Test 2 Practice Test

The nurse identifies the concept of intracranial regulation disturbance in a client diagnosed with Parkinson's Disease. Which priority intervention should the nurse implement? 1. Keep the bed low and call light in reach. 2. Provide a regular diet of three (3) meals per day. 3. Obtain an order for home health to see the client. 4. Perform the Braden scale skin assessment.

1

After reviewing the health record shown in the accompanying figure for a patient who has multiple risk factors for Alzheimer's disease (AD), which topic will be most important for the nurse to discuss with the patient? a) Tobacco use b) Cholesterol level c) Family history d) Head injury history

A

Priority Decision: When planning care for the patient with trigeminal neuralgia, which patient outcome should the nurse set as the highest priority? a) Relief of pain b) Protection of the cornea c) Maintenance of nutrition d) Maintenance of positive body image

A

The nurse performs discharge teaching for a 34-yr-old male patient with a thoracic spinal cord injury (T2) from a construction accident. Which patient statement indicates teaching about autonomic dysreflexia is successful? a) "I will perform self-catheterization at least six times per day." b) "A reflex erection may cause an unsafe drop in blood pressure." c) "If I develop a severe headache, I will lie down for 15 to 20 minutes." d) "I can avoid this problem by taking medications to prevent leg spasms."

A

Which action will the nurse include in the plan of care for a patient who is experiencing pain from trigeminal neuralgia? a) Assess fluid and dietary intake. b) Apply ice packs for 20 minutes. c) Teach facial relaxation techniques. d) Spend time talking with the patient.

A

Which clinical manifestation would the nurse interpret as a manifestation of neurogenic shock in a patient with acute spinal cord injury? a) Bradycardia b) Hypertension c) Neurogenic spasticity d) Bounding pedal pulses

A

While providing discharge teaching to a patient prescribed Ropinirole (Requip), you make it priority to teach the patient about what side effect?* A. Drowsiness B. Dry mouth C. Coughing D. Dark sweat or saliva

A

You have a patient who has a brain tumor and is at risk for seizures. In the patient's plan of care you incorporate seizure precautions. Select below all the proper steps to take in initiating seizure precautions: (Select all that apply)* A. Oxygen and suction at bedside B. Bed in highest position C. Remove all pillows from the patient's head D. Have restraints on stand-by E. Padded bed rails F. Remove restrictive objects or clothing from patient's body G. IV access

A, E, F, G

Mitoxantrone is being considered as treatment for a patient with progressive-relapsing MS. The nurse explains that a disadvantage of this drug compared with other drugs used for MS is what? a) It must be given subcutaneously every day. b) It has a lifetime dose limit because of cardiac toxicity. c) It is a muscle relaxant that increases the risk for drowsiness. d) It is an anticholinergic agent that causes urinary incontinence.

B

The early stage of AD is characterized by a) no noticeable change in behavior. b) memory problems and mild confusion. c) increased time spent sleeping or in bed. d) incontinence, agitation, and wandering behavior.

B

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

The nurse assessing a patient with newly diagnosed trigeminal neuralgia will ask the patient about a) visual problems caused by ptosis. b) triggers leading to facial discomfort. c) poor appetite caused by loss of taste. d) weakness on the affected side of the face.

B

The nurse is admitting a patient who has a neck fracture at the C6 level to the intensive care unit. Which assessment findings indicate neurogenic shock? a) Involuntary and spastic movement b) Hypotension and warm extremities c) Hyperactive reflexes below the injury d) Lack of sensation or movement below the injury

B

The nurse teaches a 38-yr-old woman who has migraine headaches about sumatriptan (Imitrex). Which statement by the patient requires clarification by the nurse? a. "The injection might feel like a bee sting." b. "This medicine will prevent a migraine headache." c. "I can take another dose if the first does not work." d. "This drug for migraine headaches could cause birth defects."

