Quiz 2

Which condition would alert the nurse of the need to use beta-adrenergic blockers cautiously? a. Hypertension b. Raynaud's phenomenon c. Emphysema d. Cardiac dysrhythmias

c. Emphysema

Following a myelogram the nurse should include in the postprocedure care assessment for: a. elevation of blood pressure. b. urine retention. c. sensation in lower extremities. d. slurred speech.

c. sensation in lower extremities.

What is a possible effect of administering beta blockers to the patient in the scenario with a known respiratory disease such as asthma? a) Hyperglycemia b) Hypertension c) Bronchodilation d) Bronchoconstriction

d) Bronchoconstriction

What is the primary response to alpha 1 receptor stimulation?

Vasoconstriction (of blood vessels)

Neurotransmitter(s) include: (Select all that apply.) a. gamma aminobutyric acid. b. acetylcholine. c. serotonin e. Histamine. f. Epinephrine

a. gamma aminobutyric acid. b. acetylcholine. c. serotonin e. Histamine. f. Epinephrine

Stimulation of the adrenergic receptors causes the smooth muscle. of the bronchial tree to relax, which results in what effect? a) Stridor b) Wheezing c) Bronchodilation d) Bronchoconstriction

c) Bronchodilation

Math: doctor order: 1.5 mg on hand 0.25 mg/ml

6ML

Doctor orders: 400 mg on hand: 200 mg tabs

2 tablets

Prior to the administration of metoprolol, a beta-adrenergic blocking agent, which is most important for the nurse to assess? a. Blood pressure b. Lung sounds c. Mental status d. Urine output

ANS: A- Blood pressure

What are the major types of receptors found in the autonomic nervous system? Select all that apply a) Alpha b) Beta c) Dopaminergic d) Gamma e) Delta

a) Alpha b) Beta c) Dopaminergic

The PNS is further subdivided into the somatic nervous system that controls voluntary movement and which other system? a) The vascular system b) The endocrine system c) The autonomic nervous system d) The system of neurotransmitters

c) The autonomic nervous system

Doctor order: 5mg on hand: 10mg/ml

0.5 ML

What is the drug of choice when treating a generalized tonic-clonic seizure? a. Diazepam (Valium) b. Haloperidol (Haldol) c. Valproic acid (Depakene) d. Risperidone (Risperdal)

ANS-C Valproic acid (Depakene)

The nurse is aware that the drug t-PA (Activase), a tissue plasminogen activator, must be given in____hours of the onset of symptoms to have maximum benefit. a. 3 hours b. 4 hours c. 6 hours d. 8 hours

ANS: A- 3 HOURS t-PA must be given within 3 hours of the onset of symptoms to be beneficial.

When a patient taking a monoamine oxidase B inhibitor receives his dietary tray, the nurse knows to remove the: a. cheese. b. eggs. c. bread. d. coffee

ANS: A CHEESE Patients taking monoamine oxidase B inhibitors should avoid food and beverages with a high tyramine content, such as cheeses. Eggs, bread, and coffee do not have a high tyramine content

The nurse is preparing to begin administration of apomorphine to a patient. Before administering, the nurse will perform a baseline assessment of the patient's: (Select all that apply.) a. mobility. b. orientation. c. intellectual ability. d. alertness. e. vital signs

ANS: A, B, D, E a. mobility. b. orientation.. d. alertness. e. vital signs

Which foods should the person who suffers from migraine headaches avoid? (Select all that apply.) a. Yogurt b. Caffeine c. Beef d. Pears e. Marinated foods f. Milk

ANS: A, B, E Some foods may cause or worsen headaches. Foods that may provoke headaches include vinegar, chocolate, yogurt, alcohol, fermented or marinated foods, ripened cheese, cured sandwich meat, caffeine, and pork.

The newly admitted patient to the emergency room 30 minutes ago after a fall off a ladder has gradually decreased in consciousness and has slowly reacting pupils, a widening pulse pressure, and verbal responses that are slow and unintelligible. What is the most appropriate position for the patient? a. Neck placed in a neutral position b. Head raised slightly with hips flexed c. Supine in gravity neutral position d. Turn on right side with head elevated

ANS: A- Neck placed in a neutral position Place the neck in a neutral position (not flexed or extended) to promote venous drainage.

What is the rationale for administering levodopa instead of dopamine for treatment of Parkinson's disease? a. Dopamine does not cross the blood-brain barrier when administered orally. b. Levodopa is much less expensive. c. The half-life of dopamine is too short. d. Dopamine has too many reactions with other medications.

ANS: A-Dopamine does not cross the blood-brain barrier when administered orally.

