Neuro questions - Myasthenia gravis, Parkinsons, SCI, stroke, MS

Toy with a tentative diagnosis of myasthenia gravis is admitted for diagnostic make up. Myasthenia gravis can confirmed by: Kernigs sign Brudzinski's sign A positive sweat chloride test A positive edrophonium (Tensilon) test

A positive edrophonium (Tensilon) test

You're providing teaching to a group of patients with myasthenia gravis. Which of the following is not a treatment option for this condition? Plasmapheresis Cholinesterase medications Thymectomy Corticosteroids

Cholinesterase medications

The healthcare provider is assessing a patient with a diagnosis of Parkinson disease (PD). Which of the following assessments will the healthcare provider anticipate? Pill-rolling tremor when the hand is at rest An absence of stereognosis Twisting and protruding movements of the tongue Deep tendon reflexes graded as 1

Pill-rolling tremor when the hand is at rest

During an interview with a patient with a diagnosis of Parkinson disease (PD), which of the following speech patterns will the healthcare provider anticipate? Pressured and hurried Slow, slurred, and monotone Bubbly and spirited Clear and rhythmic

Slow, slurred, and monotone

Which are characteristics of autonomic dysreflexia? severe hypertension, slow heart rate, pounding headache, sweating severe hypotension, tachycardia, nausea, flushed skin severe hypertension, tachycardia, blurred vision, dry skin severe hypotension, slow heart rate, anxiety, dry skin

severe hypertension, slow heart rate, pounding headache, sweating

A patient with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take Pyridostigmine. At what time should you administer this medication so the patient will have the maximum benefit of this medication? As soon as possible 1 hour after the patient has eaten (at 1300) 1 hour before the patient eats (at 1100) at 1200 right before the patient eats

· 1 hour before the patient eats (at 1100)

A client with myasthenia gravis has been receiving Neostigmine (Prostigmin). This drug acts by: Stimulating the cerebral cortex Blocking the action of cholinesterase Replacing deficient neurotransmitters Accelerating transmission along neural swaths

Blocking the action of cholinesterase

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? Mid-afternoon Morning Evening Before bedtime

Morning

Which disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells? Multiple sclerosis Parkinson disease Huntington disease Creutzfeldt-Jakob disease

Parkinson disease

When obtaining the health history of a patient diagnosed with Parkinson disease (PD), which of the following symptoms should the healthcare provider anticipate the patient to report? "Sometimes I feel like my feet are glued to the floor." "I've been getting really severe headaches lately." "My eyes have become very sensitive to light." "I used to be able to walk up the stairs without getting out of breath."

"Sometimes I feel like my feet are glued to the floor."

Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it: Promotes the removal of antibodies that impair the transmission of impulses Stimulates the production of acetylcholine at the neuromuscular junction. Decreases the production of autoantibodies that attack the acetylcholine receptors. Inhibits the breakdown of acetylcholine at the neuromuscular junction.

Decreases the production of autoantibodies that attack the acetylcholine receptors.

Myasthenia gravis reflects a deficiency in communication by _______________ because receptors for this neurotransmitter have been destroyed. Acetylcholine Norepinephrine GABA Dopamine

Acetylcholine

Helen is diagnosed with myasthenia gravis and pyridostigmine bromide (Mestinon) therapy is started. The Mestinon dosage is frequently changed during the first week. While the dosage is being adjusted, the nurse's priority intervention is to: Administer the medication exactly on time Administer the medication with food or milk Evaluate the client's muscle strength hourly after medication Evaluate the client's emotional side effects between doses

Administer the medication exactly on time

You are a neurotrauma nurse working in a neuro ICU. What would you know is an acute emergency and is seen in clients with a cervical or high thoracic spinal cord injury after the spinal shock subsides? Tetraplegia Areflexia Autonomic dysreflexia Paraplegia