B

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

What is one focus of interprofessional 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

A 25-yr-old male patient who is a professional motocross racer has anterior spinal cord syndrome at T10. His history is significant for tobacco, alcohol, and marijuana use. What is the nurse's priority when planning for rehabilitation? a) Prevent urinary tract infection. b) Monitor the patient every 15 minutes. c) Encourage him to verbalize his feelings. d) Teach him about using the gastrocolic reflex.

C

In providing care for patients with chronic, progressive neurologic disease, what is the major goal of treatment that the nurse works toward? a) Meet the patient's personal care needs. b) Return the patient to normal neurologic function. c) Maximize neurologic functioning for as long as possible. d) Prevent the future development of additional chronic diseases.

C

Keeping the previous question in mind, the patient is now experiencing characteristics of a tonic-clonic seizure. The seizure started at 1402 and it is now 1408, and the patient is still experiencing a seizure. The nurse should?* A. Continue to monitor the patient B. Suction the patient C. Initiate the emergency response system D. Restrain the patient to prevent further injury

C

Neurons in the brain are tasked with handling and transmitting information. There are different types of neurons, such as excitatory and inhibitory. Excitatory neurons release the neurotransmitter _____________, while inhibitory neurons release the neurotransmitter ________________.* A. GABA, glutamate B. Norepinephrine, GABA C. Glutamate, GABA D. Dopamine, glutamate

C

Priority Decision: A patient with MS has a nursing diagnosis of self-care deficit related to muscle spasticity and neuromuscular deficits. In providing care for the patient, what is most important for the nurse to do? a) Teach the family members how to care adequately for the patient's needs. b) Encourage the patient to maintain social interactions to prevent social isolation. c) Promote the use of assistive devices so that the patient can participate in self-care activities. d) Perform all activities of daily living (ADLs) for the patient to conserve the patient's energy.

C

True or False: A patient who is experiencing a tonic-clonic seizure is experiencing a focal (partial) seizure.* True False

False

A patient is admitted to the emergency department (ED) with SCI at the level of T2. Which finding is of most concern to the nurse? a) SpO2 of 92% b) Heart rate of 42 bpm c) Blood pressure of 88/60 mm Hg d) Loss of motor and sensory function in arms and legs

B

A nurse is assessing a client who has new diagnosis of osteoarthritis. Which of the following findings should the nurse expect? (Select all that apply) a. Crepitus with joint movement b. Decreased range of motion of the affected joint c. Low-grade fever d. Spongy tissue over the joints e. Joint pain that resolves with rest

A, B, E

The client is diagnosed with ALS. Which client problem would be most appropriate for this client? 1. Disuse syndrome. 2. Altered body image. 3. Fluid and electrolyte imbalance. 4. Alteration in pain.

1

The client is in the terminal stage of ALS. Which intervention should the nurse implement? 1. Perform passive ROM every two (2) hours. 2. Maintain a negative nitrogen balance. 3. Encourage a low-protein, soft-mechanical diet. 4. Turn the client and have him cough and deep breathe every shift.

1

The nurse and the unlicensed assistive personnel (UAP) are caring for clients on a medical-surgical unit. Which task should not be assigned to the UAP? 1. Feed the 69-year-old client diagnosed with Parkinson's disease who is having difficulty swallowing. 2. Turn and position the 89-year-old client diagnosed with a pressure ulcer secondary to Parkinson's disease. 3. Assist the 54-year-old client diagnosed with Parkinson's disease with toilet-training activities. 4. Obtain vital signs on a 72-year-old client diagnosed with pneumonia secondary to Parkinson's disease.

1

The rehabilitation nurse caring for the client with an Lumbar SCI is developing the nursing care plan. Which intervention should the nurse implement? 1. Keep oxygen via nasal cannula on at all times. 2. Administer low-dose subcutaneous anticoagulants. 3. Perform active lower extremity ROM exercises. 4. Refer to a speech therapist for ventilatorassisted speech.

