Lewis 10th Chapter 58 Chronic Neurologic Problems Evolve NCLEX practice

The patient has an order for phenytoin (Dilantin) 100 mg q8hr IV. Available is a phenytoin injection containing 50 mg/mL. How many milliliters of solution should the nurse draw up for the dose? _____mL

2 100 mg ÷ 50 mg/mL = 2 mL

The patient with type 1 diabetes mellitus is having a seizure. Which medication should the nurse anticipate will be administered first? a. IV dextrose solution b. IV diazepam (Valium) c. IV phenytoin (Dilantin) d. Oral carbamazepine (Tegretol)

a. IV dextrose solution This patient's seizure could be caused by low blood glucose, so IV dextrose solution would be given first to stop the seizure. IV diazepam, IV phenytoin, and oral carbamazepine would be used first to treat seizures from other causes such as head trauma, drugs, and infections. These drugs will be tried if the IV dextrose is ineffective.

A 48-yr-old man was just diagnosed with Huntington's disease. His 20-yr-old son is upset about his father's diagnosis. What is the nurse's best response? a. Provide emotional and psychologic support. b. Encourage him to get diagnostic genetic testing. c. Explain that cognitive deterioration will be treated with counseling. d. Instruct that chorea and psychiatric disorders can be treated with haloperidol (Haldol).

a. Provide emotional and psychologic support. The patient's son will first need emotional and psychologic support. He should be taught about diagnostic genetic testing but should decide for himself with a genetic counselor if and when he wants this done. The treatment plan for his father will be determined based on his father's needs.

Which care measure is a priority for a patient with multiple sclerosis (MS)? a. Vigilant infection control and adherence to standard precautions b. Careful monitoring of neurologic assessment and frequent reorientation c. Maintenance of a calorie count and hourly assessment of intake and output d. Assessment of blood pressure and monitoring for signs of orthostatic hypotension

a. Vigilant infection control and adherence to standard precautions Infection control is a priority in the care of patients with MS because infection is the most common cause of an exacerbation of the disease. Decreases in cognitive function are less likely, and MS does not typically result in malnutrition, hypotension, or fluid volume excess or deficit.

The nurse provides dietary instructions to the in-home caregiver of a 45-yr-old man with Huntington's disease. The nurse is most concerned if the caregiver makes which statement? a. "Depression is common and may cause a decrease in appetite." b. "If swallowing becomes difficult, a feeding tube may be needed." c. "Calories should be restricted to prevent unnecessary weight gain." d. "Muscles in the face are affected, and chewing may become impossible."

c. "Calories should be restricted to prevent unnecessary weight gain." Patients with Huntington's disease may require 4000 to 5000 calories per day to maintain body weight. Weight loss occurs in patients with Huntington's disease because of choreic movements, difficulty swallowing, depression, and mental deterioration.

The nurse provides information to the caregiver of a 68-yr-old man with epilepsy who has tonic-clonic seizures. Which statement by the caregiver indicates a need for further teaching? a. "It is normal for a person to be sleepy after a seizure." b. "I should call 911 if breathing stops during the seizure." c. "The jerking movements may last for 30 to 40 seconds." d. "Objects should not be placed in the mouth during a seizure."

b. "I should call 911 if breathing stops during the seizure." Caregivers do not need to call an ambulance or send a person to the hospital after a single seizure unless the seizure is prolonged, another seizure immediately follows, or extensive injury has occurred. Altered breathing is a clinical manifestation of a tonic-clonic seizure. Contact emergency medical services (or call 911) if breathing stops for more than 30 seconds. No objects (e.g., oral airway, padded tongue blade) should be placed in the mouth. Lethargy is common in the postictal phase of a seizure. Jerking of the extremities occurs during the clonic phase of a tonic-clonic seizure. The clonic phase may last 30 to 40 seconds.

The nurse teaches a 38-yr-old woman who has migraine headaches about sumatriptan (Imitrex). Which statement by the patient requires clarification by the nurse? a. "The injection might feel like a bee sting." b. "This medicine will prevent a migraine headache." c. "I can take another dose if the first does not work." d. "This drug for migraine headaches could cause birth defects."

b. "This medicine will prevent a migraine headache." Sumatriptan is given to abort an ongoing migraine headache and is not used to prevent migraine headaches. When given as a subcutaneous injection, this drug may cause transient pain and redness at the injection site. This drug may be repeated after a specified time period if the first dose is not effective. This drug should be avoided during pregnancy and is classified as a Food and Drug Administration Pregnancy Risk Category C drug.

The nurse observes a 74-yr-old man with Parkinson's disease rocking side to side while sitting in the chair. Which action by the nurse is most appropriate? a. Provide the patient with diversional activities. b. Document the activity in the patient's health record. c. Take the patient's blood pressure sitting and standing. d. Ask if the patient is feeling either anxious or depressed.

b. Document the activity in the patient's health record. Patients with Parkinson's disease are instructed to rock from side to side to stimulate balance mechanisms and decrease akinesia.

