Med Surge 2 TEST 4 NEURO

The nurse is documenting nursing observations in the record of a client who experienced a tonic-clonic seizure. Which clinical manifestation did the nurse most likely note in the clonic phase of the seizure? 1.Body stiffening 2.Spasms of the entire body 3.Sudden loss of consciousness 4.Brief flexion of the extremities

2.Spasms of the entire body The clonic phase of a seizure is characterized by alternating spasms and momentary muscular relaxation of the entire body, accompanied by strenuous hyperventilation. The face is contorted and the eyes roll. Excessive salivation results in frothing from the mouth. The tongue may be bitten, the client sweats profusely, and the pulse is rapid. The clonic jerking subsides by slowing in frequency and losing strength of contractions over a period of 30 seconds. Options 1, 3, and 4 identify the tonic phase of a seizure.

The patient is having some increased memory and language problems. What diagnostic tests will be done before this patient is diagnosed with Alzheimer's disease? Select all that apply. 1.Urinalysis 2.Magnetic resonance imaging (MRI) of the head 3.Liver function tests 4.Neuropsychologic testing 5.Blood urea nitrogen (BUN) and serum creatinine

1,2,3,4,5. Because there is no definitive diagnostic test for Alzheimer's disease, and many conditions can cause manifestations of dementia, testing must be done to eliminate any other causes of cognitive impairment. These include a urinary tract infection, an MRI to eliminate brain tumors, liver function tests to eliminate encephalopathy, BUN and serum creatinine to rule out renal dysfunction, and neuropsychologic testing to assess cognitive function.

The nurse is caring for a patient with Parkinson's disease. What adjustments should the nurse make in the dietary habits of the patient to prevent malnutrition and constipation? Select all that apply. 1.Include whole grains and fruits in the diet. 2.Cut food into bite-size pieces. 3.Serve hot foods on a warmed plate. 4.Include plenty of food items high in protein. 5.Provide three large meals rather than six small meals.

1,2,3. Patients with Parkinson's disease are predisposed to malnutrition and constipation, owing to inadequate food intake caused by difficulty in chewing and swallowing. To promote adequate nutrition, the nurse should include whole grains and fruits in the diet, which will prevent constipation. The food should be cut into bite size pieces so that chewing and swallowing is easy. Serving hot foods on a warmed plate makes the food more appealing. Food items high in protein should be limited in the diet, because they can interfere with the absorption of carbidopa-levodopa (Sinemet), the most common drug used in the treatment of Parkinson's disease. Six small meals, rather than three large meals, would be less exhausting for the patients.

The parent of a child newly diagnosed with a typical absence seizure is worried. What information should the nurse provide to the parent regarding typical absence seizures? Select all that apply. 1.The occurrence of seizures usually subsides during adolescence. 2.The seizures are characterized by brief staring spells. 3.The seizures are usually precipitated by flashing lights. 4.A seizure is associated with loss of postural tone. 5.The child will usually seem confused after a seizure.

1,2,3. The typical absence seizure usually occurs in childhood only, and the occurrences subside in adolescence. The seizures are characterized by brief staring spells that last for a few seconds only. Flashing lights tend to precipitate a seizure. The child may not have loss of postural tone and may not experience confusion after a seizure

A patient admitted to the hospital is diagnosed with Alzheimer's disease. What drug therapy should the nurse expect the health care provider to prescribe for this patient? Select all that apply 1.Donepezil (Aricept) 2.Rivastigmine (Exelon) 3.Memantine (Namenda) 4.Haloperidol (Haldol) 5.Risperidone (Risperdal)

1,2,3. The use of drugs for Alzheimer's disease helps to reduce the rate of decline in cognitive function. Donepezil (Aricept) and rivastigmine (Exelon) are cholinesterase inhibitors. They block cholinesterase, the enzyme responsible for the breakdown of acetylcholine in the synaptic cleft. Memantine (Namenda) protects the brain's nerve cells against excessive amounts of glutamate, which is released in large amounts by cells damaged in Alzheimer's disease. Haloperidol (Haldol) and risperidone (Risperdal) are antipsychotic drugs that are not indicated for the treatment of Alzheimer's disease; however, they can be used with caution for treating behavioral problems associated with the disease.

A nurse is teaching caregivers about the safety measures to reduce the risk of injuries for a patient with Alzheimer's disease. Which measures should be included in the teaching? Select all that apply. 1 Remove extension cords 2.Have stairwells well lit 3.Plain mats to be used in tub or shower 4.Tack down carpet edges 5. Install handrails in the bath

1,2,4,5. Owing to the decline in cognitive functions in Alzheimer's disease, the patient may be unable to navigate physical spaces and interpret environmental cues. Therefore, to ensure personal safety, the extension cords should be removed, the stairwell should be lit properly, and the carpet edges should be tacked down. Installing handrails in the bath may help prevent falls. Loose extension cords and use of plain mats increase the risk of falls.

When a patient with Alzheimer's disease is in severe pain but cannot communicate which symptoms should a nurse be observant of to recognize pain? Select all that apply.

1,2,4. Because of difficulties with oral and written language, patients with Alzheimer's disease may have difficulty expressing physical complaints, including pain. Pain can result in an alteration in the patient's behavior, such as increased vocalization, agitation, withdrawal, or changes in functioning. Wandering may be related to loss of memory or to the side effects of medications, or it may be an expression of a physical or emotional need, restlessness, curiosity, or stimuli that trigger memories of earlier routines. Sundowning is a specific type of agitation in which the patient becomes more confused and agitated in the late afternoon or evening. The cause of sundowning is unclear, but several theories propose that it is due to a disruption incircadian rhythm. Other possible causes include fatigue, being in an unfamiliar environment, noise, medications, reduced lighting, and sleep fragmentation.

A nurse is caring for an older adult postoperatively. Which symptoms should a nurse be observant for to distinguish delirium from dementia? Select all that apply. 1.Rapid onset of symptoms, often at night 2.Abrupt progression of disease 3.Difficulty in finding proper words 4.Sleeping during the day 5.Accelerated, incoherent speech

1,2,5,.Delirium is a temporary state of mental confusion caused by reversible impairment of cerebral oxidative metabolism and multiple neurotransmitter abnormalities. The onset is usually rapid, mostly at night, and with abrupt progression. Decreased oxygen supply to the brain may cause the patient's speech to become accelerated and incoherent. In contrast, dementia has a slow onset and progression. The changes are subtle and progress over many years. As the cognitive decline progresses, and more brain areas are affected, the patient may have difficulty in finding proper words. A patient with dementia may sleep during the day and awaken frequently at night, owing to changes in the sleep-wake cycle

A patient's spouse asks how one can tell if someone has routine forgetfulness that happens with age or something associated with the beginning of Alzheimer's disease. Select the examples of forgetfulness associated with mild cognitive impairment which are not "normal" forgetfulness. Select all that apply. 1.Becomes lost frequently. 2.Patient worries about memory loss. 3.Occasionally misplaces keys or glasses. 4.Momentarily forgets an acquaintance's name. 5.Frequently forgets a friend's name and is slow to recall.