2

The nurse observes a patient ambulating in the hospital hall when the patient's arms and legs suddenly jerk and the patient falls to the floor. The nurse will first a) assess the patient for a possible injury. b) give the scheduled divalproex (Depakote). c) document the timing and description of the seizure. d) notify the patient's health care provider about the seizure.

A

When caring for a patient with Alzheimer's disease, which task could be delegated to the LPN/LVN on the team? a) Administer enteral feedings via a gastrostomy tube. b) Teach patient and caregivers memory enhancement aids. c) Use bed alarms and frequent monitoring to decrease fall risk. d) Make referrals for community services such as adult day care.

A

Which action will the nurse include in the plan of care for a patient who has a cauda equina spinal cord injury? a) Catheterize patient every 3 to 4 hours. b) Assist patient to ambulate 4 times daily. c) Administer medications to reduce bladder spasm. d) Stabilize the neck when repositioning the patient.

A

Which care measure is a priority for a patient with multiple sclerosis (MS)? a. Vigilant infection control and adherence to standard precautions b. Careful monitoring of neurologic assessment and frequent reorientation c. Maintenance of a calorie count and hourly assessment of intake and output d. Assessment of blood pressure and monitoring for signs of orthostatic hypotension

A

A patient is suspected of having multiple sclerosis. The neurologist orders various test. The patient's MRI results are back and show lesions on the cerebellum and optic nerve. What signs and symptoms below would correlate with this MRI finding in a patient with multiple sclerosis?* A. Blurry vision B. Pain when moving eyes C. Dysarthria D. Balance and coordination issues E. "Pill rolling" of fingers and hands G. Heat intolerance H. Dark spots in vision I. Ptosis

A, B, C, D, H

A patient with Parkinson's disease is admitted to the hospital for treatment of pneumonia. Which nursing interventions will be included in the plan of care (select all that apply)? a) Provide an elevated toilet seat. b) Cut patient's food into small pieces. c) Serve high-protein foods at each meal. d) Place an armchair at the patient's bedside. e) Observe for sudden exacerbation of symptoms.

A, B, D

Patient-Centered Care: 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

A patient who has been treated for status epilepticus in the emergency department will be transferred to the medical nursing unit. Which equipment should the nurse have available in the patient's assigned room (select all that apply)? a) Side-rail pads b) Suction tubing c) Tongue blade d) Urinary catheter e) Oxygen mask f) Nasogastric tube

A, C, D

For a patient with moderate cognitive impairment, the HCP is trying to differentiate between a diagnosis of 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, D

The nurse is providing care for a patient diagnosed with Guillain-Barré syndrome. Which assessment should be the nurse's priority? a) Pain assessment b) Glasgow Coma Scale c) Respiratory assessment d) Musculoskeletal assessment

C

A 22-yr-old patient seen at the health clinic with a severe migraine headache tells the nurse about having similar headaches recently. Which initial action should the nurse take? a) Teach about the use of triptan drugs. b) Refer the patient for stress counseling. c) Ask the patient to keep a headache diary. d) Suggest the use of muscle-relaxation techniques.

C

A 22-yr-old woman with paraplegia after a spinal cord injury tells the home care nurse she experiences bowel incontinence two or three times each day. Which action by the nurse is most appropriate? a) Insert a rectal stimulant suppository. b) Teach the patient to gradually increase intake of high-fiber foods. c) Assess bowel movements for frequency, consistency, and volume. d) Instruct the patient to avoid all caffeinated and carbonated beverages.

C

A nurse is assessing a client who had a right hemispheric stroke. Which of the following neurologic deficits should the nurse expect? a. Aphasia b. Right-sided neglect c. Impulsive behavior d. Inability to read

C

A patient hospitalized with a new diagnosis of Guillain-Barré syndrome has numbness and weakness of both feet. The nurse will anticipate teaching the patient about a) infusion of immunoglobulin b) intubation and mechanical ventilation. c) administration of corticosteroid drugs. d) insertion of a nasogastric (NG) feeding tube.

