Pathophysiology Exam 2

A client who has been exercising says to the nurse, "My skin is so hot!" What is the nurse's best response?

"Your body is trying to lower your temperature." Rationale: After exercise, the body dilates blood vessels and shunts blood to the skin to help to decrease the temperature. Skin typically feels hot and sweaty. Evaporation of sweat from the skin surface contributes to loss of heat. As the heat is lost through the skin, the skin typically feels hot. The nurse should calm the client and explain that this is a normal response to exercise.

A client has a fever that was induced by damage to the hypothalamus due to intercranial bleeding. The nurse plans care for which type of fever?

Neurogenic Rationale: Neurogenic fever has its origin in the central nervous system and is usually caused by damage to the hypothalamus from trauma, intercranial bleeding, or increased intercranial pressure. The nurse should plan care for a client with a neurogenic fever.

Acute lymphocytic leukemia (ALL) and acute myelocytic leukemia (AML) are two distinct disorders with similar presenting clinical features. What clinical feature do ALL and AML share?

Night sweats Rationale: Although ALL and AML are distinct disorders, they typically present with similar clinical features. Both are characterized by an abrupt onset of symptoms, including fatigue resulting from anemia; low-grade fever, night sweats, and weight loss due to the rapid proliferation and hypermetabolism of the leukemic cells; bleeding because of a decreased platelet count; and bone pain and tenderness due to bone marrow expansion. Polycythemia is an increase in the erythrocytes in the blood. It is not an indication of leukemia.

A client diagnosed with Parkinson disease is displaying the following manifestations: tremor, rigidity, and slowness of movement. The nurse would interpret these as:

Normal manifestations of Parkinson disease Rationale: The client is manifesting normal responses of the disease. The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia (slowness of movement

The underlying causative problem in Parkinsonism is:

Failure of dopamine release Rationale: Lack of dopamine release is the primary cause of Parkinson disease and associated symptoms.

The nurse is working with a client who has been diagnosed with recurring migraine headaches. Which advice by the nurse is most appropriate?

"Many people find that maintaining regular eating and sleeping habits is beneficial." Rationale: Nonpharmacologic treatment includes the avoidance of migraine triggers, such as foods, that precipitate an attack. Many persons with migraines benefit from maintaining regular eating and sleeping habits. The client may need to change her lifestyle, but not to the extent of moving and changing jobs. Migraines are avoidable, most of the time, if individuals adhere to their diets and watch the triggers. Medication is very useful for most clients.

A nurse assessing an older adult 3 hours postoperative notes guarding, grimacing, and stiff body movement when changing positions. The client denies feeling pain. Which response will help the nurse best manage this client's pain?

"You seem to be uncomfortable. Pain is common with surgery. I can bring you pain medication." Rationale: Older adults are often reluctant to report pain if it might be a bother to others, or they assume they should experience pain as a result of increased age and health issues. The nurse needs to be specific in asking questions about the pain an older adult is experiencing while using therapeutic communication skills. A closed-ended question will not provide as much data as more open-ended responses will.

In which client would a clinician most suspect multiple myeloma as a diagnosis?

A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated. Rationale: The main sites involved in multiple myeloma are the bones and bone marrow. In addition to the abnormal proliferation of marrow plasma cells, there is proliferation and activation of osteoclasts that lead to bone resorption and destruction. This increased bone resorption predisposes the individual to pathologic fractures and hypercalcemia. Many clients also present with renal insufficiency. Leukostasis, susceptibility to infection, and disorders of granulocyte development are not hallmarks of multiple myeloma.

Which principle best explains symptoms of amyotrophic lateral sclerosis (ALS), including dysphagia, muscle weakness and spasticity, and dysphonia?

ALS is caused by both an upper motor neuron and lower motor neuron disturbance Rationale: ALS is both an upper motor neuron (UMN) and lower motor neuron (LMN) disorder, leading to wide variety of muscular symptoms.

A client has just been diagnosed with multiple sclerosis (MS). The nurse recognizes that the client's condition is a result of:

An immune-mediated response that is caused by the demyelination of the myelin sheath of the white matter of the brain, spinal cord, and optic nerve Rationale: MS is an immune response against the components of the myelin sheath. There is progressive demyelination of the myelin sheath of the white matter of the brain, spinal cord, and the optic nerve. The other options do not describe MS.

The nurse caring for a client with an epidural hematoma recognizes the bleeding is associated with which physiological finding?

