdomen 4 Pain in the lower back

2 Pain in the neck Bulging or herniation of the nucleus pulposus laterally in an intervertebral disk of fifth and sixth cervical vertebrae causes spinal nerve root compression. Spinal nerve root compression results in motor and sensory nerve manifestations in the neck, upper back, and down the affected arm. Pain in the leg, abdomen, and lower back are caused by herniation of intervertebral disks of the cervical vertebrae.

Which type of multiple sclerosis (MS) involves steady and gradual neurological deterioration without temporary diminution of the symptoms? 1 Relapsing-remitting multiple sclerosis (RRMS) 2 Primary progressive multiple sclerosis (PPMS) 3 Progressive relapsing multiple sclerosis (PRMS) 4 Secondary progressive multiple sclerosis (SPMS)

2 Primary progressive multiple sclerosis (PPMS) Primary progressive multiple sclerosis involves steady and gradual neurological dysfunction without the remittance of the symptoms. Relapsing-remitting multiple sclerosis involves the development and resolution of symptoms within the span of a few weeks to a few months. After the resolution of symptoms, the patient returns to the baseline. Progressive relapsing multiple sclerosis involves frequent relapses with partial recovery without the patient returning to the baseline. Secondary progressive multiple sclerosis begins with a relapsing remitting course that later becomes steadily progressive.

The nurse teaches a patient who is newly diagnosed with multiple sclerosis (MS) about the disease. The nurse tells the patient about which characteristics of MS? Select all that apply. 1 Drooping eyelids 2 Problems chewing 3 Exacerbation and remissions 4 Demineralization of the neurons 5 Breakdown in communication between nerves and muscles 6 Chronic degenerative disease of the central nervous system

2 Problems chewing 3 Exacerbation and remissions 4 Demineralization of the neurons 6 Chronic degenerative disease of the central nervous system MS may cause problems chewing. It is characterized by exacerbation and remissions and demineralization of the neurons. MS is a degenerative disease of the central nervous system. Drooping eyelids and the breakdown in communication between nerves and muscles are characteristic of myasthenia gravis, not MS.

Which condition contraindicates ziconotide therapy? 1 Seizures 2 Schizophrenia 3 Gastroenteritis 4 Respiratory depression

2 Schizophrenia Ziconotide is contraindicated in patients with severe mental or behavioral health problems such as schizophrenia because the drug may cause or exacerbate psychosis. Seizures, gastroenteritis, and respiratory depression do not contraindicate the use of ziconotide.

The nurse is caring for a patient admitted with an exacerbation of multiple sclerosis (MS). The patient reports urinary incontinence. Which primary urinary bladder alteration related to MS is most likely the cause? 1 Flaccid bladder 2 Spastic bladder 3 Interstitial cystitis 4 Vesicoureteral reflux

2 Spastic bladder A spastic bladder caused by MS can result in a small capacity for urine and the incontinence the patient is experiencing. A flaccid bladder has a large capacity for urine and no sensation to urinate. Interstitial cystitis is often related to a defect in the protective lining of the bladder, not MS. Vesicoureteral reflux is a condition in which urine flows retrograde, or backward, from the bladder into the ureters/kidneys and is not one of the primary urinary bladder issues experienced by MS patients.

The nurse teaches a patient about prevention of lower back pain and injuries. Which statement made by the patient indicates the need for further teaching? 1 "I will quit smoking." 2 "I will not wear high heel shoes." 3 "I will limit my intake of calcium and vitamin D supplements." 4 "I will maintain good posture while sitting, standing, and walking."

3 "I will limit my intake of calcium and vitamin D supplements." The patient should take care to prevent lower back pain and injuries. Limiting the intake of calcium and vitamin D may worsen the pain. Smoking can lead to disk degeneration; therefore, the patient stating a desire to quit smoking is appropriate. Wearing high heel shoes does not support good posture and may worsen back pain. Maintaining a good posture while sitting, standing, and walking helps in managing lower back pain.