D

A patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which information indicates a need for change in the medication or dosage? a) Shuffling gait b) Cogwheel rigidity of limbs c) Tremor at rest d) Uncontrolled head movement

D

A 62-yr-old patient who has Parkinson's disease is taking bromocriptine (Parlodel). Which information obtained by the nurse may indicate a need for a decrease in the dosage? a) The patient has a chronic dry cough. b) The patient has four loose stools in a day. c) The patient develops a deep vein thrombosis. d) The patient's blood pressure is 92/52 mm Hg.

D

A 7-year-old male patient is being evaluated for seizures. While in the child's room talking with the child's parents, you notice that the child appears to be daydreaming. You time this event to be 10 seconds. After 10 seconds, the child appropriately responds and doesn't recall the event. This is known as what type of seizure?* A. Focal Impaired Awareness (complex partial) B. Atonic C. Tonic-clonic D. Absence

D

To reduce the risk for falls in the patient with Parkinson's disease, what is the best thing the nurse should teach the patient to do? a) Use an elevated toilet seat. b) Use a wheelchair for mobility. c) Use a walker or cane for support. d) Consciously lift the toes when stepping.

D

True or False: Multiple Sclerosis tends to affect men more than women and occurs during the ages of 50-70 years.* True False

False

True or False: Parkinson's Disease most commonly affects patients in young adulthood, and there is currently no cure for the disease.* True False

False

True or False: Patients with multiple sclerosis have different signs and symptoms because this disease can affect various areas of the peripheral nervous system.* True False

False

Which type of seizure is most likely to cause death for the patient? a) Status epilepticus b) Myoclonic seizures c) Subclinical seizures d) Psychogenic seizures

A

You're assessing a patient who recently experienced a focal type seizure (partial seizure). As the nurse, you know that which statement by the patient indicates the patient may have experienced a focal impaired awareness (complex partial) seizure?* A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this." B. "I remember having vision changes, but it didn't last long." C. "I woke up on the floor with my mouth bleeding." D. "After the seizure I was very sleepy, and I had a headache for several hours."

A

A 33-yr-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching? a) Recommendation to drink at least 4 L of fluid daily b) Need to avoid driving or operating heavy machinery c) How to draw up and administer injections of the medication d) Use of contraceptive methods other than oral contraceptives

C

Benzodiazepines are indicated in the treatment of delirium caused by which condition? a) Polypharmacy b) Cerebral hypoxia c) Alcohol withdrawal d) Electrolyte imbalances

C

While the nurse is transporting a patient on a stretcher to the radiology department, the patient begins having a tonic-clonic seizure. Which action should the nurse take? a) Insert an oral airway during the seizure to maintain a patent airway. b) Restrain the patient's arms and legs to prevent injury during the seizure. c) Time and observe and record the details of the seizure and postictal state. d) Avoid touching the patient to prevent further nervous system stimulation.

C

You're educating a patient about the pathophysiology of myasthenia gravis. While explaining the involvement of the thymus gland, the patient asks you where the thymus gland is located. You state it is located?* A. behind the thyroid gland B. within the adrenal glands C. behind the sternum in between the lungs D. anterior to the hypothalamus

C

You're patient with Parkinson's Disease has been taking Carbidopa/Levodopa for several years. The patient reports that his signs and symptoms actually become worse before the next dose of medication is due. As the nurse, you know what medication can be prescribed with this medication to help decrease this for happening?* A. Anticholinergic (Benztropine) B. Dopamine agonists (Ropinirole) C. COMT Inhibitor (Entacapone) D: Beta blockers (Metoprolol)

C

Your patient has a history of epilepsy. While helping the patient to the restroom, the patient reports having this feeling of déjà vu and seeing spots in their visual field. Your next nursing action is to?* A. Continue assisting the patient to the restroom and let them sit down. B. Initiate the emergency response system. C. Lay the patient down on their side with a pillow underneath the head. D. Assess the patient's medication history.