1,2,5.Examples of mild cognitive impairment include forgetting a familiar person's name and having difficulty with recall, becoming lost frequently as a change in behavior, and worrying about the memory loss. Mild cognitive impairment may stabilize or advance to Alzheimer's disease. Momentarily forgetting an acquaintance's name or misplacing keys or glasses are examples of "normal" forgetfulness.

A nurse is teaching a group of caregivers about how to detect the early warning signs of Alzheimer's disease. What are the warning signs that the nurse should include in the teaching? Select all that apply. 1.Memory loss that affects job skills 2.Patient requiring help with getting dressed 3.Problems with language 4.Disorientation to time and place 5.Patient requiring assistance while walking

1,3,4.Frequent forgetfulness or unexplainable confusion, problems with language, and disorientation to time and place are all early warning signs of Alzheimer's disease. Most patients have trouble finding the "right" word and may forget simple words or substitute inappropriate words, making speech difficult to understand. Requiring help getting dressed or while walking may be usual in old age, owing to frailty and weakness or the presence of other musculoskeletal problems.

Which professionals have a high risk of developing Alzheimer's disease or another type of dementia? Select all that apply. 1.Football players 2.Tennis players 3.Military members 4.Fishermen 5.Race car drivers

1,3,5. Head trauma is a risk factor for dementia. Football players, military members, and race car drivers are at elevated risk of getting injured and eventually developing dementia. Tennis players and fishermen have a low risk of head trauma and therefore are at low risk of developing dementia related to their profession.

A patient with Parkinson disease has lost 35 pounds over two months. A swallowing study shows that the patient is able to swallow and does not aspirate. What suggestion should the nurse discuss with the patient and spouse to improve nutrition? 1.Allow adequate time for the patient to eat meals. 2.Encourage the patient to eat at least every two hours while awake. 3.Administer prescribed carbidopa/levodopa (Sinemet) with a protein drink. 4.Include foods that are chewy so the patient builds up the jaw muscles

1. Allowing adequate time for the patient to eat will limit frustration and improve overall intake. Six small feedings may improve intake, but eating every two hours would exhaust the patient. Absorption of levodopa is impaired by protein, so it is best to avoid large amounts of protein when carbidopa/levodopa is administered. Foods should be easily chewable to increase the overall intake.

A patient with Alzheimer's disease is restless and agitated. How should a nurse help the patient? Select all that apply. 1.Warn the patient to be calm or else restraints will be applied. 2.Do not ask the patient challenging "why" questions. 3.Change the patient's focus. 4.Call the health care provider. 5.Reassure the patient.

2,3,5. The agitated patient often cannot verbalize distress. In such a case, rephrase the patient's statement to validate its meaning and do not question the patient. For a patient that is agitated and restless, redirecting involves changing the patient's focus to perform other activities. Reassurance involves communicating to the patient that he or she will be protected from danger, harm, or embarrassment. Threatening the patient ("calm down or else") or calling the healthcare provider is likely to aggravate the behavior.

The nurse is providing instructions to a client with a seizure disorder who will be taking phenytoin (Dilantin). Which statement, if made by the client, would indicate an understanding of the information about this medication? 1."I need to perform good oral hygiene, including flossing and brushing my teeth." 2."I should try to avoid alcohol, but if I'm not able to, I can drink alcohol in moderation." 3."I should take my medication before coming to the laboratory to have a blood level drawn." 4."I should monitor for side effects and adjust my medication dose depending on how severe the side effects are."

1."I need to perform good oral hygiene, including flossing and brushing my teeth." The client should perform good oral hygiene, including flossing and brushing the teeth. The client also should see a dentist at regularly scheduled times because gingival hyperplasia is a side effect of this medication. The client should avoid alcohol while taking this medication. The client should also be instructed that follow-up serum blood levels are important and that, on the day of the scheduled laboratory test, the client should avoid taking the medication before the specimen is drawn. The client should not adjust medication dosages.

The nurse is assessing a client who is experiencing seizure activity. The nurse understands that it is necessary to determine information about which items as part of routine assessment of seizures? Select all that apply. 1.Postictal status 2.Duration of the seizure 3.Changes in pupil size or eye deviation 4.Seizure progression and type of movements 5.What the client ate in the 2 hours preceding seizure activity

1.Postictal status 2.Duration of the seizure 3.Changes in pupil size or eye deviation 4.Seizure progression and type of movements Typically seizure assessment includes the time the seizure began, parts of the body affected, type of movements and progression of the seizure, change in pupil size or eye deviation or nystagmus, client condition during the seizure, and postictal status. Option 5 is not a component of seizure assessment.

A nurse is teaching a group of caregivers about the guidelines for caring for a patient with dementia. What are the guidelines that the nurse should include in the teaching? Select all that apply. 1.Remind the patient to hurry to counteract bradykinesia 2.Simplify tasks for easy understanding 3.Treat with respect and dignity 4.Give directions using gestures or pictures 5.Mandate participation in all activities or events to counteract social withdrawal

2,3,4. For easy understanding, focus on one thing at a time. Simplifying the tasks may also help the patient in understanding it and carrying out the task. Treat the patient with respect and dignity, even when their behavior is childlike. Respect and dignity would encourage the patient to carry out self-care activities. When taking care of a patient with dementia, do not rush or hurry the patient or force the patient to participate in activities and events; such actions can make the patient agitated.

A nurse reviews the medical history with a patient and learns that the patient was diagnosed with restless legs syndrome. Based on this fact, which question should the nurse also ask? 1."Do you experience calf pain after walking a block?" 2."Are you able to sleep well and feel rested?" 3."Do you experience episodes where you are unable to move one leg?" 4."When exposed to cold do your legs turn pale, then blue, and become painful?"