What should the nurse do when the child arrives on the floor with the diagnosis of bacterial meningitis? a. Arrange for humidified oxygen per mask b. Place the child in respiratory isolation c. Inquire about drug allergy d. Hold NPO until orders arrive

ANS: B Persons with bacterial meningitis are placed in respiratory isolation until the pathogen can no longer be cultured, usually 24 hours.

The nurse explains that the two divisions of the autonomic nervous system work to maintain homeostasis. Place in order the autonomic events. (Separate letters by a comma and space as follows: A, B, C, D) a. Parasympathetic nervous system dominates b. Extremely stressful or frightening event c. Blood pressure, heart rate, and adrenaline output decrease d. Sympathetic nervous system dominates e. Heart rate and blood pressure rise, secretion of adrenaline

ANS: B, D, E, A, C [B-Extremely stressful or frightening event] In the event of a frightening event, the sympathetic nervous system dominates and increases the blood pressure, heart rate, and adrenaline output in the fight or flight mechanism. The body is calmed by the parasympathetic nervous system dominating and reducing the heart rate, blood pressure, and adrenaline output.

What are the effects of normal aging on the nervous system? (Select all that apply.) a. Small vessel occlusion b. Loss of neurons c. Calcification of cerebrum d. Reduction of cerebral blood flow e. Lipofuscin f. Decrease in oxygen use

ANS: B, D, E, F As the person ages, normal age-related changes occur such as loss of neurons, reduction of cerebral blood flow, appearance of lipofuscin, a decrease in oxygen use and brain metabolism, and a decline in velocity of nerve impulses.

A patient is in which stage of Alzheimer disease when she demonstrates sundowning? a. Early stage b. Second stage c. Third stage d. Final stage

ANS: B- 2ND STAGE Sundowning is seen in the AD patient in the second stage of the disease.

Which vitamin will reduce the therapeutic effects of levodopa? a. A b. B6 c. C d. D

ANS: B- B6 (Pyridoxine (vitamin B6) will reduce the therapeutic effects of levodopa in oral doses of 5 to 10 mg or more. Generally, diets typically have less than 1 mg of vitamin B6 and therefore are not restricted. The ingredients in multivitamins, however, must be assessed. Vitamins A, C, and D do not affect therapy with levodopa.

What are the two divisions of the nervous system? a. Somatic and the autonomicterm b. Cerebellum and the brainstem c. Medulla oblongata and the diencephalon d. Central and the peripheral

ANS: D- CENTRAL & THE PERIPHERAL The central and the peripheral are the two divisions of the nervous system. The autonomic and the somatic are the division of the peripheral nervous system.

A patient has recently suffered a stroke with left-sided weakness and has problems with choking, especially when drinking thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely? a. Use a straw b. Tuck chin when swallowing c. Take a sip of liquid with each bite d. Turn head to the left

ANS: B- Tuck chin when swallowing The patient should sit at a 90-degree angle with the head up and chin slightly tucked.

The nurse is aware that the characteristic gait of the person with Parkinson disease is a propulsive gait, which causes the patient to: a. stagger and need support of a walker. b. shuffle with arms flexed. c. fall over to one wide when walking. d. take small steps balanced on the toes.

ANS: B- shuffle with arms flexed. The propulsive gait causes the patient to shuffle with his arms flexed and with a loss of postural reflexes.

How would a nurse record the behavior when a patient with Alzheimer disease attempts to eat using a napkin rather than a fork? a. Apraxia b. Agnosia c. Aphasia d. Dysphagia

ANS: B-AGNOSIA Agnosia is a total or partial loss of the ability to recognize familiar objects or people through sensory stimuli as a result of organic brain damag

What is the basic problem that prompts most of the early signs of Alzheimer disease? a. Changes in mood b. Misplacing things c. Memory loss that disrupts daily life d. Problems with words in speaking

ANS: C Memory loss that disrupts daily life is the basic problem that prompts most of the early signs of AD.

Which cholinergic symptoms of Parkinson's disease are reduced with anticholinergic drugs? a. Cognitive impairments b. Rigidity c. Tremors and drooling d. Postural abnormalities

ANS: C- (Anticholinergic drugs will reduce the severity of tremors and drooling in patients with Parkinson's disease. Anticholinergics are most useful when used in combination with levodopa. Anticholinergic drugs do not affect cognitive impairments. Anticholinergics have little effect on rigidity or on postural abnormalities.)

A patient taking rasagiline is assessed by the nurse to have a lasting significant increase in blood pressure. When reviewing the patient's current list of medications, the nurse decides to hold the next dose of a. dextromethorphan. b. levodopa. c. ciprofloxacin. d. Valium.

