Neuro prepU

Which of the following is considered a central nervous system (CNS) disorder?

Multiple sclerosis Multiple sclerosis is an immune-mediated, progressive demyelinating disease of the CNS. Guillain-Barré, myasthenia gravis, and Bell's palsy are peripheral nervous system disorders.

Which of the following is the most common cause of acute encephalitis in the United States? a) Herpes simplex virus (HSV) b) Western equine bacteria

a) Herpes simplex virus (HSV)

The most common cause of cholinergic crisis includes which of the following? a) Undermedication b) Overmedication c) Infection d) Compliance with medication

b) Overmedication

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

c) Alternatively patch one eye every 2 hours.

Which of the following 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? a) Huntington disease b) Creutzfeldt-Jakob disease c) Multiple sclerosis d) Parkinson's disease

c) Multiple sclerosis

Which of the following is a rare, transmissible, progressive fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain? a) Creutzfeldt-Jakob disease b) Multiple sclerosis c) Huntington disease d) Parkinson's disease

a) Creutzfeldt-Jakob disease Creutzfeldt-Jakob disease causes severe dementia and myoclonus. Multiple sclerosis is a chronic, degenerative, progressive disease of the CNS characterized by the occurrence of small patches of demyelination in the brain and spinal cord. Parkinson's disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia

A patient diagnosed with meningitis would be expected to exhibit which of the following clinical manifestations? Select all that apply. a) Photophobia b) Nuchal rigidity c) Hypothermia d) Positive Kernig's sign e) Positive Brudzinski's sign

a) Photophobia b) Nuchal rigidity d) Positive Kernig's sign e) Positive Brudzinski's sign

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

a) Renal

A discharge nurse in a rehabilitation facility is coordinating the discharge of Mr. Rigby, 47-year-old tetraplegic, married man with two children in high school. The client is being discharged to home and will require much assistance. Who would the discharge planner recognize as being the most important member of Mr. Rigby's care team? a) Spouse b) Home care nurse c) Chaplin d) Physical therapist

a) Spouse

A client is diagnosed with meningococcal meningitis. The 22-year-old client shares an apartment with one other person. What would the nurse expect as appropriate care for the client's roommate? a) Treatment with antimicrobial prophylaxis as soon as possible b) Bedrest at home for 72 hours c) No treatment unless the roommate begins to show symptoms d) Admission to the nearest hospital for observation

a) Treatment with antimicrobial prophylaxis as soon as possible People in close contact with clients who have meningococcal meningitis should be treated with antimicrobial chemoprophylaxis, ideally within 24 hours after exposure.

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

a) rest in an air-conditioned room.

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

b) "I was brushing my teeth."

A patient with fungal encephalitis receiving IV amphotericin B complains of fever, chills, and body aches. What action by the nurse is appropriate? a) Stop the infusion immediately. b) Administer diphenhydramine (Benadryl) and acetaminophen (Tylenol) per orders. c) Notify the physician and prepare for a lumbar puncture to obtain CSF cultures. d) Assess laboratory values for renal insufficiency.

b) Administer diphenhydramine (Benadryl) and acetaminophen (Tylenol) per orders.

Which of the following nursing interventions is appropriate for a patient with double vision in the right eye due to MS? a) Exercise the right eye twice a day (BID). b) Apply an eye patch to the right eye. c) Place needed items on the right side. d) Administer eye drops as needed.

b) Apply an eye patch to the right eye.

The nurse is assessing a newly admitted client with a diagnosis of meningitis. On assessment, the nurse expects to find which of the following? a) Hyper-alertness b) Positive Romberg sign c) Positive Kernig's sign d) Negative Brudzinski's sign

c) Positive Kernig's sign

Within the acute care facility where you practice nursing, you have cared for hundreds of clients who have suffered neurologic deficits from various causes, including cerebrovascular accident and closed head injury. While caring for these clients, what was an important nursing goal that motivated you to offer the best care possible? a) Prevent infection. b) Prevent choking. c) Prevent complications, which may interfere with recovering function. d) Prevent falls.

c) Prevent complications, which may interfere with recovering function.

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

c) Pyridostigmine bromide (Mestinon) Mestinon, an anticholinesterase medication, is the first-line therapy in MG. It provides symptomatic relief by inhibiting the breakdown of acetylcholine and increasing the relative concentration of available acetylcholine at the neuromuscular junction. If Mestinon does not improve muscle strength and control fatigue, the next agents used are immunosuppressant agents. Imuran is an immunosuppressive agent that inhibits T lymphocytes and reduces acetylcholine receptor antibody levels. Baclofen is used in the treatment of spasticity in MG.