Autonomic dysreflexia

The healthcare provider is teaching a patient with a new diagnosis of Parkinson disease (PD) about lifestyle changes to make the disease more manageable. Which of the following will the healthcare provider include in the teaching? Select all that apply. Choose clothing that does not require buttons Perform range of motion exercises daily Maintain a low calorie diet, low fat diet Eat small, frequent meals Wear shoes with rubber soles

Choose clothing that does not require buttons Perform range of motion exercises daily Eat small, frequent meals

A patient who is diagnosed with Parkinson disease (PD) states, "I can't tie my shoelaces anymore." The healthcare provider recognizes that this patient's problem is due to a deficiency in which of these neurotransmitters? Dopamine Glutamate Norepinephrine Seratonin

Dopamine

A health care provider is providing community education on signs and symptoms of stroke. Which of the following best describe the signs and symptoms of a stroke? Diaphoresis and jaw pain Indigestion and shortness of breath Weakness and edema Facial droop and slurred speech

Facial droop and slurred speech

Which disturbance results in loss of half of the visual field? Homonymous hemianopsia Diplopia Nystagmus Anisocoria

Homonymous hemianopsia

The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by: Eating large, well-balanced meals Doing muscle-strengthening exercises Doing all chores early in the day while less fatigued Taking medications on time to maintain therapeutic blood levels

Taking medications on time to maintain therapeutic blood levels

You are supervising a senior nursing student who is caring for a patient with a right hemisphere stroke. Which action by the student nurse requires that you intervene? The student instructs the patient to sit up straight, resulting in the patient's puzzled expression. The student moves the patient's tray to the right side of her over-bed tray. The student assists the patient with passive range-of-motion (ROM) exercises. The student combs the left side of the patient's hair when the patient combs only the right side.

The student instructs the patient to sit up straight, resulting in the patient's puzzled expression.

When planning care for a patient diagnosed with Parkinson disease (PD), which of these patient outcomes should receive priority in the patient's plan of care? Taking a vitamin supplement each day Working on a favorite hobby Taking a daily walk around the neighborhood Toileting and bathing independently

Toileting and bathing independently

Myasthenia gravis is due to ____ receptors being blocked and destroyed by antibodies. Epinephrine Nicotinic Acetylcholine Transient

Acetylcholine

Which of the following statements made by a patient diagnosed with multiple sclerosis (MS) would alert the healthcare provider that the patient requires additional instruction about the disease? "It's important for me to inspect my skin daily make sure there aren't any injuries." "Regular exercise can help reduce fatigue and help improve my sense of balance." "I will avoid foods that are high in fiber to prevent problems with my bowels." "A hot bath in the evenings will help relax my muscles and relieve pain."

"A hot bath in the evenings will help relax my muscles and relieve pain."

A client with myasthenia gravis ask the nurse why the disease has occurred. The nurse bases the reply on the knowledge that there is: A genetic in the production acetylcholine A reduced amount of neurotransmitter acetylcholine A decreased number of functioning acetylcholine receptor sites An inhibition of the enzyme ACHE leaving the end plates folded

A decreased number of functioning acetylcholine receptor sites

Jane, a 20- year old college student is admiited to the hospital with a tentative diagnosis of myasthenia gravis. She is scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. In preparing her for this procedure, the nurse explains that her response to the medication will confirm the diagnosis if Tensilon produces: Brief exaggeration of symptoms Prolonged symptomatic improvement Rapid but brief symptomatic improvement Symptomatic improvement of just the ptosis

Rapid but brief symptomatic improvement

The most significant initial nursing observations that need to be made about a client with myasthenia include: Ability to chew and speak distinctly Degree of anxiety about her diagnosis Ability to smile and to close her eyelids Respiratory exchange and ability to swallow

Respiratory exchange and ability to swallow

Select all the signs and symptoms below that can present in myasthenia gravis Respiratory failure Increased salivation Diplopia Ptosis Slurred speech (very mild, may not see it at first) Restlessness Mask-like appearance of looking sleepy Difficulty swallowing

Respiratory failure Diplopia Ptosis Slurred speech (very mild, may not see it at first)

The health care provider is assessing a patient who is recovering from a stroke. Which of these problems should receive priority for this patient? Risk for altered coping Impaired communication Impaired mobility Risk for aspiration

Risk for aspiration

A health care provider is conducting a community education class on stroke prevention. The teaching plan for this class will include which of these instructions? "Foods high in saturated fats can be consumed in moderate amounts." "There is no correlation between diabetes and risk of stroke." "There is no known link between risk of stroke and regular exercise." "It is important to maintain a healthy weight and to control your blood pressure."

