Neuro Dx MCQs
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. Reduction in the appearance of new lesions on magnetic resonance imaging (MRI) C. Increased muscle strength in the upper extremities D. Promotion of urinary continence
A Baclofen, a GABA agonist, is the medication of choice in treating spasms. It can be administered orally or by intrathecal injection. It is not used to promote continence or to increase strength. Avonex and Betaseron reduce the appearance of new lesions on the MRI.
The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding? A. Dysphonia B. Hypokinesia C. Micrographia D. Dysphagia
A Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.
A male patient presents to the clinic complaining of a headache. The nurse notes that the patient is guarding his neck, and he tells the nurse that he has stiffness in the neck area. The nurse suspects the patient may have meningitis. What is another well-recognized sign of this infection? A. Positive Kernig's sign B. Hyperactive patellar reflex C. Sluggish pupil reaction D. Negative Brudzinski's sign
A Meningeal irritation results in a number of well-recognized signs commonly seen in meningitis, such as a positive Kernig's sign, a positive Brudzinski's sign, and photophobia. Hyperactive patellar reflex and a sluggish pupil reaction are not common signs of meningitis.
Which of the following is the first-line therapy for myasthenia gravis (MG)? A. Pyridostigmine bromide (Mestinon) B. Azathioprine (Imuran) C. Deltasone (Prednisone) D. Lioresal (Baclofen)
A Mestinon, an anticholinesterase medication, is the first-line therapy in MG. It provides symptomatic relief by inhibiting the breakdown of acetylcholine and increasing the relative concentration of available acetylcholine at the neuromuscular junction. If Mestinon does not improve muscle strength and control fatigue, the next agents used are immunosuppressant agents. Imuran is an immunosuppressive agent that inhibits T lymphocytes and reduces acetylcholine receptor antibody levels. Baclofen is used in the treatment of spasticity in MG.
A patient is admitted to the hospital for management of an extrapyramidal disorder. Included in the physician's admitting orders are the medications levodopa, benztropine, and selegiline. The nurse knows that most likely, the client has a diagnosis of: A. Parkinson disease. B. seizure disorder. C. multiple sclerosis. D. Huntington disease.
A PD affects extrapyramidal tracts. Although antiparkinson drugs are used in some clients with Huntington disease, these drugs are most commonly used in the medical management of Parkinson disease.
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. Treatment with antimicrobial prophylaxis as soon as possible B. Admission to the nearest hospital for observation C. No treatment unless the roommate begins to show symptoms D. Bedrest at home for 72 hours
A People in close contact with clients who have meningococcal meningitis should be treated with antimicrobial chemoprophylaxis, ideally within 24 hours after exposure.
The nurse is caring for a client admitted with a diagnosis of septic meningitis. The nurse is aware that this infection is caused by which of the following? A. Bacteria B. Leukemia C. Virus D. Lymphoma
A Septic meningitis is caused by bacteria. In aseptic meningitis, the cause is viral or secondary to lymphoma, leukemia, or human immunodeficiency virus.
A 70-year-old woman is being treated at home for Parkinson's disease (PD), a health problem that she was diagnosed with 18 months ago. The nurse who is participating in the woman's care should be aware that her initial symptoms most likely consisted of: A. Tremors and muscle rigidity B. Fatigue and respiratory difficulties C. Visual disturbances and muscle weakness D. Increasing forgetfulness and confusion
A The cardinal signs of PD are tremor, rigidity, akinesia/bradykinesia, and postural disturbances. (TRAP)
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. "The paralysis caused by this disease is temporary." B. "You'll be permanently paralyzed; however, you won't have any sensory loss." C. "It must be hard to accept the permanency of your paralysis." D. "You'll first regain use of your legs and then your arms."
A 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.
Select all the signs and symptoms below that can present in myasthenia gravis: A. Respiratory failure B. Increased salivation C. Diplopia D. Ptosis E. Slurred speech F. Restlessness G. Mask-like appearance of looking sleepy H. Difficulty swallowing
A,C,D,E,F,G,H MG results in muscle weakness (lower motor neuron issue-> flaccid paralysis = loss of tone). Muscular symptoms related to loss of tone are expected. Of note, restlessness is from hypoxia d/t respiratory failure.
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? A. Inform the patient that the muscle function will return as soon as the virus dissipates. B. Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone. C. Suggest applying cool compresses on the face several times a day to tighten the muscles. D. Tell the patient to smile every 4 hours.
B After the sensitivity of the nerve to touch decreases and the patient can tolerate touching the face, the nurse can suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone. Facial exercises, such as wrinkling the forehead, blowing out the cheeks, and whistling, may be performed with the aid of a mirror to prevent muscle atrophy. Exposure of the face to cold and drafts is avoided.
Which of the following tests confirms the diagnosis of myasthenia gravis (MG)? A. Computed tomography (CT) scan B. Tensilon test C. Serum studies D. Electromyogram (EMG)
B Edrophonium chloride (Tensilon) is an acetylcholinesterase inhibitor that stops the breakdown of acetylcholine. The drug is used because it has a rapid onset of 30 seconds and a short duration of 5 minutes. Immediate improvement in muscle strength after administration of this agent represents a positive test and usually confirms the diagnosis.