ANS: C- (Ciprofloxacin is an antibiotic that inhibits the metabolism of rasagiline, significantly raising rasagiline serum levels and potentially causing significant hypertension. Dextromethorphan, levodopa, and Valium are not related to significant hypertensive changes when used in conjunction with rasagiline.)

The autonomic nervous system can be subdivided into which types of adrenergic receptors? a. Nicotinic and muscarinic b. Afferent and efferent c. Alpha and beta d. Agonists and antagonists

ANS: C- Alpha and beta

Which question is likely to elicit the most valid response from the patient who is being interviewed about a neurologic problem? a. Do you have any sensations of pins and needles in your feet? b. Does the pain radiate from your back into your legs? c. Can you describe the sensations you are having? d. Do you ever have any nausea or dizziness?

ANS: C- Can you describe the sensations you are having? For patients with suspected neurologic conditions, the presence of many symptoms or subjective data may be significant. Offering leading questions is not beneficial and may allow the patient to give misinformation. Questions should be specific about symptoms.

what is the pharm action of entacapone, a potent catechol O methyl transferase (COMT) inhibitor? a. Slows the deterioration of dopaminergic nerve cells b. Inhibits the relative excess of dopaminergic activity c. Reduces the destruction of dopamine in peripheral tissues d. Enhances the cholinergic symptoms of Parkinson's disease

ANS: C-Reduces the destruction of dopamine in peripheral tissues (Entacapone, a COMT inhibitor, reduces dopamine destruction in peripheral tissues. This significantly increases the amount of dopamine available to reach the brain. Entacapone, when used with carbidopa levodopa therapy, results in more constant dopaminergic stimulation. Entacapone is not effective when used alone. Entacapone does not affect the nerve cells but blocks enzymes that break down levodopa. Parkinson's disease is characterized by a relative deficit of dopaminergic activity. Entacapone does not affect cholinergic symptoms of Parkinson's disease.)

Which category of medications is used for peripheral vascular diseases characterized by excessive vasoconstriction, such as Raynauds disease?

Alpha adrenergic blocking agents

What Glasgow Coma Scale rating would a patient receive who opens the eyes spontaneously, but has incomprehensible speech and obeys commands for movement? a. 8 b. 10 c. 11 d. 12

ANS: D- 12 The Glasgow coma scale was developed in 1974, and it consists of three parts of the neurologic assessment: eye opening, best motor response, and best verbal response. This patient gets a 4 for eye opening, a 2 for incomprehensible speech, and a 6 for moving on demand.

What does the nurse know about the stroke patient who has expressive aphasia? a. Has difficulty comprehending spoken and written communication b. Cannot make any vocal sounds c. Has total loss and comprehension of language d. Can understand the spoken word, but cannot speak

ANS: D- Can understand the spoken word, but cannot speak The patient with expressive aphasia has difficulty articulating words, but can understand the written and spoken word.

What is the cardinal sign of increased intracranial pressure in a brain injured patient? a. Pupil changes b. Ipsilateral paralysis c. Vomiting d. Decrease in the level of consciousness

ANS: D- DECREASE IN LEVEL OF CONSCIOUSNESS For patients with suspected neurologic conditions, the presence of many symptoms or subjective data may be significant. Offering leading questions is not beneficial and may allow the patient to give misinformation. Questions should be specific about symptoms.

Which nerve endings liberate norepinephrine?

Adrenergic

Which body function(s) is/are controlled by the autonomic nervous system? (Select all that apply.)

Blood pressure GI secretion Body temperature Urination

_________________ is/are responsible for the transmission of impulses between synapses

Neurotransmitters (acetylcholine, norepinephrine, dopamine, and serotonin) function to conduct transmission between the synapses.

Which statement(s) is/are true about efferent nerves? (Select all that apply.)

They leave the CNS to carry impulses to other body parts.They are part of the peripheral nervous system.They transmit signals that control contractions of smooth and skeletal muscle.They transmit signals that control contractions of some glandular secretions

Which of the following techniques are necessary for safely feeding a hemiplegic patient? (Select all that apply.) a. Mixing liquids and solid foods together b. Taking the patient's dentures out to prevent choking c. Checking the affected side of mouth for food accumulation d. Offering small bites of food e. Elevating the patient to no more than 30 degrees f. Adding a thickening agent to liquids

ANS: - C-Checking the affected side of mouth for food accumulation, D-Offering small bites of food, F-Adding a thickening agents to liquids

The nurse is aware that when assessing a patient by the FOUR score coma scale, the patient is assessed in four categories: eye response, brainstem reflexes, motor response, and respiration. How are these results reported? a. As a sum of the scores of the four categories b. As part of the Glasgow coma scale c. As individual scores in each category d. As progressive scores during a 24-hour period

ANS: C- As individual scores in each category The FOUR score coma scale assesses the patient in four categories: eye response, brainstem reflexes, motor response, and respiration. The scores are reported as individual scores in each category. It is frequently done in conjunction with the Glasgow coma scale, not part of it.