What statement by the patient diagnosed with multiple sclerosis indicates a need for further teaching? 1 "I will try to use stress relief techniques." 2 "I will stay away from people who have infections." 3 "If my muscles are feeling tired I will take a hot bath." 4 "I will alternate an eyepatch from side to side when I have diplopia."

3 "If my muscles are feeling tired I will take a hot bath." Taking a hot bath is contraindicated in patients with multiple sclerosis; extreme heat will exacerbate the multiple sclerosis. Use of stress relief techniques is indicated. The patient should avoid people with infections. If the patient has diplopia, alternating an eyepatch from side to side is appropriate.

Which action does the nurse take first for a patient following back surgery who has a suspected cerebrospinal leak? 1 Notify the surgeon. 2 Remove the dressing. 3 Administer analgesics. 4 Place the patient in a flat-lying position.

4 Place the patient in a flat-lying position. The first action by the nurse would be to place the patient in a flat-lying position to slow the leakage of fluid. After laying the patient down, the nurse can then notify the surgeon. The dressing would have clear fluid, be bulging, or have a halo on or around it, but there is no need to remove it. Administration of analgesics would be done for the patient experiencing pain.

The nurse is teaching a patient about multiple sclerosis. What statement by the patient indicates a need for further teaching? 1 "There's a good chance multiple sclerosis is related to viruses." 2 "People in colder climates are more prone to developing multiple sclerosis." 3 "People with Asian ancestry are more likely to get multiple sclerosis." 4 "I am at higher risk of developing multiple sclerosis because my mother had it."

3 "People with Asian ancestry are more likely to get multiple sclerosis." Patients with families of Northern European ancestry, not Asian ancestry, are more likely to develop multiple sclerosis. Multiple sclerosis has been linked to viruses that may be a potential cause. Multiple sclerosis is seen more in colder climates. People with a first-degree relative, such as a parent or sibling, are more likely to develop multiple sclerosis.

What treatment can be used to relieve diplopia in a patient diagnosed with multiple sclerosis? 1 Use corrective lenses as prescribed. 2 Ensure adequate sleep and rest periods. 3 Alternate an eyepatch from eye to eye every few hours. 4 Use scanning techniques by moving the head side to side.

3 Alternate an eyepatch from eye to eye every few hours. Alternating an eyepatch from eye to eye every few hours can relieve diplopia. Corrective lenses help with visual acuity. Rest does not affect diplopia. Scanning techniques are used for issues with preferable vision.

A patient returns to the neuromedicine floor after undergoing an anterior cervical diskectomy and fusion (ACDF). What is the nurse's first action? 1 Assist with ambulation. 2 Administer pain medication. 3 Assess airway and breathing. 4 Check the patient's ability to void.

3 Assess airway and breathing. Assessment in the immediate postoperative period after an ACDF is maintaining an airway and ensuring that the patient has no problem with breathing. Swelling from the surgery can narrow the trachea, causing a partial obstruction. Ambulation, administration of pain medication, and assessing the patient's ability to void are important, but are not the highest priority.

Which concern does the nurse anticipate to be of the most importance to a patient who has lower back pain? 1 Numbness 2 Constipation 3 Continuous pain 4 Urinary incontinence

3 Continuous pain The primary concern of the patient with lower back pain is the presence of continuous pain that impacts mobility and all activity including sleep and rest. Numbness may occur if the cause of the lower back pain involves the ability of the nerve to conduct sensation. Constipation and continence changes may occur if spinal nerve intervention to the bowel and bladder are impacted.

The nurse is caring for a patient with severe chronic back pain. The primary health care provider orders an intrathecal infusion of ziconotide with a surgically implanted pump. Which action of the nurse is most appropriate in this situation? 1 Ensuring that the patient can void without difficulty 2 Monitoring the patient's blood glucose level regularly 3 Discontinuing the infusion if the patient exhibits delusions 4 Assessing the patient's neurologic status above the level of the pump's insertion

3 Discontinuing the infusion if the patient exhibits delusions Ziconotide therapy can cause psychotic symptoms like hallucinations and delusions. In such a case, the drug should be stopped immediately and the adverse effects reported to the health care provider. The nurse should assess the neurologic status of a patient with surgically implanted pumps below, not above, the level of insertion. Ziconotide therapy does not cause blood glucose fluctuations. For patients who have a spinal cord stimulator implanted in the epidural space, not an intrathecal pump, the nurse should ensure that the patient can void without difficulty.