2. Restless legs syndrome is a condition in which patients experience paresthesias, including numbness, tingling, pain, and restlessness in one or both legs. The condition occurs commonly at night, interferes with the patient's ability to sleep, and contributes to daytime fatigue. Asking whether the patient sleeps well and feels rested is appropriate. Calf pain that occurs with walking is termed intermittent claudication and is a symptom of peripheral vascular disease. A temporary episode of paralysis describes a transient ischemic attack (TIA), a precursor to a stroke. Raynaud's disease occurs in persons with connective tissue conditions and involves vasospasms in response to cold. The legs become pale, then cyanotic and often reddened post vasospasm. The episodes are painful.

An 84-year-old client in an acute state of disorientation is brought to the hospital emergency department by his or her daughter. The daughter states that the client was "clear as a bell this morning." The nurse determines from this piece of information that which is an unlikely cause of the disorientation? 1.Hypoglycemia 2.Alzheimer's disease 3.Medication dosage error 4.Impaired circulation to the brain

2.Alzheimer's disease Alzheimer's disease is a chronic disease with progression of memory deficits over time. The situation presented in the question represents an acute problem. Evaluation is necessary to determine whether hypoglycemia, medication use, or impaired cerebral circulation has had a role in causing the client's current symptoms.

The home care nurse is visiting a client with a diagnosis of Parkinson's disease. The client is taking benztropine mesylate (Cogentin) orally daily. The nurse provides information to the spouse regarding the side effects of this medication and should tell the spouse to report which side effect if it occurs? 1.Shuffling gait 2.Inability to urinate 3.Decreased appetite 4.Irregular bowel movements

2.Inability to urinate Benztropine mesylate is an anticholinergic, which causes urinary retention as a side effect. The nurse would instruct the client or spouse about the need to monitor for difficulty with urinating, a distended abdomen, infrequent voiding in small amounts, and overflow incontinence. Options 1, 3, and 4 are unrelated to the use of this medication.

The nurse in the health care clinic is providing medication instructions to a client with a seizure disorder who will be taking divalproex sodium (Depakote). The nurse should instruct the client about the importance of returning to the clinic for monitoring of which laboratory study? 1.Electrolyte panel 2.Liver function studies 3.Renal function studies 4.Blood glucose level determination

2.Liver function studies Divalproex sodium, an anticonvulsant, can cause fatal hepatotoxicity. The nurse should instruct the client about the importance of monitoring the results of liver function studies and ammonia level determinations. Options 1, 3, and 4 are not studies that are required with the use of this medication.

A client with Parkinson's disease is at risk for falls because of an abnormal gait. The nurse assesses the client, expecting to observe which type of gait? 1.Unsteady and staggering 2.Shuffling and propulsive 3.Broad-based and waddling 4.Accelerating with walking on the toes

2.Shuffling and propulsive The parkinsonian gait is characterized by short, accelerating, shuffling steps. The client leans forward with the head, hips, and knees flexed and has difficulty starting and stopping. An ataxic gait is unsteady and staggering. A dystrophic gait is broad-based and waddling. A festinating gait is accelerating with walking on the toes.

A patient is admitted to the long-term care facility in the mild stage of Alzheimer's disease. What are the findings that the nurse may expect in this patient? Select all that apply. 1.Unable to perform self-care activities 2.Cannot understand words 3.Short-term memory impairment 4.Not able to solve simple math problems 5.Not able to sit up without help

3,4. The patient in the mild stage of Alzheimer's disease may have mild cognitive impairment manifested by short-term memory impairment and inability to solve simple math problems. The cognitive impairment becomes more severe as the disease progresses to the severe stage. In this stage, the patient most likely cannot perform self-care activities and cannot understand words. The patient may need help even to sit up.

A patient displays jerky muscle movements of the extremities and is incontinent of bowel and bladder. The nurse recognizes that these clinical manifestations are associated with: 1.Aura seizures 2.Postictal seizures 3.Generalized seizures 4.Simple partial seizures

3. In a generalized, or grand mal, seizure the patient may experience incontinence along with jerking, or tonic-clonic, movements of the entire body. An aura is an individualized, subjective auditory, visual, olfactory, or taste hallucination that may precede a seizure. Postictal is the period of recovery after a seizure; it may be characterized by confusion and sedation. A simple partial seizure may be isolated to one side of the brain and remain partial or focal in nature, or it may spread to involve the entire brain, culminating in a generalized tonic-clonic seizure. Simple partial seizures generally do not involve loss of consciousness and rarely last more than one minute.

The nurse visits a patient who is being treated with phenytoin (Dilantin) for seizures. Which instruction is important to prevent precipitation of seizures in this patient? 1.Notify the health care provider about unusual hair growth. 2.Practice good dental hygiene to control gingival hyperplasia. 3.Do not stop the drug abruptly without consulting the health care provider. 4.Maintain a healthy lifestyle with regular exercise and nutritious diet.

3. Phenytoin (Dilantin) is an antiseizure drug. Abrupt withdrawal of the drug after long-term use may precipitate seizures; therefore, the patient should not stop the drug without consulting the health care provider. Unusual hair growth and gingival hyperplasia are side effects of antiseizure drugs and are not relevant in preventing precipitation of seizures. Maintaining a healthy lifestyle is a general measure to keep healthy and may not contribute to prevention of precipitation of seizures.

A client had a seizure 1 hour ago. Family members were present during the episode and reported that the client's jaw was moving as though grinding food. In helping to determine the origin of this seizure, what should the nurse include in the client's assessment? 1.Presence of diaphoresis 2.Loss of consciousness 3.History of prior trauma 4.Rotating eye movements

3.History of prior trauma Seizures that originate with specific motor phenomena are considered focal and are indicative of a focal structural lesion in the brain, often caused by trauma, infection, or drug consumption. Options 1, 2, and 4 address signs, rather than an origin of the seizure.

The nurse performs a pull test on a patient with suspected Parkinson's disease. The nurse stands behind the patient and gives a tug backward on the shoulder. What would be the patient's reaction if he has Parkinson's disease? 1.Lose balance and sit down 2.Lose balance and fall forward 3.Lose balance and fall backward 4.Lose balance and become unconscious

3.In a pull test, when the examiner stands behind the patient and gives a tug backward on the shoulder, the patient loses balance and falls backward. This reaction indicates postural instability, a common feature in Parkinson's disease. Sitting down, falling forward, or becoming unconscious after losing balance is not indicative of postural instability related to Parkinson's disease.

The nurse has given instructions to a client with Parkinson's disease about maintaining mobility. Which action demonstrates that the client understands the directions? 1.Sits in soft, deep chairs to promote comfort. 2.Exercises in the evening to combat fatigue. 3.Rocks back and forth to start movement with bradykinesia. 4.Buys clothes with many buttons to maintain finger dexterity.