The newly admitted patient to the emergency room after a motorcycle accident has serosanguineous drainage coming from the nose. What is the most appropriate nursing response to this assessment? a. Cleanse nose with a soft cotton-tipped swab b. Gently suction the nasal cavity c. Gently wipe nose with absorbent gauze d. Ask patient to blow his nose

ANS: C-Gently wipe nose with absorbent gauze The patients ear and nose are checked carefully for signs of blood and serous drainage, which indicate that the meninges are torn and spinal fluid is escaping. No attempt should be made to clean out the orifice or to blow the nose. The drainage can be wiped away. The drainage can be tested for the presence of glucose, which would confirm that the fluid is spinal fluid and not mucus.

How would the nurse instruct a patient with Parkinson disease to improve activity level? a. To use a soft mattress to relax the spine b. To walk with a shuffling gait to avoid tripping c. To walk with hands clasped behind back to help balance d. To sit in hard chair with arms for posture control

ANS: C-To walk with hands clasped behind back to help balance The patient with Parkinson disease can improve the activity level by sleeping on a firm mattress without a pillow to prevent spinal curvature, hold hands clasped behind to keep better balance, and keep the arms from hanging stiffly at the side. Walk with a lifting of the feet to avoid tripping and freezing.

What is the cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and also carries motor fibers to glands that produce digestive juices and other secretions? a. Somatic motor nerve b. Visceral sensory nerve c. Abducens nerve d. Vagus nerve

ANS: D- VAGUS NERVE [ CRANIAL NERVE X ] The vagus nerve extends from the throat, larynx, and organs in the thoracic and abdominal cavities. It is responsible for sensations and will accelerate peristalsis when stimulated.

Cholinergic fibers are those nerve endings that secrete which neurotransmitter? a) Histamine b) Acetylcholine c) Dopamine d) Norepinephrine

ANS: D-Norepinephrine

The nurse is caring for a home health patient who had a spinal cord injury at C5 three years ago. The nurse bases the plan of care on the knowledge that the patient will be able to: a. feed self with setup and adaptive equipment. b. transfer self to wheelchair. c. stand erect with full leg braces. d. sit with good balance.

ANS: A- feed self with setup and adaptive equipment. A cord injury at C5 allows for ability to drive an electric wheelchair with mobile hand supports and feed self with adaptive equipment.

What is the first sign of Bells palsy? a. Inability to wrinkle forehead and pucker lips on affected side b. Sudden pain in nostril on affected side c. Excessive salivation on the affected side d. Excessive mucus running from nostril on affected side

ANS: A-Inability to wrinkle forehead and pucker lips on affected side Unilateral weakness of the facial muscles usually occurs, resulting in a flaccidity of the affected side of the face with inability to wrinkle the forehead, close the eyelid, pucker the lips, smile, frown, whistle, or retract the mouth on that side. The face appears asymmetric.

The nurse is providing information to a patient recently prescribed entacapone. Which statement is correct? a. This medication is not to be taken with carbidopa levodopa. b. Dosage is adjusted according to the patient's response. c. There will be fewer incidences of dopaminergic effects, such as confusion. d. This medication increases the production of dopamine in the brain

ANS: B-. Dosage is adjusted according to the patient's response.

Which adverse effects associated with levodopa therapy would support the nursing diagnosis risk for injury? a. Nausea and vomiting b. Orthostatic hypotension c. Anorexia and depression d. Tachycardia and palpitations

ANS: B-Orthostatic hypotension (When initiating levodopa therapy, orthostatic hypotension may occur. Although generally mild, patients may experience dizziness and weakness. Symptoms usually resolve within 1 or 2 weeks once tolerance is developed to the levodopa therapy. Orthostatic hypotension increases the risk for injury in Parkinson's patients because they are also experiencing alterations in gait patterns. Although nausea, vomiting, anorexia, and depression are adverse effects of levodopa, they do not contribute to a risk for falling. Tachycardia and palpitations are not common adverse effects of levodopa.