"It is important to maintain a healthy weight and to control your blood pressure."

A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: Getting too little exercise Taking excess medication Omitting doses of medication Increasing intake of fatty foods

Omitting doses of medication

Which meal option would be the most appropriate for a patient with myasthenia gravis? Roasted potatoes and cubed steak Hamburger with baked fries Clam chowder with mashed potatoes Fresh veggie tray with sliced cheese cubes

Clam chowder with mashed potatoes

The healthcare provider is exploring the health history of a patient diagnosed with Parkinson disease. During the interview, which of these questions should the healthcare provider ask the patient? Select all that apply. "Do you ever experience visual disturbances before your headaches?" "Did your muscle weakness first occur in your legs or your arms?" "Have any of your family members had difficulty writing or holding a pencil?" "Have you noticed a decrease in your sense of taste or smell?" "Do you know if you have ever been exposed to pesticides?"

"Have any of your family members had difficulty writing or holding a pencil?" "Have you noticed a decrease in your sense of taste or smell?" "Do you know if you have ever been exposed to pesticides?"

A clinician is providing education to a patient with a recent diagnosis of a transient ischemic attack (TIA). Which of the statements by the patient indicates that the patient understands the information? "Because TIAs don't cause permanent damage, I do not need to worry if I have another one." "TIAs are usually caused by large bleeds in the brain that resolve on their own." "It is important for you to seek medical attention immediately if you experience these symptoms again because they could mean that you are having a stroke." "Transient ischemic attacks (TIAs) are often caused by small bleeds in the brain that resolve on their own."

"It is important for you to seek medical attention immediately if you experience these symptoms again because they could mean that you are having a stroke." THIS IS THE BEST ANSWER, REMEMBER THEY SHOULD SEEK HELP NOW.

Which action (s) should you delegate to the experienced nursing assistant when caring for a patient with a thrombotic stroke with residual left-sided weakness? Assist patient to reposition every 2 hours. Reapply pneumatic compression boots. Remind patient to perform active ROM. Check extremities for redness and edema.

Check extremities for redness and edema.

A patient with a spinal cord injury (SCI) complains about a severe throbbing headache that suddenly started a short time ago. Assessment of the patient reveals increased blood pressure (168/94) and decreased heart rate (48/minute), diaphoresis, and flushing of the face and neck. What action should you take first? Administer the ordered acetaminophen (Tylenol). Check the Foley tubing for kinks or obstruction. Adjust the temperature in the patient's room. Notify the physician about the change in status.

Check the Foley tubing for kinks or obstruction.

A client with a C5 spinal cord injury has tetraplegia. After being moved out of the ICU, the client reports a severe throbbing headache. What should the nurse do first? Check the client's indwelling urinary catheter for kinks to ensure patency. Lower the HOB to improve perfusion. Administer PRN analgesia as prescribed. Reassure the client that headaches are expected during recovery from spinal cord injuries.

Check the client's indwelling urinary catheter for kinks to ensure patency.