3.Rocks back and forth to start movement with bradykinesia. The client with Parkinson's disease should exercise in the morning when energy levels are highest. The client should avoid sitting in soft deep chairs because they are difficult to get up from. The client can rock back and forth to initiate movement. The client should buy clothes with Velcro fasteners and slide-locking buckles to support the ability to dress self.

A nurse is interviewing a patient who is seeking relief for frequent headaches. Which description is consistent with symptoms of a migraine headache? 1.Extreme tenseness in the area of the neck and shoulders. 2.Tears flow from one eye and nasal drainage occurs with the headache. 3.The pain of the headache wakes the patient from sleep. 4.The pain throbs and is synchronous with the patient's pulse

4. A migraine headache is caused by a series of neurovascular events that result from some trigger stimulus. The pain usually is one-sided, throbbing in nature, and synchronous with the patient's pulse. Palpable tenseness in the neck and shoulders occurs with a tension headache. A cluster headache awakens the patient from sleep and involves tearing of one eye with nasal drainage on the same side.

Which patient may face the greatest risk of developing delirium? 1.A patient with fibromyalgia whose chronic pain recently has worsened 2.A patient with a fracture who has spent the night in the emergency department 3.An older patient whose recent computed tomography (CT) shows brain atrophy 4.An older patient who takes multiple medications to treat various health problems

4. Polypharmacy is implicated in many cases of delirium , and this phenomenon is especially common among older adults. Brain atrophy, if associated with cognitive changes, is indicative of dementia. Alterations in sleep and environment, as well as pain, may cause delirium, but this is less of a risk than in an older adult who takes multiple medications.

The nurse is teaching a client hospitalized with a seizure disorder and the client's spouse about safety precautions after discharge. The nurse determines that the client needs more information if he or she states an intention to take which action? 1.Refrain from smoking alone. 2.Take all prescribed medications on time. 3.Have the spouse nearby when showering. 4.Drink alcohol in small amounts and only on weekends.

4.Drink alcohol in small amounts and only on weekends. The client should avoid the intake of alcohol. Alcohol could interact with the client's seizure medications, or the alcohol could precipitate seizure activity. The client should take all medications on time to avoid decreases in therapeutic drug levels, which could precipitate seizures. The client should not bathe in the shower or tub without someone nearby and should not smoke alone, to minimize the risk of injury if a seizure occurs.

A nurse is caring for a patient with mild cognitive impairment (MCI). What are the manifestations that a nurse should expect to observe in this patient? Select all that apply. 1.Frequently misplaces items 2.May forget recent events 3.May not remember knowing a person 4.Becomes easily lost in familiar places 5.Has increasing difficulty finding desired words

A person with MCI may develop memory problems that can be easily noticed and measured. MCI does not affect a person's independence. The nurse should suspect mild cognitive impairment if the patient frequently misplaces items, forgets recent events, and has an increasing difficulty in finding desired words. The symptoms indicate progressive neurodegeneration. Symptoms such as not remembering a known person or becoming easily lost in familiar places indicate profound memory loss related to Alzheimer's disease.

To encourage adequate nutritional intake for a female client with Alzheimer's disease, the nurse should: A.stay with the client and encourage him to eat. B.help the client fill out his menu. C.give the client privacy during meals. D. fill out the menu for the client.

A. Staying with the client and encouraging him to feed himself will ensure adequate food intake. A client with Alzheimer's disease can forget how to eat. Allowing privacy during meals, filling out the menu, or helping the client to complete the menu doesn't ensure adequate nutritional intake.

The newly admitted patient has moderate AD. What does the nurse know this patient will need help with? a. Eating b. Walking c. Dressing d. Self-care activities

c. In the moderate stage of AD, the patient may need help with getting dressed. In the severe stage, patients will be unable to dress or feed themselves and are usually incontinent.

The nurse finds a patient in bed having a generalized tonic-clonic seizure. During the seizure activity, what actions should the nurse take (select all that apply)? a. Loosen restrictive clothing. b. Turn the patient to the side. c. Protect the patient's head from injury. d. Place a padded tongue blade between the patient's teeth. e. Restrain the patient's extremities to prevent soft tissue and bone injury.

a, b, c. The focus is on maintaining a patent airway and preventing patient injury. The nurse should not place objects in the patient's mouth or restrain the patient.

The RN in charge at a long-term care facility could delegate which activities to unlicensed assistive personnel (UAP) (select all that apply)? a. Assist the patient with eating. b. Provide personal hygiene and skin care. c. Check the environment for safety hazards. d. Assist the patient to the bathroom at regular intervals. e. Monitor for skin breakdown and swallowing difficulties.

a, b, d. All caregivers are responsible for the patient's safety. Basic care activities, such as those associated with personal hygiene and activities of daily living (ADLs) can be delegated to unlicensed assistive personnel (UAP). The RN will perform ongoing assessments and develop and revise the plan of care as needed. The RN will assess the patient's safety risk factors, provide education, and make referrals. The licensed practical nurse (LPN) could check the patient's environment for potential safety hazards.

The sister of a patient with AD asks the nurse whether prevention of the disease is possible. In responding, the nurse explains that there is no known way to prevent AD but there are ways to keep the brain healthy. What is included in the ways to keep the brain healthy (select all that apply)? a. Avoid trauma to the brain. b. Recognize and treat depression early. c. Avoid social gatherings to avoid infections. d. Do not overtax the brain by trying to learn new skills. e. Daily wine intake will increase circulation to the brain. f. Exercise regularly to decrease the risk for cognitive decline.

a, b, f. Avoiding trauma to the brain, treating depression early, and exercising regularly can maintain cognitive function. Staying socially active, avoiding intake of harmful substances, and challenging the brain to keep its connections active and create new ones also help to keep the brain healthy.

What manifestations of cognitive impairment are primarily characteristic of delirium (select all that apply)? a. Reduced awareness b. Impaired judgments c. Words difficult to find d. Sleep/wake cycle reversed e. Distorted thinking and perception f. Insidious onset with prolonged duration

a, d, e. Manifestations of delirium include cognitive impairment with reduced awareness, reversed sleep/wake cycle, and distorted thinking and perception. The other options are characteristic of dementia.