A female patient complains of a throbbing headache. The nurse learns the patient has experienced photophobia and headaches previously. Which diagnosis does the nurse suspect? a. Cluster headache b. Migraine headache c. Polycythemia vera d. Hemorrhagic stroke

b. Migraine headache Although a headache may occur with any of these options, a migraine headache is the only one that has a throbbing headache with an aura (the photophobia). Headache from polycythemia vera is from erythrocytosis. The cluster headache pain is sharp and stabbing. The headache associated with a hemorrhagic stroke has a sudden onset and is not recurrent.

A patient has been receiving scheduled doses of phenytoin (Dilantin) and begins to experience diplopia. Which additional findings would the nurse expect? a. An aura or focal seizure b. Nystagmus or confusion c. Abdominal pain or cramping d. Irregular pulse or palpitations

b. Nystagmus or confusion Diplopia is a sign of phenytoin toxicity. The nurse should assess for other signs of toxicity, which include neurologic changes, such as nystagmus, ataxia, confusion, dizziness, or slurred speech. An aura, focal seizure, abdominal pain or cramping, irregular pulse, or palpitations are not associated with phenytoin toxicity.

A 50-yr-old male patient has been diagnosed with amyotrophic lateral sclerosis (ALS). What strategy will prevent a common cause of death for patients with ALS? a. Reduce fat intake. b. Reduce the risk of aspiration. c. Decrease injury related to falls. d. Decrease pain secondary to muscle weakness.

b. Reduce the risk of aspiration. Reducing the risk of aspiration can help prevent respiratory infections that are a common cause of death from deteriorating muscle function. Reducing fat intake may reduce cardiovascular disease, but this is not a common cause of death for patients with ALS. Decreasing injury related to falls and decreasing pain secondary to muscle weakness are important nursing interventions for patients with ALS but are unrelated to causes of death for these patients.

The nurse is caring for a group of patients on a medical unit. After receiving report, which patient should the nurse see first? a. A 42-yr-old patient with multiple sclerosis who was admitted with sepsis b. A 72-yr-old patient with Parkinson's disease who has aspiration pneumonia c. A 38-yr-old patient with myasthenia gravis who declined prescribed medications d. A 45-yr-old patient with amyotrophic lateral sclerosis who refuses enteral feedings

c. A 38-yr-old patient with myasthenia gravis who declined prescribed medications Patients with myasthenia gravis who discontinue pyridostigmine (Mestinon) will experience myasthenic crisis. Myasthenia crisis results in severe muscle weakness and can lead to a respiratory arrest.

Which nursing diagnosis is a priority in the care of a patient with myasthenia gravis (MG)? a. Acute confusion b. Bowel incontinence c. Activity intolerance d. Disturbed sleep pattern

c. Activity intolerance The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG. Although sleep disturbance is likely, activity intolerance is of primary concern.

When establishing a diagnosis of multiple sclerosis (MS), which diagnostic tests will the nurse expect? Select all that apply. a. EEG b. ECG c. CT scan d. Carotid duplex scan e. Evoked response testing f. Cerebrospinal fluid analysis

c. CT scan e. Evoked response testing f. Cerebrospinal fluid analysis No definitive diagnostic test exists for MS. Along with history and physical examination, CT scan, evoked response testing, cerebrospinal fluid analysis, and MRI are used to establish a diagnosis of MS. EEG, ECG, and carotid duplex scan are not used to diagnose MS.

A male patient with a diagnosis of Parkinson's disease (PD) is admitted to a long-term care facility. Which action should the health care team take to promote adequate nutrition for this patient? a. Provide multivitamins with each meal. b. Provide a diet that is low in complex carbohydrates and high in protein. c. Provide small, frequent meals throughout the day that are easy to chew and swallow. d. Provide the patient with a minced or pureed diet that is high in potassium and low in sodium.

c. Provide small, frequent meals throughout the day that are easy to chew and swallow. Nutritional support is a priority in the care of individuals with PD. Patients may benefit from smaller, more frequent meals that are easy to chew and swallow. Multivitamins are not necessary at each meal. Vitamin and protein intake must be monitored to prevent interactions with medications. Introducing a minced or pureed diet is likely premature, and a low carbohydrate diet is not indicated.

Which characteristic will the nurse associate with a focal seizure? a. The patient lost consciousness during the seizure. b. The seizure involved both sides of the patient's brain. c. The seizure involved lip smacking and repetitive movements. d. The patient fell to the ground and became stiff for 20 seconds.

c. The seizure involved lip smacking and repetitive movements. Complex focal seizure is characterized commonly by lip smacking and automatisms (repetitive movements that may not be appropriate). Loss of consciousness, bilateral brain involvement, and a tonic phase are associated with generalized seizure activity.