Arterial Tear Rationale: The bleeding associated with an epidural hematoma is associated with a tear in the artery, most often in the middle meningeal and in association with a skull fracture.

The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first?

Assess for other signs/symptoms of increased intracranial pressure Rationale: The tumor may be causing increased intracranial pressure. Vomiting, with or without nausea, is a common symptom of increased intracranial pressure and/or brain stem compression. The nurse's first action is to assess for other signs/symptoms of increased intracranial pressure. Once the assessment is completed, the nurse should contact the physician if indicated by the findings.

A nurse caring for a client with hypothermia anticipates that the client's temperature will be:

Below 35°C (95°F) Rationale: Hypothermia occurs when the body's core body temperature drops below 35°C (95°F).

Which cardinal assessment finding would lead the nurse to suspect a client has developed Parkinson disease?

Bradykinesia Rationale: The cardinal symptoms of Parkinson disease are tremor, rigidity (hypertonicity), and bradykinesia (slowness of movement). Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Because the basal ganglia also influence the autonomic nervous system, persons with Parkinson disease often have excessive and uncontrolled sweating, sebaceous gland secretion, and salivation. Paresthesia is characteristic of demyelinating disease such as multiple sclerosis, rather than Parkinson disease.

A client who has experienced a spinal cord injury has an ipsilateral loss of voluntary motor function and a contralateral loss of pain and temperature sensation. Based on these symptoms, which classification of spinal cord injury does the client have?

Brown Sequard Rationale: A condition called Brown-Séquard syndrome results from damage to a hemisection of the anterior and posterior cord. The effect is an ipsilateral loss of voluntary motor function from the corticospinal tract and proprioception loss with a contralateral loss of pain and temperature sensation from the lateral spinothalamic tracts for all levels below the lesion.

What will the nurse teach a client with trigeminal neuralgia about the condition?

Carbamazepine is a first-line treatment. Rationale: Trigeminal neuralgia is a condition in which clients experience brief, severe, repetitive lightninglike or throbbing pain along the distribution of one or more of the branches of the fifth cranial nerve. Clients should be taught to avoid triggers when possible, but although eating may be a trigger, it is necessary for the client to maintain nutrition. Social isolation is a possible problem arising from the condition. Time alone does not contribute significantly to improvement of the condition. Although treatment rarely provides total relief, trigeminal neuralgia can be controlled with carbamazepine and surgical release of vessels, nerve roots, or scar tissue. If other treatments are ineffective, partial destruction of the nerve branches with heat, balloon compression, or glycerol injection may be performed. Newer therapies to be considered are botulinum toxin injection and gamma radiation with stereotactic surgery.

Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy?

Carpal tunnel syndrome Rationale: The most common clinical presentation is slowly progressive weakness and atrophy in distal muscles of one upper extremity.

Which intracranial volume is most capable of compensating for increasing intracranial pressure?

Cerebrospinal fluid Rationale: Initial increases in intracranial pressure (ICP) are largely buffered by a translocation of cerebrospinal fluid (CSF) to the spinal subarachnoid space and increased reabsorption of CSF. Of the intracranial volumes, the tissue volume is least capable of undergoing change. Surface sulcus fluid is negligible and not a factor in increased ICP. The compensatory ability of the intravascular blood compartment is also limited by the small amount of blood that is in the cerebral circulation. As the volume-buffering capacity of this compartment becomes exhausted, venous pressure increases and cerebral blood volume and ICP rise.

A client with a rising temperature is pale and has begun to shiver. The nurse reports that the client is in which phase of fever development?

Chill Rationale: During the second phase or chill phase of fever development, the client's skin is pale; there is an onset of shivering, a rising temperature, and the sensation of being chilled. Therefore, the nurse should report that the client is in the second or chill phase of fever development.

The nurse assesses the client with Huntington disease demonstrating irregular wriggling and writhing movements. The client is also having facial grimacing, raising the eyebrows, and rolling the eyes. How would the nurse document this finding?

Chorea Rationale: Chorea is irregular wriggling and writhing movements that can be accentuated by movement and by environmental stimulation; they often interfere with normal movement patterns. They may be grimacing movements of the face, raising the eyebrows, rolling of the eyes, and curling, protrusion, or withdrawal of the tongue. In the limbs, the movements largely are distal. There may be piano-playing-type movements with alternating extension and flexion of the fingers.