The wife of a man with moderate AD has a nursing diagnosis of social isolation related to diminishing social relationships and behavioral problems of the patient with AD. What is a nursing intervention that would be appropriate to provide respite care and allow the wife to have satisfactory contact with significant others? a. Help the wife to arrange for adult day care for the patient. b. Encourage permanent placement of the patient in the Alzheimer's unit of a long-term care facility. c. Refer the wife to a home health agency to arrange daily home nursing visits to assist with the patient's care. d. Arrange for hospitalization of the patient for 3 or 4 days so that the wife can visit out-of-town friends and relatives.

a. Adult day care is an option to provide respite for caregivers and a protective environment for the patient during the early and middle stages of AD. There are also in-home respite care providers. The respite from the demands of care allows the caregiver to maintain social contacts, perform normal tasks of living, and be more responsive to the patient's needs. Visits by home health nurses involve the caregiver and cannot provide adequate respite. Institutional placement is not always an acceptable option at earlier stages of AD, nor is hospitalization available for respite care.

A patient with Alzheimer's disease (AD) dementia has manifestations of depression. The nurse knows that treatment of the patient with antidepressants will most likely do what? a. Improve cognitive function b. Not alter the course of either condition c. Cause interactions with the drugs used to treat the dementia d. Be contraindicated because of the central nervous system (CNS)-depressant effect of antidepressants

a. Depression is often associated with AD, especially early in the disease when the patient has awareness of the diagnosis and the progression of the disease. When dementia and depression occur together, intellectual deterioration may be more extreme. Depression is treatable and use of antidepressants often improves cognitive function.

The son of a patient with early-onset AD asks if he will get AD. What should the nurse tell this man about the genetics of AD? a. The risk of early-onset AD for the children of parents with it is about 50%. b. Women get AD more often than men do, so his chances of getting AD are slim. c. The blood test for the ApoE gene to identify this type of AD can predict who will develop it. d. This type of AD is not as complex as regular AD, so he does not need to worry about getting AD.

a. The risk of early-onset AD for the children of parents with it is 50%. Women do get AD more often than men but that is more likely related to women living longer than men than to the type of AD. ApoE gene testing is used for research with late-onset AD but does not predict who will develop the disease. Late-onset AD is more genetically complex than early-onset AD and is more common in those over age 60 but because his parent has early-onset AD he is at a 50% risk of getting it.

A patient is diagnosed with cluster headaches. The nurse knows that which characteristics are associated with this type of headache (select all that apply)? a. Family history b. Alcohol is the only dietary trigger c. Abrupt onset lasting 5 to 180 minutes d. Severe, sharp, penetrating head pain e. Bilateral pressure or tightness sensation f. May be accompanied by unilateral ptosis or lacrimation

b, c, d, f. Cluster headaches have only alcohol as a dietary trigger and have an abrupt onset lasting 5 minutes to 3 hours with severe, sharp, penetrating pain. Cluster headaches may be accompanied by unilateral ptosis, lacrimation, rhinitis, facial flushing or pallor and commonly recur several times each day for several weeks, with months or years between clustered attacks. Family history and nausea, vomiting, or irritability may be seen with migraine headaches. Bilateral pressure occurring between migraine headaches and intermittent occurrence over long periods of time are characteristics of tension-type headaches.

The health care provider is trying to differentiate the diagnosis of the patient between dementia and dementia with Lewy bodies (DLB). What observations by the nurse support a diagnosis of DLB (select all that apply)? a. Tremors b. Fluctuating cognitive ability c. Disturbed behavior, sleep, and personality d. Symptoms of pneumonia, including congested lung sounds e. Bradykinesia, rigidity, and postural instability without tremor

b, e. Dementia with Lewy bodies (DLB) is diagnosed with dementia plus two of the following symptoms: (1) extrapyramidal signs such as bradykinesia, rigidity, and postural instability but not always a tremor, (2) fluctuating cognitive ability, and (3) hallucinations. The extrapyramidal signs plus tremors would more likely indicate Parkinson's disease. Disturbed behavior, sleep, personality, and eventually memory are characteristics of frontotemporal lobe degeneration (FTLD

A patient with moderate AD has a nursing diagnosis of impaired memory related to effects of dementia. What is an appropriate nursing intervention for this patient? a. Post clocks and calendars in the patient's environment. b. Establish and consistently follow a daily schedule with the patient. c. Monitor the patient's activities to maintain a safe patient environment. d. Stimulate thought processes by asking the patient questions about recent activities.

b. Adhering to a regular, consistent daily schedule helps the patient to avoid confusion and anxiety and is important both during hospitalization and at home. Clocks and calendars may be useful in early AD but they have little meaning to a patient as the disease progresses. Questioning the patient about activities and events they cannot remember is threatening and may cause severe anxiety. Maintaining a safe environment for the patient is important but does not change the disturbed thought processes

A patient with a tremor is being evaluated for Parkinson's disease. The nurse explains to the patient that Parkinson's disease can be confirmed by a. CT and MRI scans. b. relief of symptoms with administration of dopaminergic agents. c. the presence of tremors that increase during voluntary movement. d. cerebral angiogram that reveals the presence of cerebral atherosclerosis.

b. Although clinical manifestations are characteristic in PD, no laboratory or diagnostic tests are specific for the condition. A diagnosis is made when at least two of the three signs of the classic triad are present and it is confirmed with a positive response to antiparkinsonian medication. Research regarding the role of genetic testing and MRI to diagnose PD is ongoing. Essential tremors increase during voluntary movement whereas the tremors of PD are more prominent at rest.

What is one focus of collaborative care of patients with AD? a. Replacement of deficient acetylcholine in the brain b. Drug therapy for cognitive problems and undesirable behaviors c. The use of memory-enhancing techniques to delay disease progression d. Prevention of other chronic diseases that hasten the progression of AD

b. Because there is no cure for AD, collaborative management is aimed at controlling the decline in cognition, controlling the undesirable manifestations that the patient may exhibit, and providing support for the family caregiver. Anticholinesterase agents help to increase acetylcholine (ACh) in the brain but a variety of other drugs are also used to control behavior. Memoryenhancing techniques have little or no effect in patients with AD, especially as the disease progresses. Patients with AD have limited ability to communicate health symptoms and problems, leading to a lack of professional attention for acute and other chronic illnesses.

The family caregiver for a patient with AD expresses an inability to make decisions, concentrate, or sleep. The nurse determines what about the caregiver? a. The caregiver is also developing signs of AD. b. The caregiver is manifesting symptoms of caregiver role strain. c. The caregiver needs a period of respite from care of the patient. d. The caregiver should ask other family members to participate in the patient's care.

b. Family caregiver role strain is characterized by such symptoms of stress as the inability to sleep, make decisions, or concentrate. It is frequently seen in family members who are responsible for the care of the patient with AD. Assessment of the caregiver may reveal a need for assistance to increase coping skills, effectively use community resources, or maintain social relationships. Eventually the demands on a caregiver exceed the resources and the person with AD may be placed in an institutional setting.