A patient with Parkinson's disease asks the nurse why anticholinergics are used in the treatment. Which response by the nurse is most accurate? a. "These drugs help you urinate." b. "These drugs will decrease your eye pressure." c. "These drugs inhibit the action of acetylcholine." d. "These drugs will assist in lowering your heart rate."

ANS:C-"These drugs inhibit the action of acetylcholine."

What primary function is controlled by the somatic nervous system? a) Skeletal muscle contractions b) Secretion of enzymes into the digestive system c) Involuntary contraction of the digestive system d) Transmission of neuronal impulses within the synaptic junctions

ANS; A- Skeletal muscle contractions

What are the 2 major neurotransmitters of the autonomic nervous system? a) Norepinephrine and acetylcholine b) Epinephrine and acetylcholine c) Epinephrine and dopamine d) Norepinephrine and epinephrine

ANS; A-Norepinephrine and acetylcholine

Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition? a. Hypertension b. Infectious diseases c. Diabetes d. Closed-angle glaucoma

ANS; D-Closed-angle glaucoma

A family member of a patient who has just suffered a tonic-clonic seizure is concerned about the patients deep sleep. What is this behavior called? a. Convalescent period b. Neural recovery period c. Sombulant period d. Postictal period

ANS: D-Postictal period Seizures are followed by a rest period of variable length, called a postictal period.

Why are the drugs neostigmine (Prostigmin) and pyridostigmine (Mestinon) helpful to the person with myasthenia gravis? a. Improves speech b. Improves visual disturbances c. Reduces pain d. Promotes nerve impulse transmission

ANS: D-Promotes nerve impulse transmission Prostigmine and Mestinon improve the nerve impulses and alleviate the symptoms.

The nurse is caring for a patient taking a cholinergic agent. When auscultating lung sounds, the nurse notes inspiratory and expiratory wheezing bilaterally. The best action for the nurse to take would be to a. provide the next dose of the cholinergic agent immediately. b. assess heart rate and blood pressure. c. reposition the patient. d. withhold the next dose and notify the physician.

ANS: D-withhold the next dose and notify the physician.

Which instruction(s) given by the nurse will assist a patient to cope with the common adverse effects of anticholinergic medications? (Select all that apply.) a. "Take the medication with meals." b. "Increase fluids daily." c. "Decrease fiber in the diet." d. "Suck on candy or ice chips." e. "Monitor blood glucose."

ANS: (B,D) b. "Increase fluids daily.", d. "Suck on candy or ice chips."

Which symptom is specific to migraine headaches? a. Tachycardia b. They become worse in the evening c. They involve the entire head d. They are preceded by an aura

ANS: D- They are preceded by an aura Migraine headaches are unusual in that signs and symptoms occur before the acute attack

What is the nurse aware of when assessing a person with a craniocerebral injury? a. Most injuries of this type are irreversible b. Open injuries are always more serious than closed injuries c. Signs and symptoms may not occur until several days after the trauma d. Trauma to the frontal lobe is more significant than to any other area

ANS: C-Signs and symptoms may not occur until several days after the trauma If a patient who has been conscious for several days after head injury loses consciousness or develops neurologic signs and symptoms, a subdural hematoma should be suspected.

Dopamine agonists have been linked with which adverse effects in patients with Parkinson's disease? a. Oculogyric crisis b. Tardive dyskinesia c. Sudden sleep events d. Akathisia

ANS: C-Sudden sleep events Sleep episodes have been reported with the dopamine agonists bromocriptine, pergolide, pramipexole, and ropinirole. These are described as "sleep attacks," including daytime sleep. Oculogyric crisis is an adverse effect of neuroleptic drugs such as phenothiazines

Why is the patient with suspected Guillain-Barre Syndrome (GBS) hospitalized immediately? a. The infection needs to be treated with IV antibiotics to prevent paralysis b. The brain may swell quickly causing seizures c. The disease can rapidly progress into respiratory failure d. IV hydration is needed to prevent possible fatal hypotension

ANS: C-The disease can rapidly progress into respiratory failure Hospitalization is necessary for GBS patients because the disease progresses very quickly and respiratory failure may occur.

What is the nurse assessing when asking the patient, Who is the president of the United States? during a level of consciousness assessment? a. Orientation b. Memory c. Calculation d. Fund of knowledge

ANS: D- FUND OF KNOWLEDGE (worded different on the exam) Fund of knowledge is tested by questions such as Who is the president? or asking about current events.

A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned with respect to this diagnostic test? a. Obtain an allergy history before the test. b. Ambulate the patient when returned to the room after the test. c. Use heated blanket to keep patient warm after procedure. d. Keep NPO for 6 to 8 hours after the test.

ANS: A- Obtain an allergy history before the test.