A patient diagnosed with MS 2 years ago has been admitted to the hospital with another relapse. The previous relapse was followed by a complete recovery with the exception of occasional vertigo. What type of MS does the nurse recognize this patient most likely has? a) Disabling b) Primary progressive c) Relapsing-remitting (RR) d) Benign

c) Relapsing-remitting (RR)

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

c) Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes. Thirty seconds after injection, facial muscle weakness and ptosis should resolve for about 5 minutes (Hickey, 2009). Immediate improvement in muscle strength after administration of this agent represents a positive test and usually confirms the diagnosis.

A 45-year-old client is admitted to the facility with excruciating paroxysmal facial pain. He reports that the episodes occur most often after feeling cold drafts and drinking cold beverages. Based on these findings, the nurse determines that the client is most likely suffering from which neurologic disorder? a) Angina pectoris b) Bell's palsy c) Trigeminal neuralgia d) Migraine headache

c) Trigeminal neuralgia

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

d) Facial distortion and pain

A patient has been diagnosed with a frontal lobe brain abscess. Which of the following nursing interventions is appropriate? a) Assess visual acuity. b) Ensure that patient takes nothing by mouth (NPO). c) Assess for facial weakness. d) Initiate seizure precautions.

d) Initiate seizure precautions.

A client is brought to the emergency department in a confused state, with slurred speech, characteristics of a headache, and right facial droop. The vital signs reveal a blood pressure of 170/88 mm Hg, pulse of 92 beats/minute, and respirations at 24 breaths/minute. On which bodily system does the nurse focus the nursing assessment? a) Endocrine system b) Cardiovascular system c) Respiratory system d) Neurovascular system

d) Neurovascular system

A patient has been diagnosed with meningococcal meningitis at a community living home. When should prophylactic therapy begin for those who have had close contact with the patient? a) Within 72 hours after exposure b) Within 48 hours after exposure c) Therapy is not necessary prophylactically and should only be used if the person develops symptoms. d) Within 24 hours after exposure

d) Within 24 hours after exposure

Which diagnostic test is used for early diagnosis of HSV-1 encephalitis? a) Electroencephalography (EEG) b) Polymerase chain reaction (PCR) c) MRI d) Lumbar puncture

b) Polymerase chain reaction (PCR) The PCR is the standard test for early diagnosis of HSV-1 encephalitis. A lumbar puncture often reveals a high opening pressure and low glucose and high protein levels in CSF samples. EEG is used to diagnose seizures. An MRI is used to detect lesions in the brain.

Guillain-Barré syndrome is an autoimmune attack on the peripheral myelin sheath. Which of the following is an action of myelin? a) Carries message to the next nerve cell b) Speeds nerve impulse transmission c) Represents building block of nervous system d) Acts as chemical messenger

b) Speeds nerve impulse transmission

Which of the following tests confirms the diagnosis of myasthenia gravis (MG)?

Tensilon test Edrophonium chloride (Tensilon) is an acetylcholinesterase inhibitor that stops the breakdown of acetylcholine. The drug is used because it has a rapid onset of 30 seconds and a short duration of 5 minutes. Immediate improvement in muscle strength after administration of this agent represents a positive test and usually confirms the diagnosis. The presence of acetylcholine receptor antibodies is identified in serum. Repetitive nerve stimulation demonstrates a decrease in successive action potentials. The thymus gland may be enlarged in MG, and a T scan of the mediastinum is performed to detect thymoma or hyperplasia of the thymus.

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

b) Edrophonium (Tensilon)

The diagnosis of multiple sclerosis is based upon which of the following tests? a) MRI b) Evoked potential studies c) Neuropsychological testing d) CSF electrophoresis

a) MRI

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

a) Muscle weakness and hyporeflexia of the lower extremities

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

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

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

b) Tensilon test

Stephen Oswald, a 68-year-old retired salesman, was brought by squad into the acute care facility where you practice nursing. His wife accompanies him and relates how Stephen reported a severe headache and then was unable to talk or move his right arm and leg. After diagnostics are completed and Mr. Oswald is admitted to the hospital, when would you expect basic rehabilitation to begin? a) After 1 week b) Upon transfer to a rehabilitation unit c) Two to 3 days d) Immediately

d) Immediately