Following a generalized tonic-clonic seizure, the patient is tired and sleepy. What care should the nurse provide? a. Suction the patient before allowing him to rest. b. Allow the patient to sleep as long as he feels sleepy. c. Stimulate the patient to increase his level of consciousness. d. Check the patient's level of consciousness every 15 minutes for an hour.

b. In the postictal phase of generalized tonic-clonic seizures, patients are usually very tired and may sleep for several hours and the nurse should allow the patient to sleep as long as necessary. Suctioning is performed only if needed and decreased level of consciousness is not a problem postictally

Which type of headache is suspected when the headaches are unilateral and throbbing, preceded by a prodrome of photophobia, and associated with a family history of this type of headache? a. Cluster b. Migraine c. Frontal-type d. Tension-type

b. Migraine headaches are frequently unilateral and usually throbbing. They may be preceded by a prodrome and frequently there is a family history. Cluster headaches are also unilateral with severe bone-crushing pain but there is no prodrome or family history. Frontal-type headache is

A patient with a seizure disorder is being evaluated for surgical treatment of the seizures. The nurse recognizes that what is one of the requirements for surgical treatment? a. Identification of scar tissue that is able to be removed b. An adequate trial of drug therapy that had unsatisfactory results c. Development of toxic syndromes from long-term use of antiseizure drugs d. The presence of symptoms of cerebral degeneration from repeated seizures

b. Most patients with seizure disorders maintain seizure control with medications but if surgery is considered, three requirements must be met: the diagnosis of epilepsy must be confirmed, there must have been an adequate trial with drug therapy without satisfactory results, and the electroclinical syndrome must be defined. The focal point must be localized but the presence of scar tissue is not required.

During the diagnosis and long-term management of a seizure disorder, what should the nurse recognize as one of the major needs of the patient? a. Managing the complicated drug regimen of seizure control b. Coping with the effects of negative social attitudes toward epilepsy c. Adjusting to the very restricted lifestyle required by a diagnosis of epilepsy d. Learning to minimize the effect of the condition in order to obtain employment

b. One of the most common complications of a seizure disorder is the effect it has on the patient's lifestyle. This is because of the social stigma attached to seizures, which causes patients to hide their diagnosis and to prefer not to be identified as having epilepsy. Medication regimens usually require only once- or twice-daily dosing and the major restrictions of lifestyle usually involve driving and high-risk environments. Job discrimination against the handicapped is prevented by federal and state laws and patients only need to identify their disease in case of medical emergencies.

A patient with AD in a long-term care facility is wandering the halls very agitated, asking for her "mommy" and crying. What is the best response by the nurse? a. Ask the patient, "Why are you behaving this way?" b. Tell the patient, "Let's go get a snack in the kitchen." c. Ask the patient, "Wouldn't you like to lie down now?" d. Tell the patient, "Just take some deep breaths and calm down."

b. Patients with moderate to severe AD frequently become agitated but because their short-term memory loss is so pronounced, distraction is a very good way to calm them. "Why" questions are upsetting to them because they don't know the answer and they cannot respond to normal relaxation techniques.

The wife of a patient who is manifesting deterioration in memory asks the nurse whether her husband has AD. The nurse explains that a diagnosis of AD is usually made when what happens? a. A urine test indicates elevated levels of isoprostanes b. All other possible causes of dementia have been eliminated c. Blood analysis reveals increased amounts of β-amyloid protein d. A computed tomography (CT) scan of the brain indicates brain atrophy

b. The only definitive diagnosis of AD can be made on examination of brain tissue during an autopsy but a clinical diagnosis is made when all other possible causes of dementia have been eliminated. Patients with AD may have β-amyloid proteins in the blood, brain atrophy, or isoprostanes in the urine but these findings are not exclusive to those with AD.

The patient is diagnosed with complex focal seizures. Which characteristics are related to complex focal seizures (select all that apply)? a. Formerly known as grand mal seizure b. Often accompanied by incontinence or tongue or cheek biting c. Psychomotor seizures with repetitive behaviors and lip smacking d. Altered memory, sexual sensations, and distortions of visual or auditory sensations e. Loss of consciousness and stiffening of the body with subsequent jerking of extremities f. Often involves behavioral, emotional, and cognitive functions with altered consciousness

c, d, f. Complex focal seizures are psychomotor seizures with automatisms such as lip smacking. They cause altered consciousness or loss of consciousness producing a dreamlike state and may involve behavioral, emotional, or cognitive experiences without memory of what was done during the seizure. In generalized tonic-clonic seizures (previously known as grand mal seizures) there is loss of consciousness and stiffening of the body with subsequent jerking of extremities. Incontinence or tongue or cheek biting may also occur.

A patient admitted to the hospital following a generalized tonic-clonic seizure asks the nurse what caused the seizure. What is the best response by the nurse? a. "So many factors can cause epilepsy that it is impossible to say what caused your seizure." b. "Epilepsy is an inherited disorder. Does anyone else in your family have a seizure disorder?" c. "In seizures, some type of trigger causes sudden, abnormal bursts of electrical brain activity." d. "Scar tissue in the brain alters the chemical balance, creating uncontrolled electrical discharges."

c. A seizure is a paroxysmal, uncontrolled discharge of neurons in the brain, which interrupts normal function, but the factor that causes the abnormal firing is not clear. Seizures may be precipitated by many factors and although scar tissue may make the brain neurons more likely to fire, it is not the usual cause of seizures. Epilepsy is established only by a pattern of spontaneous, recurring seizures.

What should be included in the management of a patient with delirium? a. The use of restraints to protect the patient from injury b. The use of short-acting benzodiazepines to sedate the patient c. Identification and treatment of underlying causes when possible d. Administration of high doses of an antipsychotic drug such as haloperidol (Haldol)

c. Care of the patient with delirium is focused on identifying and eliminating precipitating factors if possible. Treatment of underlying medical conditions, changing environmental conditions, and discontinuing medications that induce delirium are important. Drug therapy is reserved for those patients with severe agitation because the drugs themselves may worsen delirium.