Which mechanism of spinal cord injury occurs when the head turns beyond the normal range? 1 Hyperflexion 2 Hyperextension 3 Excessive rotation 4 Vertical compression

3 Excessive rotation Excessive rotation results from injuries that are caused by turning the head beyond the normal range. A sudden and forceful acceleration of the head forward may cause hyperflexion. Hyperextension occurs when the head is suddenly accelerated and then decelerated. Axial loading or vertical compression injuries may result from diving accidents, falls on the buttocks, or a jump in which a person lands on the feet.

What chemotherapy drug has been shown to effectively reduce neurologic disability in patients with multiple sclerosis? 1 Fingolimod 2 Cyclosporine 3 Mitoxantrone 4 Methotrexate

3 Mitoxantrone Mitoxantrone is a chemotherapy drug that has been shown to be effective in reducing neurologic disability. Fingolimod was the first oral immunomodulator. Cyclosporine and methotrexate are immunosuppressants.

A patient admitted to the intensive care unit after sustaining a cervical spinal cord injury in a motor vehicle crash is intubated and is receiving mechanical ventilation. The nurse notes a heart rate of 56 beats/min; blood pressure of 88/60 mm Hg; and warm, dry skin. Which priority action does the nurse perform? 1 Continue to assess the patient every 2-4 hours. 2 Increase the oxygen flow to the patient. 3 Notify the provider of these findings immediately. 4 Suction the patient to clear the airway of secretions.

3 Notify the provider of these findings immediately. Neurogenic shock is a potentially life-threatening complication of spinal cord injury in patients with injuries above T6 and is characterized by bradycardia; hypotension; and warm, dry skin. The nurse should notify the provider immediately so that fluids can be restored to the circulating blood volume. Bradycardia is related to shock and not hypoxia, so increasing oxygen or suctioning are not indicated.

The nurse teaches a patient with multiple sclerosis (MS) how to reduce fatigue. Which recommendation does the nurse provide? 1 Take a hot bath. 2 Avoid naps during the day. 3 Rest in an air-conditioned room. 4 Increase the dose of muscle relaxants.

3 Rest in an air-conditioned room. Fatigue is a common symptom in patients with MS. Lowering the body temperature by resting in an air-conditioned room may relieve fatigue, though extreme cold should be avoided. A hot bath or shower can increase body temperature, producing fatigue. Planning for frequent rest periods and naps can relieve fatigue. Muscle relaxants, prescribed to reduce spasticity, can cause drowsiness and fatigue and should only be taken as prescribed.

What should the patient recovering from an anterior cervical diskectomy and fusion (ACDF) expect to wear after he or she is permitted to remove the hard collar? 1 Back brace 2 Woolen scarf 3 Soft cervical collar 4 Nothing is required

3 Soft cervical collar After the initial brace is removed, the patient should expect to wear a soft collar for several weeks, or longer if needed. A back brace would be appropriate for a lumbar spinal fusion. A woolen scarf is not required to be worn after an ACDF. Wearing nothing around the neck is not an option for this patient.

The family member of a patient diagnosed with multiple sclerosis expresses concern over the patient's inappropriate behavior. What statement by the nurse is most appropriate? 1 "It may be important to avoid social situations." 2 "We can talk to the doctor about medication to help with the behavior." 3 "Unfortunately this is part of the disease process and will likely get worse." 4 "It is a good idea to develop a cue to let them know they're being inappropriate."

4 "It is a good idea to develop a cue to let them know they're being inappropriate." Developing a cue to let the patient know she is behaving inappropriately is indicated. Avoiding social situations is not indicated. This behavior may be a permanent part of the disease; however, telling the family that this will likely get worse is not supporting the family. There are no medications to improve the behavioral changes related to MS.

