Chapter 40: Caring for Clients with Neurologic Deficits

A client with herpes simplex virus encephalitis (HSV) has been admitted to the ICU. What medication would the nurse expect the health care provider to order for the treatment of this disease process?

Acyclovir

A 33-year-old client presents at the clinic with reports of weakness, incoordination, dizziness, and loss of balance. The client is hospitalized and diagnosed with MS. What sign or symptom, revealed during the initial assessment, is typical of MS?

Blurred vision, intention tremor, and urinary hesitancy

A 25-year-old female client with brain metastases is considering her life expectancy after her most recent meeting with her oncologist. Based on the fact that the client is not receiving treatment for her brain metastases, what is the nurse's most appropriate action?

Ensuring that the client receives adequate palliative care

The nurse is caring for a boy who has muscular dystrophy. When planning assistance with the client's ADLs, what goal should the nurse prioritize?

Maximizing the client's level of function

Which 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?

Multiple sclerosis

A client with MS has developed dysphagia as a result of cranial nerve dysfunction. What nursing action should the nurse consequently perform?

Position the client upright during feeding.

The primary arthropod vector in North America that transmits encephalitis is the

mosquito.

A male client presents at the free clinic with reports of erectile dysfunction. Upon physical examination, the nurse practitioner notes the presence of hypogonadism. What diagnosis should the nurse suspect?

Prolactinoma

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?

Trigeminal neuralgia

The nurse is providing postoperative care for a client who just underwent surgery to remove a metastatic intramedullary tumor. On postoperative day 3, the client states, "I am really looking forward to going running again, it had become too difficult because of the loss of feeling in my feet." Which should the nurse address in the client's care plan?

Knowledge deficit

A client with possible bacterial meningitis is admitted to the ICU. What assessment finding would the nurse expect for a client with this diagnosis?

Neck flexion produces flexion of knees and hips

A client with suspected Parkinson disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor?

When the client is resting

While caring for clients who have suffered neurologic deficits from causes such as cerebrovascular accident and closed head injury, an important nursing goal that motivate nurses to offer the best care possible is preventing:

complications.

The nurse is caring for a patient with Huntington's disease in the long-term care facility. What does the nurse recognize as the most prominent symptom of the disease that the patient exhibits?

Rapid, jerky, involuntary movements

Following a traumatic brain injury, a client has been in a coma for several days. Which of the following statements is true of this client's current LOC?

The client may occasionally make nonpurposeful movements.

The nurse is caring for a client newly diagnosed with a primary brain tumor. The client asks the nurse where the tumor came from. What would be the nurse's best response?

"Your tumor originated from cells within your brain itself."

A client, diagnosed with cancer of the lung, has just been told he has metastases to the brain. What change in health status would the nurse attribute to the client's metastatic brain disease?

Personality changes

The nurse is caring for a client with Huntington disease who has been admitted to the hospital for treatment of malnutrition. What independent nursing action should be implemented in the client's plan of care?

Apply deep, gentle pressure around the client's mouth to aid swallowing.

A client, brought to the clinic by his wife and son, is diagnosed with Huntington disease. When providing anticipatory guidance, the nurse should address the future possibility of what effect of Huntington disease?

Emotional and personality changes

A client is diagnosed with a brain angioma. When teaching the client about the risks associated with this type of brain tumor, the nurse would educate about signs and symptoms associated with which condition?

Hemorrhagic stroke

The nurse is caring for a client with multiple sclerosis (MS). The client tells the nurse the hardest thing to deal with is the fatigue. When teaching the client how to reduce fatigue, what action should the nurse suggest?

Resting in an air-conditioned room whenever possible

A client with Parkinson disease is undergoing a swallowing assessment because she has recently developed adventitious lung sounds. The client's nutritional needs should be met by what method?

Semisolid food with thick liquids

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?

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

A client diagnosed with myasthenia gravis has been hospitalized to receive therapeutic plasma exchange (TPE) for a myasthenic exacerbation. The nurse should anticipate what therapeutic response?

Symptom improvement that lasts a few weeks after TPE ceases

A client with Guillain-Barré syndrome has experienced a sharp decline in vital capacity. What is the nurse's most appropriate action?