During assessment of a patient with dementia, the nurse determines that the condition is potentially reversible when finding out what about the patient? a. Has long-standing abuse of alcohol b. Has a history of Parkinson's disease c. Recently developed symptoms of hypothyroidism d. Was infected with human immunodeficiency virus (HIV) 10 years ago

c. Hypothyroidism can cause dementia but it is a treatable condition if it has not been long standing. The other conditions are causes of irreversible dementi

The patient is receiving donepezil (Aricept), lorazepam (Ativan), risperidone (Risperdal), and sertraline (Zoloft) for the management of AD. What benzodiazepine medication is being used to help manage ta. Sertraline (Zoloft) b. Donepezil (Aricept) c. Lorazepam (Ativan) d. Risperidone (Risperdal)his patient's behavior?

c. Lorazepam (Ativan) is a benzodiazepine used to manage behavior with AD. Sertraline (Zoloft) is a selective serotonin reuptake inhibitor used to treat depression. Donepzil (Aricept) is a cholinesterase inhibitor used for decreased memory and cognition. Risperidone (Risperdal) is an antipsychotic used for behavior management.

To reduce the risk for falls in the patient with Parkinson's disease, what should the nurse teach the patient to do? a. Use an elevated toilet seat. b. Use a walker or cane for support. c. Consciously lift the toes when stepping. d. Rock side to side to initiate leg movements.

c. Peripheral dopamine does not cross the blood-brain barrier but its precursor, levodopa, is able to enter the brain, where it is converted to dopamine, increasing the supply that is deficient in PD. Other drugs used to treat PD include bromocriptine, which stimulates dopamine receptors in the basal ganglia, and amantadine, which blocks the reuptake of dopamine into presynaptic neurons. Carbidopa is an agent that is usually administered with levodopa to prevent the levodopa from being metabolized in peripheral tissues before it can reach the brain.

A patient at the clinic for a routine health examination mentions that she is exhausted because her legs bother her so much at night that she cannot sleep. The nurse questions the patient further about her leg symptoms with what knowledge about restless legs syndrome? a. The condition can be readily diagnosed with EMG. b. Other more serious nervous system dysfunctions may be present. c. Dopaminergic agents are often effective in managing the symptoms. d. Symptoms can be controlled by vigorous exercise of the legs during the day.

c. Restless legs syndrome that is not related to other pathologic processes, such as diabetes mellitus or rheumatic disorders, may be caused by a dysfunction in the basal ganglia circuits that use the neurotransmitter dopamine, which controls movements. Dopamine precursors and dopamine agonists, such as those used for parkinsonism, are effective in managing sensory and motor symptoms. Polysomnography studies during sleep are the only tests that have diagnostic value and although exercise should be encouraged, excessive leg exercise does not have an effect on the symptoms

The nurse teaches the patient taking antiseizure drugs that this method is most commonly used to measure compliance and monitor for toxicity. a. A daily seizure log b. Urine testing for drug levels c. Blood testing for drug levels d. Monthly electroencephalography (EEG)

c. Serum levels of antiseizure drugs are monitored regularly to maintain therapeutic levels of the drug, above which patients are likely to experience toxic effects and below which seizures are likely to occur. Many newer drugs do not require drug level monitoring because of large therapeutic ranges. A daily seizure log and urine testing for drug levels will not measure compliance or monitor for toxicity. EEGs have limited value in diagnosis of seizures and even less value in monitoring seizure control

For what purpose would the nurse use the Mini-Mental State Examination to evaluate a patient with cognitive impairment? a. It is a good tool to determine the etiology of dementia. b. It is a good tool to evaluate mood and thought processes. c. It can help to document the degree of cognitive impairment in delirium and dementia. d. It is useful for initial evaluation of mental status but additional tools are needed to evaluate changes in cognition over time.

c. The Mini-Mental State Examination is a tool to document the degree of cognitive impairment and it can be used to determine a baseline from which changes over time can be evaluated. It does not evaluate mood or thought processes but can detect dementia and delirium and differentiate these from psychiatric mental illness. It cannot help to determine etiology

A patient with Parkinson's disease is started on levodopa. What should the nurse explain about this drug? a. It stimulates dopamine receptors in the basal ganglia. b. It promotes the release of dopamine from brain neurons. c. It is a precursor of dopamine that is converted to dopamine in the brain. d. It prevents the excessive breakdown of dopamine in the peripheral tissues.

c. The bradykinesia of PD prevents automatic movements and activities such as beginning to walk, rising from a chair, or even swallowing saliva cannot be executed unless they are consciously willed. Handwriting is affected by the tremor and results in the writing trailing off at the end of words. Specific limb weakness and muscle spasms are not characteristic of PD.

Which observation of the patient made by the nurse is most indicative of Parkinson's disease? a. Large, embellished handwriting b. Weakness of one leg resulting in a limping walk c. Difficulty rising from a chair and beginning to walk d. Onset of muscle spasms occurring with voluntary movement

c. The bradykinesia of PD prevents automatic movements and activities such as beginning to walk, rising from a chair, or even swallowing saliva cannot be executed unless they are consciously willed. Handwriting is affected by the tremor and results in the writing trailing off at the end of words. Specific limb weakness and muscle spasms are not characteristic of PD.

Which type of seizure occurs in children, is also known as a petit mal seizure, and consists of a staring spell that lasts for a few seconds? a. Atonic b. Simple focal c. Typical absence d. Atypical absence

c. The typical absence seizure is also known as petit mal and the child has staring spells that last for a few seconds. Atonic seizures occur when the patient falls from loss of muscle tone accompanied by brief unconsciousness. Simple focal seizures have focal motor, sensory, or autonomic symptoms related to the area of the brain involved without loss of consciousness. Staring spells in atypical absence seizures last longer than those in typical absence seizures and are accompanied by peculiar behavior during the seizure or confusion after the seizure.

The nurse is preparing to admit a newly diagnosed patient experiencing tonic-clonic seizures. What could the nurse delegate to unlicensed assistive personnel (UAP)? a. Complete the admission assessment. b. Explain the call system to the patient. c. Obtain the suction equipment from the supply cabinet. d. Place a padded tongue blade on the wall above the patient's bed.

c. The unlicensed assistive personnel (UAP) is able to obtain equipment from the supply cabinet or department. The RN may need to provide a list of necessary equipment and should set up the equipment and ensure proper functioning. The RN is responsible for the initial history and assessment as well as teaching the patient about the room's call system. Padded tongue blades are no longer used and no effort should be made to place anything in the patient's mouth during a seizure.