A patient diagnosed with multiple sclerosis is examining the use of complementary therapies. What statement by the patient indicates a need for further teaching? 1 "Massage or acupuncture may help me move around better." 2 "Aromatherapy and meditation may help me manage stress." 3 "Reflexology and yoga may help with my weakness and balance." 4 "Massage and acupuncture may allow me to not use medications anymore."

4 "Massage and acupuncture may allow me to not use medications anymore." Using massage, acupuncture, or other complementary therapies will not replace medications for patients with multiple sclerosis. Complementary therapies are meant for symptomatic treatment. Aromatherapy and meditation may help manage stress. Reflexology and yoga may help with balance and weakness. Massage and acupuncture may help the patient move better.

Which intervention is the priority for the nurse to perform for a patient following anterior cervical discectomy and fusion? 1 Manage pain. 2 Evaluate the ability to swallow. 3 Check the incision site for bleeding. 4 Assess airway, breathing, and circulation.

4 Assess airway, breathing, and circulation. The priority for the nurse is to assess airway, breathing, and circulation for a patient following anterior cervical discectomy and fusion to ensure the airway and cardiovascular system are stable. Managing pain, evaluating the ability to swallow, and checking the incision site for bleeding are all best practices in patient care after this surgery, but airway, breathing, and circulation must first be assessed and deemed stable.

Which secondary spinal cord injury typically results from decreased circulating blood volume? 1 Ischemia 2 Hemorrhage 3 Local edema 4 Hypovolemia

4 Hypovolemia Secondary spinal cord injuries can cause hypovolemia resulting from decreased circulating blood volume. Ischemia (lack of oxygen, typically from reduced or absent blood flow), hemorrhage (excessive bleeding), and local edema (swelling of soft tissues due to increased interstitial fluid) can also occur.

What pain management modality is commonly used on patients with failed back surgery syndrome? 1 Iontophoresis 2 Phonophoresis 3 Thermotherapy 4 Implantable spinal cord stimulators

4 Implantable spinal cord stimulators In failed back surgery syndrome, patients suffer from chronic lower back pain even after repeated surgical procedures. The best pain management modality for patients with failed back surgery syndrome is implantable spinal cord stimulators. Iontophoresis, phonophoresis, and thermotherapy are used for acute lower back pain management.

Which spinal surgical procedure uses the umbilical approach? 1 Diskectomy 2 Laminectomy 3 Microdiskectomy 4 Laser-assisted laparoscopic lumbar diskectomy

4 Laser-assisted laparoscopic lumbar diskectomy Laser-assisted laparoscopic lumbar diskectomy combines a laser with modified standard disk instruments inserted through the laparoscope using an umbilical, or belly button, incision. The diskectomy, laminectomy, and microdiscectomy use the spinal approach for the surgery.

A patient reports pain when moving the neck. What diagnostic test is used to provide images of the muscles in the neck? 1 Plain x-rays 2 Computed tomography (CT) 3 Myelogram or postmyelogram CT 4 Magnetic resonance imaging (MRI)

4 Magnetic resonance imaging (MRI) MRI provides images of spinal tissue, bones, spinal cord, nerves, ligaments, disks, and musculature. Plain x-rays show changes in the bone, such as changes in the joints and in the positioning and alignment of bones. CT shows the bones, nerves, disks, and ligaments. Myelogram or postmyelogram CT is used for evaluating lesions of the nerve root and any other mass lesion or infection that is within or invading the thecal sac.

Which diagnostic test does the nurse anticipate for the patient with back pain in need of spinal tissue and spinal cord imaging? 1 Bone scan 2 Plain x-ray 3 Myelogram 4 Magnetic resonance imaging (MRI)

4 Magnetic resonance imaging (MRI) MRI shows the soft tissue and spinal cord along with spinal bones, nerves, ligaments, and disks. A bone scan shows changes in bone and areas of vascularity associated with tumors and infection. Plain x-ray images bones for alignment and would show arthritic changes. The myelogram images nerve roots and lesions of the spinal cord.