Helen, a client with myasthenia gravis, begins to experience increased difficulty in swallowing. To prevent aspiration of food, the nursing action that would be most effective would be to: Change her diet order from soft foods to clear liquids Place an emergency tracheostomy set in her room Assess her respiratory status before and after meals Coordinate her meal schedule with the peak effect of her medication, Mestinon

Coordinate her meal schedule with the peak effect of her medication, Mestinon

The nurse is completing an assessment on a client with myasthenia gravis. Which of the following historical recounting provides the most significant evidence regarding when the disorder begin? Shortness of breath Sensitivity to bright light Muscle spasms Drooping eyelids

Drooping eyelids

A physician diagnoses a client with myasthenia gravis, prescribing pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the client's history. Which preexisting condition would contraindicate the use of pyridostigmine? Ulcerative colitis Blood dyscrasia Intestinal obstruction Spinal cord injury

Intestinal obstruction

The nursing assistant reports to you, the RN, that the patient with myasthenia gravis (MG) has an elevated temperature (102.20 F), heart rate of 120/minute, rise in blood pressure (158/94), and was incontinent off urine and stool. What is your best first action at this time? Administer an acetaminophen suppository. Notify the physician immediately. Recheck vital signs in 1 hour. Reschedule patient's physical therapy.

Notify the physician immediately.

A patient diagnosed with multiple sclerosis (MS) is admitted to the medical unit. When assessing the patient, which of the following will the healthcare expect to identify? Select all that apply Nystagmus Resting tremors Flaccid paralysis Scanning speech

Nystagmus Scanning speech

Which are the most commonly reported clinical manifestations of multiple sclerosis? Select all that apply. Pain Fatigue Spasticity Aphasia Depression Numbness

Pain Fatigue Spasticity Depression Numbness

While reviewing a client's chart, the nurse notices that the female client has myasthenia gravis. Which of the following statements about neuromuscular blocking agents is true for a client with this condition? The client may be less sensitive to the effects of a neuromuscular blocking agent. Succinylcholine shouldn't be used; pancuronium may be used in a lower dosage. Pancuronium shouldn't be used; succinylcholine may be used in a lower dosage Pancuronium and succinylcholine both require cautious administration.

Pancuronium and succinylcholine both require cautious administration.

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? Multiple sclerosis Myesthenia gravis Parkinson's disease Huntington's disease

Parkinson's disease

A patient with a C7 spinal cord fracture informs the nurse, "My head is killing me!" The nurse assesses a blood pressure of 210/140 mm Hg, heart rate of 48 and observes diaphoresis on the face. What is the first action by the nurse? Place the patient in a sitting position. Call the physician. Assess the patient for a full bladder. Assess the patient for a fecal impaction.

Place the patient in a sitting position.

The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirms a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is: Prostigmine (neostigmine) Atropine (atropine sulfate) Didronel (etidronate) Tensilon (edrophonium)

Prostigmine (neostigmine)

You are providing care for a patient with an acute hemorrhage stroke. The patient's husband has been reading a lot about strokes and asks why his wife did not receive alteplase. What is your best response? "Your wife was not admitted within the time frame that alteplase is usually given." "This drug is used primarily for patients who experience an acute heart attack." "Alteplase dissolves clots and may cause more bleeding into your wife's brain." "Your wife had gallbladder surgery just 6 months ago and this prevents the use of alteplase."

"Alteplase dissolves clots and may cause more bleeding into your wife's brain."

When providing discharge teaching for a client with multiple sclerosis (MS), the nurse should include which instruction? "Avoid taking daytime naps." "Avoid hot baths and showers." "Limit your fruit and vegetable intake." "Restrict fluid intake to 1,500 ml/day."

"Avoid hot baths and showers."

The healthcare provider is teaching a group of patients diagnosed with multiple sclerosis (MS) about common bladder problems. Which of the following will the healthcare provider include? Choose all answers that apply: "Drinking caffeinated beverages can help you empty your bladder completely." "Drinking lots of citrus juices will decrease the amount of bacteria in your urinary tract." "MS may cause the bladder to contract and empty more often than usual." "Drink 1.5 - 2 liters of water each day so your urine isn't too concentrated." "You should not attempt to urinate until you feel that your bladder is full." "Patients with MS are at increased risk of developing urinary tract infections."

"MS may cause the bladder to contract and empty more often than usual." "Drink 1.5 - 2 liters of water each day so your urine isn't too concentrated." "Patients with MS are at increased risk of developing urinary tract infections."