A client's emergency room report includes the presence of a contrecoup injury. The nurse plans care for a client with which of the following?

Closed head injury opposite the area of impact Rationale: In a contrecoup injury, the client experiences a rebound injury on the side of the brain opposite the site of external force.

A severe type of headache that occurs more frequently in men than women and is described as having unrelenting, unilateral pain located most frequently in the orbit is called:

Cluster headache Rationale: Cluster headache is a type of primary neurovascular headache that typically includes severe, unrelenting, unilateral pain located, in order of decreasing frequency, in the orbital, retro-orbital, temporal, supraorbital, and infraorbital region.

The loss of heat from the body through the circulation of air currents is known as:

Convection Rationale: Convection refers to heat transfer through the circulation of air currents, while radiation is the transfer of heat through air or a vacuum. Conduction is the direct transfer of heat from one molecule to another, and evaporation involves the use of body heat to convert water on the skin to water vapor.

A nurse assessing an older adult for signs and symptoms of infection in the absence of a fever should assess for which of the following? Select all that apply.

Decreased mental status Change in functional capacity Fatigue Rationale: Signs and symptoms of infection in an older adult in the absence of a fever include decreases in mental status and functional capacity, fatigue, weight loss, and weakness.

Which statement best describes the pathophysiology of Parkinson disease?

Degeneration of the nigrostriatal dopamine system Rationale: Parkinson disease presents with degenerative changes in the basal ganglia. Dopamine depletion results from degeneration in the nigrostriatal system. The cause of Parkinson disease is still unknown; it is widely believed that most cases are caused by an interaction of environmental and genetic factors.

A client's recent diagnosis of Parkinson disease has prompted the care provider to promptly begin pharmacologic therapy. The drugs prescribed will likely influence the client's levels of which substance?

Dopamine Rationale: Although some antiparkinsonian drugs act by reducing the excessive influence of excitatory cholinergic neurons, most act by improving the function of the dopaminergic system. Serotonin and adenosine are not known to participate directly in the pathophysiology of Parkinson disease.

The nurse on the pediatric unit is implementing distraction strategies for a child who is experiencing pain. Which strategies would be best for the nurse to implement? Select all that apply.

Games Bubbles Television Music Rationale: Distraction helps children of any age divert their attention away from pain and onto other activities. Common diversions include bubbles, music, television, conversation, and games.

The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced:

Generalized Seizure Rationale: When seizure activity begins simultaneously in both cerebral hemispheres, it is considered a generalized seizure.

An older adult tells the nurse, "My friend just developed shingles and has a lot of pain. Is there a way for me to protect myself from it?" Which of the following is an appropriate response from the nurse?

Get a Zostavax vaccination Rationale: Herpes zoster is the viral infection caused by the varicella zoster virus. The first infection is called chickenpox. When there is a recurrence it is called shingles. The virus is believed to remain dormant in the nerve root until the client has a decline in cellular immunity when the virus will replicate. The pain is often described as throbbing, burning, or stabbing. The best prevention is a vaccine for adults age 60 and older. Antivirals will lessen the severity at the time but will not prevent infection.

A high school student sustained a concussion during a football game. The school nurse will educate the family about postconcussion syndrome and ask them to watch for and report which manifestations of its presence?

Headaches and poor concentration Rationale: Postconcussion syndrome includes mild symptoms, such as headache, irritability, insomnia, and poor concentration and memory. Nosebleeds, hypersomnia, unilateral motor changes, and neck pain are indicative of more severe brain injury and/or soft tissue injury.

Herniated disks put pressure on the nerve root. This type of injury occurs most often in the cervical and lumbar region of the spine. What is an important assessment technique for a herniated disk in the lumbar region?

Hip flexion test CT scan Straight-leg test Rationale: Diagnosis of herniated disk include neurologic assessment of straight-leg testing; hip and knee flexion; MRI; computed tomography (CT); and CT myelography.

A client has been diagnosed with an advanced tumor that has invaded the mediastinum. The client would most likely manifest:

Hoarseness and difficulty swallowing rationale: Tumors that invade the mediastinum cause hoarseness, difficulty in swallowing, and retrosternal pain. Hemoptysis may occur but is not specific to mediastinal involvement.

A febrile, 3-week-old infant is currently undergoing a diagnostic workup to determine the cause of the fever. Which statement best conveys the rationale for this careful examination?