C

Your patient has entered the post ictus stage for seizures. The patient's seizure presented with an aura followed by body stiffening and then recurrent jerking. The patient had incontinence and bleeding in the mouth from injury to the tongue. What is an expected finding in this stage based on the type of seizure this patient experienced?* A. Crying and anxiety B. Immediate return to baseline behavior C. Sleepy, headache, and soreness D. Unconsciousness

C

Which medications below can help treat muscle spasms in a patient with multiple sclerosis? Select all that apply:* A. Propranolol B. Isoniazid C. Baclofen D. Diazepam E. Modafinil

C, D

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

Following a T2 spinal cord injury, the patient develops paralytic ileus. While this condition is present, what should the nurse anticipate that the patient will need? a) IV fluids b) Tube feedings c) Parenteral nutrition d) Nasogastric suctioning

D

A 68-yr-old man is admitted to the ED 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 should not 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

A client with myasthenia gravis is diagnosed with cholinergic crisis. What should the nurse expect when assessing this client? a) Dysphagia b) Tachycardia c) Impaired speech d) Respiratory distress

D

A nurse is assessing a client who is quadriplegic following a cervical fracture at vertebral level C5. The client reports a throbbing headache and nausea. The nurse notes facial flushing and a blood pressure of 220/110 mm Hg. Which of the following actions should the nurse take first? a. Administer hydralazine via IV bolus b. Loosen the client's clothing c. Empty the client's bladder d. Elevate the head of the client's bed

D

Which drug therapy is included for acute migraine and cluster headaches that appears to alter the pathophysiologic process for these headaches? a) Tricyclic antidepressants such as amitriptyline b) Nonsteroidal antiinflammatory drugs (NSAIDs) c) β-adrenergic blockers such as propranolol (Inderal) d) Specific serotonin receptor agonists such as sumatriptan (Imitrex)

D

Which medication taken by a patient with restless legs syndrome should the nurse discuss with the patient? a) Ibuprofen b) Acetaminophen c) Multivitamin d) Diphenhydramine

D

Which nursing diagnosis is of highest priority for a patient with Parkinson's disease who is unable to move the facial muscles? a) Activity intolerance b) Self-care deficit: toileting c) Ineffective self-health management d) Imbalanced nutrition: less than body requirements

D

Which of these nursing actions for a patient with Guillain-Barré syndrome is appropriate for the nurse to delegate to experienced unlicensed assistive personnel (UAP)? a) Nasogastric tube feeding q4hr b) Artificial tear administration q2hr c) Assessment for bladder distention q2hr d) Passive range of motion to extremities q4hr

D

Which patient below is MOST at risk for developing a cholinergic crisis?* A. A patient with myasthenia gravis is who is not receiving sufficient amounts of their anticholinesterase medication. B. A patient with myasthenia gravis who reports not taking the medication Pyridostigmine for 2 weeks. C. A patient with myasthenia gravis who is experiencing a respiratory infection and recently had left hip surgery. D. A patient with myasthenia gravis who reports taking too much of their anticholinesterase medication.

D

Which patient has the greatest risk of developing delirium? a) A patient with fibromyalgia whose chronic pain has recently worsened b) A patient with a fracture who has spent the night in the emergency department c) An older patient whose recent computed tomography shows brain atrophy d) An older patient who takes multiple medications to treat various health problems

D

Which patient is most at risk for developing delirium? a) A 50-yr-old woman with cholecystitis b) A 19-yr-old man with a fractured femur c) A 42-yr-old woman having an elective hysterectomy d) A 78-yr-old man admitted to the medical unit with complications related to heart failure

D

Which statement most 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

In which order will the nurse perform the following actions when caring for a patient with possible C5 spinal cord trauma who is admitted to the emergency department? (Put a comma and a space between each answer choice [A, B, C, D, E].) a) Infuse normal saline at 150 mL/hr. b) Monitor cardiac rhythm and blood pressure. c) Administer O2 using a nonrebreather mask. d) Immobilize the patient's head, neck, and spine. e) Transfer the patient to radiology for spinal computed tomography (CT).