The nurse is providing health education to a client who has a C6 spinal cord injury. The client asks why autonomic dysreflexia is considered an emergency. What would be the nurse's best answer? "The sudden increase in BP can raise the ICP or rupture a cerebral blood vessel." "The suddenness of the onset of the syndrome tells us the body is struggling to maintain its normal state." "Autonomic dysreflexia causes permanent damage to delicate nerve fibers that are healing." "The sudden, severe headache increases muscle tone and can cause further nerve damage."

"The sudden increase in BP can raise the ICP or rupture a cerebral blood vessel."

Which of the following interventions will the healthcare provider put in place when caring for a patient who has been diagnosed with Parkinson disease (PD)? Select all that apply. Insert an indwelling urinary catheter Auscultate the patient's lung sounds Provide a clear liquid diet, then progress to solid foods Advise the patient to make position changes slowly Administer the prescribed stool softener Assist the patient with ambulation

Auscultate the patient's lung sounds Advise the patient to make position changes slowly Administer the prescribed stool softener Assist the patient with ambulation

Which of these measures should be included in the plan of care to prevent complications in a patient who is recovering from a stroke? Monitor cardiac rhythm Conduct a swallow evaluation Reposition every shift Assess vital signs every two hours

Conduct a swallow evaluation

The healthcare provider is assessing a patient with a diagnosis of Parkinson disease (PD). Which of the following findings would the healthcare provider anticipate? Select all that apply. Kyphosis Depression Bradykinesia Exophthalamos Receptive aphasia Daytime sleepiness

Kyphosis Depression Bradykinesia Daytime sleepiness

The initial nursing goal for a client with myasthenia gravis during the diagnostic phase of her hospitalization would be to: Develop a teaching plan Facilitate psychologic adjustment Maintain the present muscle strength Prepare for the appearance of myasthenic crisis

Maintain the present muscle strength

A client is receiving baclofen for management of symptoms associated with multiple sclerosis. The nurse evaluates the effectiveness of this medication by assessing which of the following? Sleep pattern Mood and affect Appetite Muscle spasms

Muscle spasms

In making a diagnosis of myasthenia gravis Edrophonium HCI (Tensilon) is used. The nurse knows that this drug will cause a temporary increase in: Muscle strength Symptoms Blood pressure Consciousness

Muscle strength

The patient who had a stroke needs to be fed. What instruction should you give to the nursing assistant who will feed the patient? Position the patient sitting up in bed before you feed her. Check the patient's gag and swallowing reflexes. Feed the patient quickly because there are three more waiting. Suction the patient's secretions between bites of food.

Position the patient sitting up in bed before you feed her.

The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis? Visual disturbances, including diplopia Ascending paralysis and loss of motor function Cogwheel rigidity and loss of coordination Progressive weakness that is worse at the day's end

Progressive weakness that is worse at the day's end

A student is assisting the healthcare provider with the care of a patient diagnosed with multiple sclerosis (MS). The student correctly identifies which of the following as part of the pathophysiological process of MS? Choose all answers that apply: Scarring and plaque development Hypoxic damage to cerebral tissue Deficiency of acetylcholine at the neuromuscular junction Axonal loss in the central nervous system Myelin regeneration and remission of symptoms Autoimmune damage to myelin sheath

Scarring and plaque development Myelin regeneration and remission of symptoms Autoimmune damage to myelin sheath

The nurse is caring for a client immediately following a spinal cord injury (SCI). Which is an acute complication of SCI? Cardiogenic shock Tetraplegia Spinal Shock Paraplegia

Spinal Shock

The neurologist is conducting a Tensilon test (Edrophonium) at the bedside of a patient who is experiencing unexplained muscle weakness, double vision, difficulty breathing, and ptosis. Which findings after the administration of Edrophonium would represent the patient has myasthenia gravis? The patient experiences worsening of the muscle weakness. The patient experiences wheezing along with facial flushing. The patient reports a tingling sensation in the eyelids and sudden ringing in the ears. The patient experiences improved muscle strength.

The patient experiences improved muscle strength.