Med Surg: Chapter 46: Nursing Management: Patients With Neurologic Disorders: PREPU
A patient with Parkinson's disease is undergoing a swallowing assessment because she is experiencing difficulties when swallowing. What consistency is most appropriate for this patient, to reduce the risk of aspiration? A Thin liquids only B Pureed food with water C Semisolid food with thick liquids D Solid food with thin liquids
C
After a seizure, the nurse should place the patient in which of the following positions to prevent complications? A High Fowler's, to prevent aspiration B Supine, to rest the muscles of the extremities C Side-lying, to facilitate drainage of oral secretions D Semi-Fowler's, to promote breathing
C
Which is the most common cause of acute encephalitis in the United States? A West Nile virus B St. Louis virus C Herpes simplex virus D Western equine virus
C
The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe? A Patchy blindness B Loss of proprioception C Diplopia and ptosis D Numbness
C The initial manifestation of myasthenia gravis involves the ocular muscles, such as diplopia and ptosis. The remaining choices relate to multiple sclerosis.
A patient diagnosed with multiple sclerosis (MS) has been admitted to the medical unit for treatment of an MS exacerbation. Included in the admission orders is baclofen (Lioresal). What would be the expected outcome of this medication? A Decreased muscle spasms in the lower extremities B Promotion of urinary continence C Increased muscle strength in the upper extremities D Reduction in the appearance of new lesions on magnetic resonance imaging (MRI)
A
A patient with epilepsy is having a seizure. Which of the following should the nurse do after the seizure? A Keep the patient to one side. B Place a cooling blanket beneath the patient. C Pry the patient's mouth open to allow a patent airway. D Help the patient sit up.
A
The nurse is expecting to admit a client with a diagnosis of meningitis. While preparing the client's room, which of the following would the nurse most likely have available? A Equipment to maintain infection control precautions B IV tensilon C Extra lighting D Nasogastric tubing
A
When obtaining the vital signs of a client with multiple traumatic injuries, a nurse detects bradycardia, bradypnea, and systolic hypertension. The nurse must notify the physician immediately because these findings may reflect which complication? A Increased intracranial pressure (ICP) B Shock C Encephalitis D Status epilepticus
A
A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide (Mestinon) on time. The nurse gets busy and does not administer the medication until after breakfast. What outcome will the patient have related to this late dose? A There should not be a problem, since the medication was only delayed by about 2 hours. B The muscles will become fatigued and the patient will not be able to chew food or swallow pills. C The patient will require a double dose prior to lunch. D The patient will go into cardiac arrest.
B
A client's spouse relates how the client reported a severe headache, and shortly after was unable to talk or move their right arm and leg. The spouse indicates the client has hypertension. What should be the focus of management during this phase? A reporting changes to the physician B destabilizing client's condition C assessing vital signs frequently D preventing further neurologic damage
D
A patient is exhibiting bradykinesia, rigidity, and tremors related to Parkinson's disease. The nurse understands that these symptoms are directly related to what decreased neurotransmitter level? A Acetylcholine B Phenylalanine C Serotonin D Dopamine
D
Which medication is the most effective agent in the treatment of Parkinson disease? A Amantadine B Benztropine C Bromocriptine mesylate D Levodopa
D
Bell's palsy is a paralysis of which of the following cranial nerves? A Facial B Otic C Trigeminal D Optic
A
The school nurse notes a 6-year-old running across the playground with friends. The child stops in mid-stride, freezing for a few seconds. Then the child resumes his progress across the playground. The school nurse suspects what in this child? A An absence seizure B A tonic-clonic seizure C A partial seizure D A complex seizure
A Absence seizures, formerly referred to as petit mal seizures, are more common in children. They are characterized by a brief loss of consciousness, during which physical activity ceases. The person stares blankly; the eyelids flutter; the lips move; and slight movement of the head, arms, and legs occurs. These seizures typically last for a few seconds, and the person seldom falls to the ground.
The nurse is caring for a client with Guillain-Barré syndrome. Which assessment finding would indicate the need for oral suctioning? A Increased pulse rate, adventitious breath sounds B Increased pulse rate, respirations of 16 breaths/minute C Decreased pulse rate, respirations of 20 breaths/minute D Decreased pulse rate, abdominal breathing
A An increased pulse rate above baseline with adventitious breath sounds indicate compromised respirations and signal a need for airway clearance. A decrease in pulse rate is not indicative of airway obstruction
A client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond? A "You'll first regain use of your legs and then your arms." B "The paralysis caused by this disease is temporary." C "It must be hard to accept the permanency of your paralysis." D "You'll be permanently paralyzed; however, you won't have any sensory loss."
B The nurse should inform the client that the paralysis that accompanies Guillain-Barré syndrome is only temporary. Return of motor function begins proximally and extends distally in the legs.
When performing a postoperative assessment on a client who has undergone surgery to manage increased intracranial pressure (ICP), a nurse notes an ICP reading of 0 mm Hg. Which action should the nurse perform first? A Continue the assessment because no actions are indicated at this time. B Contact the physician to review the care plan. C Document the reading because it reflects that the treatment has been effective. D Check the equipment.