A patient is being discharged with paraplegia secondary to a motor vehicle crash and expresses concern over the ability to cope in the home setting after the injury. Which is the best resource for the nurse to provide for the patient? 1 Internet 2 Hospital library 3 Provider's office 4 National Spinal Cord Injury Association

4 National Spinal Cord Injury Association The National Spinal Cord Injury Association will inform the patient of support groups in the area and will assist in answering questions regarding adjustment in the home setting. The hospital library is not typically consumer-oriented; most information available is targeted to health care professionals. The Internet is not the best resource simply because of the unlimited volume of information available and its questionable quality. The health care provider's office typically does not provide information about spinal cord injury support groups.

Which pharmacological treatment does the nurse anticipate being prescribed first for the treatment of new onset back pain? 1 Opioids 2 Antibiotics 3 N-type calcium channel blockers (NCCBs) 4 Nonsteroidal antiinflammatory drugs (NSAIDs)

4 Nonsteroidal antiinflammatory drugs (NSAIDs) NSAIDs are the first pharmacological treatment prescribed to treat the pain and inflammation of the back. Opioids are introduced if NSAIDs are not effective. Antibiotics are used for infection and not indicated for back pain. NCCBs are used for severe, chronic back pain.

Following a spinal cord injury (SCI), what is the patient with weakness in the legs and arms experiencing? 1 Paraparesis 2 Hypoesthesia 3 Hyperesthesia 4 Quadraparesis

4 Quadraparesis The patient with weakness in the upper and lower extremities following SCI is experiencing quadraparesis. Paraparesis is weakness involving the lower extremities. Hypoesthesia is decreased sensation. Hyperesthesia is increased sensation.

A patient is admitted to the hospital following a motor vehicle accident. A spinal cord injury is suspected. The nurse identifies that which assessment findings should be addressed as a priority? Select all that apply. 1 Flaccidity of the lower extremities 2 Tingling and numbness in the fingers 3 Temperature - 100° F, pale skin, sweating 4 Respiratory rate - 30 breaths per minute; shallow and rapid breaths 5 BP - 90/60 mm of Hg, Pulse - 100 beats per minute; weak and thready pulse

4 Respiratory rate - 30 breaths per minute; shallow and rapid breaths 5 BP - 90/60 mm of Hg, Pulse - 100 beats per minute; weak and thready pulse Spinal cord injuries may be life-threatening and the priority during immediate care is maintaining the airway, breathing, and circulation. An increased respiratory rate with shallow and rapid breaths may be a sign of a foreign body in the airway or injury to the spinal nerves that is innervating the respiratory muscles; therefore, maintaining the airway and breathing is the first priority. A low BP with tachycardia and a weak, thready pulse indicate compromised circulation, possibly caused by hemorrhage. This may be life-threatening if not managed on time. Flaccidity of the lower limbs and tingling and numbness may be signs of nerve damage, but these findings can be addressed once the airway, breathing, and circulation are stabilized. A temperature of 100° F indicates fever, which is not a life-threatening condition in this situation.

Which statement accurately describes the Williams position? 1 Lying prone with the head of the bed flat 2 Sitting in a reclining wheelchair with the knee-gatch raised 3 Lying supine with the head flat and the feet elevated 30 degrees 4 Semi-Fowler's with a pillow under the knees to keep them flexed

4 Semi-Fowler's with a pillow under the knees to keep them flexed The Williams position, typically used for patients with low back pain from a bulging or herniated disk, is described as lying in a semi-Fowler's position with a pillow under the knees to keep them flexed. The other statements do not reflect the Williams position accurately.

Which assessment finding suggests to the nurse that a patient is experiencing sciatic nerve compression? 1 Urinary incontinence 2 Frequent diarrhea-like bowel movements 3 Inability to bear weight on the affected leg 4 Severe pain when the patient's leg is held straight and lifted upward

4 Severe pain when the patient's leg is held straight and lifted upward If the sciatic nerve is compressed, severe pain occurs when the patient's leg is held straight and lifted upward. Diarrhea and urinary incontinence are not signs of nerve compression. The affected leg may be weak, but the patient should be able to bear weight.