A 68-year-old man is admitted to the emergency department with multiple blunt trauma following a one-vehicle car accident. He is restless; disoriented to person, place, and time; and agitated. He resists attempts at examination and calls out the name "Janice." Why should the nurse suspect delirium rather than dementia in this patient? a. The fact that he wouldn't have been allowed to drive if he had dementia b. His hyperactive behavior, which differentiates his condition from the hypoactive behavior of dementia c. The report of emergency personnel that he was noncommunicative when they arrived at the accident scene d. The report of his family that although he has heart disease and is "very hard of hearing," this behavior is unlike him

d. Delirium is an acute problem that usually has a rapid onset in response to a precipitating event, especially when the patient has underlying health problems, such as heart disease and sensory limitations. In the absence of prior cognitive impairment, a sudden onset of confusion, disorientation, and agitation is usually delirium. Delirium may manifest with both hypoactive and hyperactive symptoms

How do generalized seizures differ from focal seizures? a. Focal seizures are confined to one side of the brain and remain focal in nature. b. Generalized seizures result in loss of consciousness whereas focal seizures do not. c. Generalized seizures result in temporary residual deficits during the postictal phase. d. Generalized seizures have bilateral synchronous epileptic discharges affecting the whole brain at onset of the seizure.

d. Generalized seizures have bilateral synchronous epileptic discharge affecting the entire brain at onset of the seizure. Loss of consciousness is also characteristic but many focal seizures also include an altered consciousness. Focal seizures begin in one side of the brain but may spread to involve the entire brain. Focal seizures that start with a local focus and spread to the entire brain, causing a secondary generalized seizure, are associated with a transient residual neurologic deficit postictally known as Todd's paralysis

The husband of a patient is complaining that his wife's memory has been decreasing lately. When asked for examples of her memory loss, the husband says that she is forgetting the neighbors' names and forgot their granddaughter's birthday. What kind of loss does the nurse recognize this to be? a. Delirium b. Memory loss in AD c. Normal forgetfulness d. Memory loss in mild cognitive impairment

d. In mild cognitive impairment people frequently forget people's names and begin to forget important events. Delirium changes usually occur abruptly. In Alzheimer's disease the patient may not remember knowing a person and loses the sense of time and which day it is. Normal forgetfulness includes momentarily forgetting names and occasionally forgetting to run an errand.

When caring for a patient in the severe stage of AD, what diversion or distraction activities would be appropriate? a. Watching TV b. Playing games c. Books to read d. Mobiles or dangling ribbons

d. In the severe stage of AD, the patient is at a developmental level of 15 months or less; therefore appropriate distractions would be infant toys. Watching

What N-methyl-d-aspartate (NMDA) receptor antagonist is frequently used for a patient with AD who is experiencing decreased memory and cognition? a. Trazodone (Desyrel) b. Olanzapine (Zyprexa) c. Rivastigmine (Exelon) d. Memantine (Namenda)

d. Memantine (Namenda) is the N-methyl-d-aspartate (NMDA) receptor antagonist frequently used for AD patients with decreased memory and cognition. Trazodone (Desyrel) is an atypical antidepressant that may help with sleep problems. Olanzapine (Zyprexa) is an antipsychotic medication used for behavior management. Rivastigmine (Exelon) is a cholinesterase inhibitor used for decreased memory and cognition.

The classic triad of manifestations associated with Parkinson's disease is tremor, rigidity, and bradykinesia. What is a consequence related to rigidity? a. Shuffling gait b. Impaired handwriting c. Lack of postural stability d. Muscle soreness and pain

d. The degeneration of dopamine-producing neurons in the substantia nigra of midbrain and basal ganglia lead to this triad of signs. Muscle soreness, pain, and slowness of movement are patient function consequences related to rigidity. Shuffling gait, lack of postural stability, absent arm swing while walking, absent blinking, masked facial expression, and difficulty initiating movement are all related to bradykinesia. Impaired handwriting and hand activities are related to the tremor of Parkinson's disease (PD).

Which statement accurately describes dementia? a. Overproduction of β-amyloid protein causes all dementias. b. Dementia resulting from neurodegenerative causes can be prevented. c. Dementia caused by hepatic or renal encephalopathy cannot be reversed. d. Vascular dementia can be diagnosed by brain lesions identified with neuroimaging

d. The diagnosis of vascular dementia can be aided by neuroimaging studies showing vascular brain lesions along with exclusion of other causes of dementia. Overproduction of β-amyloid protein contributes to Alzheimer's disease (AD). Vascular dementia can be prevented or slowed by treating underlying diseases (e.g., diabetes mellitus, cardiovascular disease). Dementia caused by hepatic or renal encephalopathy potentially can be reversed.

3. What is the most important method of diagnosing functional headaches? a. CT scan b. Electromyography (EMG) c. Cerebral blood flow studies d. Thorough history of the headache

d. The primary way to diagnose and differentiate between headaches is with a careful history of the headaches, requiring assessment of specific details related to the headache. Electromyelography (EMG) may reveal contraction of the neck, scalp, or facial muscles in tensiontype headaches but this is not seen in all patients. CT scans and cerebral angiography are used to rule out organic causes of the headaches.

Which type of seizure is most likely to cause death for the patient? a. Subclinical seizures b. Myoclonic seizures c. Psychogenic seizures d. Tonic-clonic status epilepticus

d. Tonic-clonic status epilepticus is most dangerous because the continuous seizing can cause respiratory insufficiency, hypoxemia, cardiac dysrhythmia, hyperthermia, and systemic acidosis, which can all be fatal. Subclinical seizures may occur in a patient who is sedated, so there is no physical movement. Myoclonic seizures may occur in clusters and have a sudden, excessive jerk of the body that may hurl the person to the ground. Psychogenic seizures are psychiatric in origin and diagnosed with videoelectroencephalography (EEG) monitoring. They occur in patients with a history of emotional abuse or a specific traumatic episode.

What drug therapy is included for acute migraine and cluster headaches that appears to alter the pathophysiologic process for these headaches? a. β-Adrenergic blockers such as propranolol (Inderal) b. Serotonin antagonists such as methysergide (Sansert) c. Tricyclic antidepressants such as amitriptyline (Elavil) d. Specific serotonin receptor agonists such as sumatriptan (Imitrex)

d. Triptans (sumatriptan [Imitrex]) affect selected serotonin receptors that decrease neurogenic inflammation of the cerebral blood vessels and produce vasoconstriction. Both migraine headaches and cluster headaches appear to be related to vasodilation of cranial vessels and drugs that cause vasoconstriction are useful in treatment of migraine and cluster headaches. Methysergide blocks serotonin receptors in the central and peripheral nervous systems and is used for prevention of migraine and cluster headaches. β-adrenergic blockers and tricyclic antidepressants are used prophylactically for migraine headaches but are not effective for cluster headaches.