NURS 301 PrepU Neuro, Autoimmune & Neuropathies
The nurse is assisting with administering a Tensilon test to a patient with ptosis. If the test is positive for myasthenia gravis, what outcome does the nurse know will occur? 1) Eight hours after administration, the acetylcholinesterase begins to regenerate the available acetylcholine and will relieve symptoms. 2) Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes. 3) The patient will have recovery of symptoms for at least 24 hours after the administration of the Tensilon. 4) After administration of the medication, there will be no change in the status of the ptosis or facial weakness.
2
Which of the following is considered a central nervous system (CNS) disorder? 1) Myasthenia gravis 2) Multiple sclerosis 3) Guillain-Barré 4) Bell's palsy
2
A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by: 1) a positive edrophonium (Tensilon) test. 2) Brudzinski's sign. 3) Kernig's sign. 4) a positive sweat chloride test.
1
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? 1) "You'll first regain use of your legs and then your arms." 2) "The paralysis caused by this disease is temporary." 3) "It must be hard to accept the permanency of your paralysis." 4) "You'll be permanently paralyzed; however, you won't have any sensory loss."
2
A client with myasthenia gravis is admitted with an exacerbation. The nurse is educating the client about plasmapheresis and explains this in which of the following statements? 1) Immune globulin is given intravenously. 2) Antibodies are removed from the plasma. 3) The thymus gland is removed. 4) Mestinon therapy is initiated.
2
A nurse is teaching a client with multiple sclerosis (MS). When teaching the client how to reduce fatigue, the nurse should tell the client to: 1) take a hot bath. 2) rest in an air-conditioned room. 3) increase the dose of muscle relaxants. 4) avoid naps during the day.
2
During a Tensilon test to determine if a patient has myasthenia gravis, the patient complains of cramping and becomes diaphoretic. Vital signs are BP 130/78, HR 42, and respiration 18. What intervention should the nurse prepare to do? 1) Call the rapid response team because the patient is preparing to arrest. 2) Administer atropine to control the side effects of edrophonium. 3) Place the patient in the supine position. 4) Administer diphenhydramine (Benadryl) for the allergic reaction.
2
The nurse is performing an initial nursing assessment on a client with possible Guillain-Barre syndrome. Which of the following findings would be most consistent with this diagnosis? 1) Fever and cough 2) Muscle weakness and hyporeflexia of the lower extremities 3) Ptosis and muscle weakness of upper extremities 4) Hyporeflexia and skin rash
2
While performing an initial nursing assessment on a client admitted with suspected tic douloureux (trigeminal neuralgia), for which of the following would the nurse expect to observe? 1) Ptosis and diplopia 2) Facial pain in the areas of the fifth cranial nerve 3) Hyporeflexia and weakness of the lower extremities 4) Fatigue and depression
2
A 45-year-old client is admitted to the facility with excruciating paroxysmal facial pain. He reports that the episodes occur most often after feeling cold drafts and drinking cold beverages. Based on these findings, the nurse determines that the client is most likely suffering from which neurologic disorder? 1) Migraine headache 2) Bell's palsy 3) Trigeminal neuralgia 4) Angina pectoris
3
The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe? 1) Patchy blindness 2) Loss of proprioception 3) Diplopia and ptosis 4) Numbness
3
The parents of a client intubated due to the progression of Guillain-Barré syndrome ask whether their child will die. What is the best response by the nurse? 1) "Don't worry; your child will be fine." 2) "Once Guillain-Barré syndrome progresses to the diaphragm, survival decreases significantly." 3) "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive." 4) "It's too early to give a prognosis."
3
Which nursing intervention is the priority for a client in myasthenic crisis? 1) Ensuring adequate nutritional support 2) Preparing for plasmapheresis 3) Assessing respiratory effort 4) Administering intravenous immunoglobin (IVIG) per orders
3
Myasthenia gravis occurs when antibodies attack which receptor sites? 1) Dopamine 2) GABA 3) Serotonin 4) Acetylcholine
4
The diagnosis of multiple sclerosis is based on which test? 1) Evoked potential studies 2) CSF electrophoresis 3) Neuropsychological testing 4) Magnetic resonance imaging
4
The nurse is performing an initial assessment on a client admitted to rule out Guillain-Barre syndrome. On which of the following areas will the nurse focus most heavily? 1) Gastrointestinal 2) Skin 3) Urinary 4) Respiratory
4
The nurse is performing an initial assessment on a client with suspected Bell's palsy. Which of the following findings would the nurse be most focused on related to this medical diagnosis? 1) Ptosis and diplopia 2) Fatigue and depression 3) Hyporeflexia and weakness of the lower extremities 4) Facial distortion and pain
4
Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of demyelination in the brain and spinal cord? 1) Parkinson disease 2) Huntington disease 3) Creutzfeldt-Jakob disease 4) Multiple sclerosis
4
A client has been hospitalized for diagnostic testing. The client has just been diagnosed with multiple sclerosis, which the physician explains is an autoimmune disorder. How would the nurse explain an autoimmune disease to the client? 1) A disorder in which killer T cells and autoantibodies attack or destroy natural cells—those cells that are "self" 2) A disorder in which histocompatible cells attack the immunoglobulins 3) A disorder in which the body has too many immunoglobulins 4) A disorder in which the body does not have enough immunoglobulins
1
A patient suspected of having Guillain-Barré syndrome has had a lumbar puncture for cerebrospinal fluid (CSF) evaluation. When reviewing the laboratory results, what does the nurse find that is diagnostic for this disease? 1) Elevated protein levels in the CSF 2) Red blood cells present in the CSF 3) Glucose in the CSF 4) White blood cells in the CSF
1
A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide (Mestinon) on time. The nurse gets busy and does not administer the medication until after breakfast. What outcome will the patient have related to this late dose? 1) The muscles will become fatigued and the patient will not be able to chew food or swallow pills. 2) There should not be a problem, since the medication was only delayed by about 2 hours. 3) The patient will require a double dose prior to lunch. 4) The patient will go into cardiac arrest.
1
When providing discharge teaching for a client with multiple sclerosis (MS), the nurse should include which instruction? 1) "Avoid taking daytime naps." 2) "Avoid hot baths and showers." 3) "Limit your fruit and vegetable intake." 4) "Restrict fluid intake to 1,500 ml/day."
2
A client is undergoing testing to confirm a diagnosis of myasthenia gravis. The nurse explains that a diagnosis is made if muscle function improves after the client receives an IV injection of a medication. What is the medication the nurse tells the client he'll receive during this test? 1) Azathioprine (Imuran) 2) Cyclosporine (Sandimmune) 3) Edrophonium (Tensilon) 4) Immunoglobulin G (Iveegam EN)
3
A client with Guillain-Barre syndrome cannot swallow and has a paralytic ileus; the nurse is administering parenteral nutrition intravenously. The nurse is careful to assess which of the following related to intake of nutrients? 1) Condition of skin 2) Respiratory status 3) Gag reflex and bowel sounds 4) Urinary output and capillary refill
3