Infants are susceptible to serious infections because of their decreased immune function. Rationale: Fever in infants and children can be classified as low risk or high risk, depending on the probability of the infection progressing to bacteremia or meningitis and signs of toxicity. Infants between the ages of 1 to 28 days with fever should be considered to bave a bacterial infection that can cause bacteremia or meningitis. Younger children have decreased immunologic function and are more commonly infected with virulent organisms. Infants are at particularly high risk for serious bacterial infections that can cause bacteremia or meningitis. Infants are capable of thermoregulation, and fever is not necessarily indicative of a congenital disorder. Antipyretics are effective in the treatment of fever in infants.

Which neuron connects sensory and motor neurons?

Interneurons Rationale: Neurons that connect sensory and motor neurons are known as interneurons. Motor neurons receive input from axons descending from higher centers. These supraspinal signals can modify reflex responses to peripheral stimuli by facilitating or inhibiting different populations of interneurons. They also coordinate movements through these interneurons.

A client's emergency magnetic resonance imaging (MRI) has been examined by the physician and tissue plasminogen activator (tPA) has been administered to the client. What was this client's most likely diagnosis?

Ischemic stroke Rationale: Thrombolytic therapy for the acute treatment of ischemic stroke consists of the intravenous administration of tPA. This drug would exacerbate a subarachnoid hemorrhage by inhibiting the clotting mechanism, and it is not relevant to the care of clients with encephalitis or status epilepticus.

In understanding the pathology of pneumococcal pneumonia, what occurs in the gray hepatization stage?

Macrophages phagocytose the red blood cells and other cellular debris, leaving the lung firm and less congested. Rationale: In the gray hepatization stage, macrophages phagocytose the fragmented polymorphonuclear cells, RBCs, and other cellular debris. Alveolar exudate is removed in the resolution stage, while the lung becomes red during the red hepatization phase. The alveoli become filled with rich edema fluid in the edema stage.

Muscular dystrophy is characterized by what pathophysiologic changes?

Muscular necrosis, with replacement with fat and connective tissue Rationale: Insidious muscular necrosis followed by replacement of muscle tissue with fat and connective tissues leads to muscular weakness in muscular dystrophy. Myasthenia gravis is characterized by loss of acetylcholine receptors. Carpal tunnel syndrome is caused by compression mononeuropathy. Guillain Barré is caused by an acute immune-related polyneuropathy.

Disorders of the pyramidal tracts, such as a stroke, are characterized by which physical finding? You Selected:

Paralysis Rationale: Disorders of the pyramidal tracts (e.g., stroke) are characterized by spasticity and paralysis, whereas those affecting the extrapyramidal tracts (e.g., Parkinson disease) are characterized by involuntary movements, muscle rigidity, and immobility without paralysis. Hypotonia is a condition of less-than-normal muscle tone. Hypertonia or spasticity is a condition of excessive tone. Paralysis refers to a loss of muscle movement. Upper motor neuron (UMN) lesions produce spastic paralysis and lower motor neuron (LMN) lesions flaccid paralysis.

What disease results from the degeneration of the dopamine nigrostriatal system of the basal ganglia?

Parkinson disease Rationale: The aminoglycoside antibiotics (e.g., gentamicin) may produce a clinical disturbance similar to botulism by preventing the release of acetylcholine from nerve endings. These drugs are particularly dangerous in persons with preexisting disturbances of neuromuscular transmission, such as myasthenia gravis.

Multiple sclerosis is characterized by what type of neuron damage?

Polyneuropathy Rationale: MS is classified as a polyneuropathy due to many nerves being affected by the disease, involving demyelination of peripheral nerves.

Which treatment should take place immediately in a client experiencing autonomic dysreflexia?

Position the client in upright position, and correct the initiating stimulus. Rationale: Position the client in upright position, and correct the initiating stimulus.

Following peripheral blood testing and a bone marrow biopsy, a client has been diagnosed with chronic myelogenous leukemia. Which abnormality is most likely to have preceded the client's diagnosis?

Presence of a Philadelphia chromosome rationalization: Chronic myelogenous leukemia develops when a single, pluripotent hematopoietic stem cell acquires a Philadelphia chromosome. Down syndrome and radiation exposure are associated with acute leukemias, and exposure to the Epstein-Barr virus is not implicated in the etiology of leukemias.

Which complication of spinal cord injury is the most preventable in a paraplegic client?

Skin breakdown

When testing nociceptive stimuli to elicit a withdrawal reflex in the body, what stimuli are commonly used?