D The nurse should check the equipment and report problems. Normal and stable ICP values are less than 15 mm Hg. Some pressure is always present in the cranial vault. The nurse shouldn't contact the physician to review the care plan at this time.
The nurse is taking care of a client with a history of headaches. The nurse takes measures to reduce headaches and administer medications. Which appropriate nursing interventions may be provided by the nurse to such a client? A Maintain hydration by drinking eight glasses of fluid a day B Apply warm or cool cloths to the forehead or back of the neck C Perform the Heimlich maneuver D Use pressure-relieving pads or a similar type of mattress
B
The nurse is volunteering for a Red Cross blood drive and is taking the history of potential donors. Which volunteer would the nurse know will not be allowed to donate blood? A A donor who moved to the United States from Canada B A donor who was in college in England for 1 year C A donor who is taking medication for benign prostatic hyperplasia D A donor with a history of hypertension with a blood pressure of 140/90 mm Hg
B
Which is a component of the nursing management of the client with variant Creutzfeldt-Jakob disease (vCJD)? A Providing palliative care B Initiating isolation procedures C Preparing for organ donation D Administering amphotericin B
A
Which is the primary medical management of arthropod-borne virus (arboviral) encephalitis? A Maintaining hemodynamic stability and adequate cardiac output B Controlling seizures and increased intracranial pressure C Preventing renal insufficiency D Preventing muscular atrophy
B
The nurse has been educating a client newly diagnosed with MS. Which statement by the client indicates an understanding of the education? A "I will take hot tub baths to decrease spasms." B "The exercises should be completed quickly to reduce fatigue." C "I will stretch daily as directed by the physical therapist." D "I should participate in non-weight-bearing exercises."
C. stretching routine should be established. Stretching can help prevent contractures and muscle spasticity. Hot baths are discouraged because of the risk of injury. Clients have sensory loss that may contribute to the risk of burns.
The most common cause of cholinergic crisis includes which of the following? A Undermedication B Compliance with medication C Infection D Overmedication
D
A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order: A electromyography (EMG). B quantitative spectral phonoangiography. C Doppler scanning. D Doppler ultrasonography.
A To help confirm ALS, the physician typically orders EMG, which detects abnormal electrical activity of the involved muscles
A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following? A Micrographia B Dyskinesia C Bradykninesia D Dysphonia
B Most clients within 5 to 10 years of taking levodopa develop a response to the medication called dyskinesia, manifested as facial grimacing, rhythmic jerking movements of the hands, head bobbing, chewing and smacking movements, and involuntary movements of the trunk and extremities
A client with herpes simplex virus (HSV) encephalitis is receiving acyclovir. To ensure early intervention, the nurse monitors laboratory values and urine output for which type of adverse reactions? A Integumentary B Hepatic C Musculoskeletal D Renal
D Monitoring of blood chemistry test results and urinary output will alert the nurse to the presence of renal complications related to acyclovir therapy.
Which condition is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain? A Creutzfeldt-Jakob disease B Multiple sclerosis C Huntington disease D Parkinson disease
A
Which positions is used to help reduce intracranial pressure (ICP)? A Extreme hip flexion, with the hip supported by pillows B Keeping the head flat, avoiding the use of a pillow C Rotating the neck to the far right with neck support D Avoiding flexion of the neck with use of a cervical collar
D Use of a cervical collar promotes venous drainage and prevents jugular vein distortion, which can increase ICP. Slight elevation of the head is maintained to aid in venous drainage unless otherwise prescribed. Extreme rotation of the neck is avoided because compression or distortion of the jugular veins increases ICP.
Which phase of a migraine headache usually lasts less than an hour? A Premonitory B Aura C Headache D Postdrome
B
A client is newly diagnosed with relapsing-remitting multiple sclerosis (RRMS). Which instruction should the nurse provide? A "Your type of MS is the least common, making it difficult to manage." B "You will have a steady and gradual decline in function." C "You must avoid stress and extreme fatigue, because these can trigger a relapse." D "You should take your medications only during times of relapse."
C
Which nursing intervention is the priority for a client in myasthenic crisis? A Administering intravenous immunoglobin (IVIG) per orders B Ensuring adequate nutritional support C Preparing for plasmapheresis D Assessing respiratory effort
D
A 55-year-old male patient has been admitted to the hospital with a gastrointestinal bleed, and the patient has just experienced a generalized seizure that may be attributable to alcohol withdrawal. When providing immediate care during the patient's seizure, what nursing diagnosis should be prioritized? A Acute pain B Acute confusion C Risk for impaired skin integrity D Impaired gas exchange
D Airway and breathing are priorities in any emergency situation, including seizures. These considerations would be prioritized over confusion, pain, and skin integrity.
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 putting my shoes on." C "I was sitting at home watching television." D "I was brushing my teeth."
D Paroxysms can occur with any stimulation of the terminals of the affected nerve branches, such as washing the face, shaving, brushing the teeth, eating, and drinking.
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 Admission to the nearest hospital for observation B Bedrest at home for 72 hours C No treatment unless the roommate begins to show symptoms D Treatment with antimicrobial prophylaxis as soon as possible
D People in close contact with clients who have meningococcal meningitis should be treated with antimicrobial chemoprophylaxis, ideally within 24 hours after exposure.