Prepare to assist with intubation.

During the recovery phase of a neurologic deficit, assessment tools may be used to help identify a client's level of functioning. Which tool is used to measure performance in activities of daily living (ADL)?

The Barthel Index

The nurse is caring for a client diagnosed with Parkinson disease. The client is having increasing problems with rising from the sitting to the standing position. What should the nurse suggest to the client to use that will aid in getting from the sitting to the standing position as well as aid in improving bowel elimination?

Use of a raised toilet seat

The nurse caring for a client diagnosed with Guillain-Barré syndrome is planning care with regard to the clinical manifestations associated this syndrome. The nurse's communication with the client should reflect the possibility of what sign or symptom of the disease?

Vocal paralysis

A nurse in a rehabilitation facility is coordinating the discharge of a client who is tetraplegic. The client, who is married and has two children in high school, is being discharged to home and will require much assistance. Who would the discharge planner recognize as being the most important member of this client's care team?

spouse

A critically ill client is being treated for signs and symptoms of altered level of consciousness (LOC), hypertension, fever, and difficulty in breathing. Identify the phase of neurologic deficit that the client is experiencing.

acute

Clients who have suffered neurologic deficits from various causes, including cerebrovascular accident, closed head injury, etc., have all experienced which phase of neurologic deficit?

acute

An older adult has encouraged her husband to visit their primary provider, stating that she is concerned that he may have Parkinson disease. Which of the wife's descriptions of her husband's health and function is most suggestive of Parkinson disease?

"Lately he seems to move far more slowly than he ever has in the past."

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?

Relapsing-remitting (RR)

A client diagnosed with MS has been admitted to the medical unit for treatment of an MS exacerbation. Included in the admission orders is baclofen. What should the nurse identify as an expected outcome of this treatment?

Decreased muscle spasms in the lower extremities

A client is being admitted to the neurologic ICU with suspected herpes simplex virus encephalitis. What nursing action best addresses the client's complaints of headache?

Dimming the lights and reducing stimulation

The clinic nurse is caring for a client with a recent diagnosis of myasthenia gravis. The client has begun treatment with pyridostigmine bromide. What change in status would most clearly suggest a therapeutic benefit of this medication?

Increased muscle strength

The nurse cares for a client with Huntington disease. What intervention is a priority for safe care?

Protecting the client from falls

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?

Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes.

The nurse caring for a client in ICU diagnosed with Guillain-Barré syndrome should prioritize monitoring for what potential complication?

Autonomic dysfunction

The nurse is discharging a client home after surgery for trigeminal neuralgia. What advice should the nurse provide to this client in order to reduce the risk of injury?

Avoid rubbing the eye on the affected side of the face.

A client diagnosed with Bell palsy is being cared for on an outpatient basis. During health education, the nurse should promote which of the following actions?

Applying a protective eye shield at night

The nurse is planning the care of a client who has been recently diagnosed with a cerebellar tumor. Due to the location of this client's tumor, the nurse should implement measures to prevent what complication?

Falls

A client has been admitted to the neurologic unit for the treatment of a newly diagnosed brain tumor. The client has just exhibited seizure activity for the first time. What is the nurse's priority response to this event?

Implement precautions to ensure the client's safety.

A client has just returned to the unit from the PACU after surgery for a tumor within the spine. The client complains of pain. When positioning the client for comfort and to reduce injury to the surgical site, the nurse will position to client in what position?

In a flat side-lying position

The nurse in an extended care facility is planning the daily activities of a client with postpolio syndrome. The nurse recognizes the client will best benefit from physical therapy when it is scheduled at what time?

In the morning

A client with a malignant brain tumor comes to the clinic for a follow up. During the visit, the client asks the nurse, "Why am I so tired all the time?" When responding to the client, which information would the nurse include as possible causes? Select all that apply.

Tumor Treatment being used Stress

The nurse is planning discharge education for a client with trigeminal neuralgia. The nurse knows to include information about factors that precipitate an attack. What would the nurse be correct in teaching the client to avoid?

Washing his face

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?

Within 24 hours after exposure