Pressure from a sharp object Rationale: Stimuli used to elicit a withdrawal reflex include pressure from a sharp object, strong electric current to the skin, or application of heat or cold of approximately 10°C above or below normal skin temperature.

A client has a mild headache and fatigue. He also states he has some aches and pains. Which stage of fever does the nurse determine the client is experiencing?

Prodrome Rationale: During the first or prodromal period there are nonspecific complaints such as mild headache and fatigue, general malaise, and fleeting aches and pains.

The parent of a toddler with Duchenne muscular dystrophy reports that the child has an increase in muscle size but a decrease in strength. The nurse documents this using which medical term?

Pseudohypertrophy Rationale: Pseudohypertrophy, as occurs with Duchenne muscular dystrophy (DMD), refers to an increase in bulk without an accompanying increase in strength.

A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which cause can best explain this?

Psychological manifestation due to involvement of white matter of cerebral cortex Rationale: Involvement of the cerebral cortex can lead to a variety of mood and cognitive disruptions.

Reflex activity involves which neurons?

Rationale: Afferent neurons synapse with efferent neurons directly, innervating a muscle, or with an interneuron that synapses with an effector neuron.

Nystagmus due to cerebellar dysfunction would most likely interfere with which activity?

Reading Rationale: Conjugate readjustment of eye position due to cerebellar damage can make reading very difficult.

The nurse needs to assess a 1-year-old child for fever. Which approach will produce the most accurate reading?

Rectal Rationale: Measurement of core body temperature is important when evaluating fever. The rectal route is considered the most accurate. In adults and older children, the oral route is lower, but still accurate; however, in young children the oral route may be unreliable. Forehead thermometers can predict trends, but are not as accurate as other routes. The axillary route requires up to 10 minutes for the temperature to register appropriately.

A client with a diagnosis of myasthenia gravis underwent a mastectomy. The surgery was a success, but the client has gone into a myasthenic crisis on postoperative day 1. Which priority measure should the care team initiate immediately?

Respiratory support and protection of the client's airway Rationale: Myasthenic crisis occurs when muscle weakness becomes severe enough to compromise ventilation to the extent that ventilatory support and airway protection are needed. Seizures, dyskinesias, hypertonia, and muscle rigidity are not associated with myasthenia gravis in general or myasthenic crisis in particular.

A client reports "the worst headache" of her life with associated blurred vision. Subsequent diagnostic testing has resulted in a diagnosis of an intra-axial brain tumor. What other clinical manifestations would be consistent with this diagnosis? Select all that apply.

Seizure activity, Cognitive and personality changes, Nausea and vomiting Rationale: The clinical manifestations of brain tumors depend on the size and location of the tumor. General signs and symptoms include headache, nausea, vomiting, mental changes, papilledema, visual disturbances (e.g., diplopia), alterations in sensory and motor function, and seizures. Tinnitus, ear pain, and epistaxis are not among the more common signs and symptoms of a brain tumor.

When talking to a group of homeless women living in a shelter, the nurse should educate about risk for developing tuberculosis. The nurse should emphasize which lab/diagnostic test as considered to be the "gold" standard for diagnosing tuberculosis?

Sputum or bronchial cultures Rationale: A definitive diagnosis of active pulmonary tuberculosis requires identification of the organism from cultures or DNA amplification techniques. CT scans help determine the extent of lung involvement. CBC and CD4+ T-cell testing will show extent of body's response to the infection and if antigens are activated.

The nurse taking a report on a client coming into the emergency room plans care for a client with brain dysfunction based on which symptom?

Stupor Rationale: The most frequent sign of brain dysfunction is an altered level of consciousness such as stupor. Pupils that react to light, wheezing, and chest pain are not symptoms of brain function.

A client with newly diagnosed squamous cell carcinoma of the lung asks, "So how do we treat this cancer?" Which response from the health care provider is most accurate? Select all that apply.

Surgery to remove tumor Radiation therapy Chemotherapy Rationale: Although all forms of lung cancer are serious and potentially fatal diagnoses, individuals with small cell lung cancer, adenocarcinoma, and large cell lung cancer often face prognoses that are worse than those associated with squamous cell lung cancer. Treatment methods for NSCLC include surgery, radiation therapy, and systemic chemotherapy. These treatments may be used singly or in combination. Stem cell transplant is not utilized in lung cancer. New trials are exploring the use of monoclonal antibodies but have not been approved by the Food and Drug Administration (FDA) at this time.