The nurse is taking health history from a client admitted to rule out Guillain-Barre syndrome. An important question to ask related to the diagnosis is which of the following? A. "Have you experienced any ptosis in the last few weeks?" B. "Have you experienced any viral infections in the last month?" C. "Have you developed any new allergies in the last year?" D. "Have you had difficulty with urination in the last 6 weeks?"
B For GB, an antecedent event (most often a viral infection) precipitates clinical presentation. The antecedent event usually occurs about 2 weeks before the symptoms begin.
Myasthenia gravis occurs when antibodies attack which receptor sites? GABA Acetylcholine Serotonin Dopamine
B In myasthenia gravis, antibodies directed at the acetylcholine receptor sites impair transmission of impulses across the myoneural junction. Serotonin, dopamine, and GABA are not receptor sites that are attacked in myasthenia gravis.
A nurse is caring for a client admitted to the unit with a seizure disorder. The client seems upset and asks the nurse, "What will they do to me? I'm scared of the tests and of what they'll find out." The nurse should focus her teaching plans on which diagnostic tests? A. Transesophageal echocardiogram (TEE), troponin levels, and a complete blood count B. EEG, blood cultures, and neuroimaging studies C. X-ray of the brain, bone marrow aspiration, and EEG D. Electrocardiography, TEE, prothrombin time (PT), and International Normalized Ratio (INR)
B Providers use EEG and neuroimaging studies to diagnose neurologic problems. Blood cultures can identify infection that can cause seizures.
The diagnosis of multiple sclerosis is based on which test? A. CSF electrophoresis B. Magnetic resonance imaging C. Evoked potential studies D. Neuropsychological testing
B The diagnosis of MS is based on the presence of multiple plaques in the central nervous system observed with magnetic resonance imaging. Electrophoresis of CSF identifies the presence of oligoclonal banding. Evoked potential studies can help define the extent of the disease process and monitor changes. Neuropsychological testing may be indicated to assess cognitive impairment. (Image: MRI of MS patient; white areas show areas of demyelination)
You're a home health nurse providing care to a patient with myasthenia gravis. Today you plan on helping the patient with bathing and exercising. When would be the best time to visit the patient to help these tasks? A. Mid-afternoon B. Morning C. Evening D. Before bedtime
B atients with MG tend to have the best muscle strength in the morning after sleeping or resting rather than at the end of the day....the muscles are tired from being used and the muscle become weaker as the day progresses etc. Therefore any rigorous activities are best performed in the morning or after the patient has rested.
A 44-year-old woman has been admitted to the medical unit because of a recent exacerbation of multiple sclerosis. Which of the following nursing actions should be prioritized in this patient's care? A. Implement universal infection control precautions. B. Reorient the patient to time and place during interactions. C. Institute measures to reduce the patient's risk of falls. D. Provide a liquid diet.
C Involvement of the cerebellum or basal ganglia can produce ataxia (impaired coordination of movements) and tremor. This phenomenon, combined with muscle weakness, creates a risk of falls. Severe confusion is less common, and the patient does not normally have a greatly increased risk of infection. A liquid diet is not necessary
A 55-year-old female client presents at the walk-in clinic complaining of feeling like a mask is on her face. While doing the initial assessment, the nurse notes the demonstration of a pill-rolling movement in the right hand and a stooped posture. Physical examination shows bradykinesia and a shuffling gait. What would the nurse suspect is the causative factor for these symptoms? A. Multiple sclerosis B. Myasthenia gravis C. Huntington's disease D. Parkinson's disease
D Early signs include stiffness, referred to as rigidity, and tremors of one or both hands, described as pill-rolling (a rhythmic motion of the thumb against the fingers). The hand tremor is obvious at rest and typically decreases when movement is voluntary, such as picking up an object. Bradykinesia, slowness in performing spontaneous movements, develops. Clients have a masklike expression, stooped posture, hypophonia (low volume of speech), and difficulty swallowing saliva. Weight loss occurs. A shuffling gait is apparent, and the client has difficulty turning or redirecting forward motion. Arms are rigid while walking.
Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of demyelination in the brain and spinal cord? A. Creutzfeldt-Jakob disease B. Huntington disease C. Parkinson disease D. Multiple sclerosis
D MS is associated with demyelination of CNS and resulting neurodegeneration. Parkinson disease is associated with decreased levels of dopamine caused by destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia. Creutzfeldt-Jakob disease is a rare, transmissible, progressive fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.
A client with epilepsy is having a seizure. What intervention should the nurse do after the seizure? A. Place a cooling blanket beneath the client. B. Help the client sit up. C. Pry the client's mouth open to allow a patent airway. D. Keep the client on one side.
D The nurse will need to keep the client on one side to prevent aspiration. Make sure the airway is patent. On awakening, reorient the client to the environment. If the client is confused or wandering, guide the client gently to a bed or chair. If the client becomes agitated after a seizure (postictal), stay a distance away, but close enough to prevent injury until the client is fully aware.