Which client is most likely to be susceptible to developing a neurogenic fever?

Sustained a head injury in a bicycle crash Rationale: Neurogenic fever is the result of damage to the hypothalamus caused by central nervous system trauma, intracerebral bleeding, or an increase in intracranial pressure. All these problems may be precipitated by a head injury. Alzheimer disease and drug administration are not typical causes of a neurogenic fever.

The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to nonpharmacologic therapy?

Tension Rationale: Tension-type headaches often are more responsive to nonpharmacologic techniques, such as biofeedback, massage, acupuncture, relaxation, imagery, and physical therapy, than other types of headache. For people with poor posture, a combination of range-of-motion exercises, relaxation, and posture improvement may be helpful. The other options are usually best treated with medications that focus on the cause of the pain.

The nurse is explaining to a client's family how vasogenic brain edema occurs. The most appropriate information for the nurse to provide would be:

The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid. Rationale: Vasogenic brain edema occurs with conditions that impair the function of the blood-brain barrier and allow the transfer of water and protein from the vascular space into the interstitial space. Increased production of CSF and decreased absorption result in hydrocephalus. It occurs in conditions such as hemorrhage, brain injury, and infectious processes.

A client comes to the clinic and informs the nurse that he believes he is suffering from Parkinson disease. What objective data assessed by the nurse would correlate with the client's concern? Select all that apply.

Tremor Rigidity Bradykinesia Rationale: The cardinal manifestations of Parkinson disease are tremor, rigidity, and bradykinesia (slowness of movement). Tremor is the most visible manifestation of the disorder. The tremor affects the distal segments of the limbs, mainly the hands and feet; head, neck, face, lips, and tongue; or jaw.

Which pain disorder is a manifestation of a disruption of cranial nerve function?

Trigeminal neuralgia Rationale: Trigeminal neuralgia is manifested by facial tics or spasms and characterized by paroxysmal attacks of stabbing pain that usually are limited to the unilateral sensory distribution of one or more branches of the trigeminal cranial nerve (CN V). Cranial nerve involvement is not implicated in postherpetic neuralgia, phantom limb pain, or TMJ syndrome.

Which characteristic differentiates a migraine with aura from a migraine without aura?

Visual symptoms such as flickering lights precede the headache Rationale: An aura is visual (flickering lights, spots, or loss of vision), sensory (feeling of pins and needles, or numbness), and/or speech disturbance that precedes a migraine. Nonpharmacologic treatments may be used with varying success in both types of migraine, and nausea and vomiting may precede or accompany each. Changes in mood and affect are not central to an aura.

A surgical client is at greatest risk for hypothermia during a surgical procedure related to:

impaired thermoregulatory mechanisms brought on by anesthesia Rationale: A surgical client has a higher risk of hypothermia related to impaired thermoregulatory mechanisms brought on by anesthesia and other drugs. The instillation of warmed intravenous fluids is used to increase the core temperature, not lower it. The remaining options related to room temperature and the regulation of body temperature are not relevant.

A client with laryngeal dystonia has gotten to the point that people on the telephone cannot understand her. She has heard about getting Botox injections into her vocal cords. The nurse will teach about the actions of Botox. What is the most accurate description? This drug:

produces paralysis of the larynx muscles by blocking acetylcholine release. Rationale: Pharmacologic preparations of the botulinum toxin (botulinum type A toxin [Botox] and botulinum type B toxin [Myobloc]) produce paralysis by blocking acetylcholine release. Glucocorticoids are the only medication currently available to slow the decline in muscle strength and function in DMD. Curare acts on the postjunctional membrane of the motor endplate to prevent the depolarizing effect of the neurotransmitter. Neuromuscular transmission is blocked by curare-type drugs during many types of surgical procedures to facilitate relaxation of involved musculature. Levodopa, a dopamine agonist used in Parkinson disease, is administered with carbidopa, which inhibits its peripheral metabolism, allowing therapeutic concentrations of the drug to enter the brain without disabling adverse effects.

A client is experiencing a cluster headache. The client would most likely manifest:

severe pain behind the eye. Rationale: Symptoms of cluster headache include severe, unrelenting unilateral pain located in the orbital area. The pain radiates behind the eye to the ipsilateral trigeminal nerve. The client may also experience symptoms such as restlessness or agitation, conjunctival redness, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, and eyelid edema. The other options are associated with migraine headache.