D, C, B, A, E

Priority Decision: The nurse finds a patient in bed having a generalized tonic-clonic seizure. During the seizure activity, what actions should the nurse take first (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

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

A female patient complains of a throbbing headache. The nurse learns the patient has experienced photophobia and headaches previously. Which diagnosis does the nurse suspect? a. Cluster headache b. Migraine headache c. Polycythemia vera d. Hemorrhagic stroke

B

When evaluating outcomes of a glycerol rhizotomy for a patient with trigeminal neuralgia, the nurse will a) assess if the patient is doing daily facial exercises. b) question if the patient is using an eye shield at night. c) ask the patient about social activities with family and friends. d) remind the patient to chew on the unaffected side of the mouth.

C

A nurse is caring for a client who has a basilar skull fracture following a fall from a ladder. Which of the following assessment findings should the nurse report to the provider? a. Glasgow Coma Scale score of 15 b. Intracranial pressure reading of 15 mm Hg c. Ecchymosis at base of skull d. Clear drainage from nose

D

As the home health nurse you are helping a patient with Parkinson's Disease get dressed. What item gathered by the patient to wear should NOT be worn?* A. Velcro pants B. Pull over sweatshirt C. Non-slip socks D. Rubber sole shoes

D

Social effects of a chronic neurologic disease include (select all that apply) a. divorce. b. job loss. c. depression. d. role changes. e. loss of self-esteem.

A, B, C, D, E

A patient with multiple sclerosis has issues with completely emptying the bladder. The physician orders the patient to take ___________, which will help with bladder emptying.* A. Bethanechol B. Oxybutynin C. Avonex D. Amantadine

A

While on a mission trip, the nurse is caring for a patient diagnosed with tetanus. The patient has been given tetanus immune globulin (TIG). What interprofessional care is appropriate (select all that apply.)? a) Administer penicillin. b) Administer polyvalent antitoxin. c) Control spasms with diazepam (Valium). d) Teach correct processing of canned foods. e) Provide analgesia with opioids (morphine). f) Prepare for tracheostomy for mechanical ventilation.

A, C, E, F

A patient who is having a tonic-clonic seizure is prescribed Phenobarbital. During administration of this drug, it is important the nurse monitors for: (Select all that apply)* A. Respiratory depression B. Hypertension C. Disseminated intravascular clotting D. Hypotension E. Fever

A, D

A patient is diagnosed with Bell's palsy. What information should the nurse teach the patient about Bell's palsy (select all that apply)? a) Bell's palsy affects the motor branches of the facial nerve. b) Antiseizure drugs are the drugs of choice for treatment of Bell's palsy. c) Nutrition and avoidance of hot foods or beverages are special needs of this patient. d) Herpes simplex virus 1 is strongly associated as a precipitating factor in the development of Bell's palsy. e) Moist heat, gentle massage, electrical stimulation of the nerve, and exercises are prescribed to treat Bell's palsy. f) An inability to close the eyelid, with an upward movement of the eyeball when closure is attempted, is evident.

A, D, E, F

A 20-yr-old patient who sustained a T2 spinal cord injury 10 days ago tells the nurse, "I want to be transferred to a hospital where the nurses know what they are doing." Which action by the nurse is appropriate? a) Respond that abusive language will not be tolerated. b) Request that the patient provide input for the plan of care. c) Perform care without responding to the patient's comments. d) Reassure the patient about the competence of the nursing staff.

B

A 50-yr-old male patient has been diagnosed with amyotrophic lateral sclerosis (ALS). What strategy will prevent a common cause of death for patients with ALS? a. Reduce fat intake. b. Reduce the risk of aspiration. c. Decrease injury related to falls. d. Decrease pain secondary to muscle weakness.

B

A 59-yr-old female patient with a frontotemporal lobar dementia has difficulty with verbal expression. While her husband was at work, she walked to the gas station for a soda but did not understand the request for payment. What can the nurse suggest to keep the patient safe? a) Assisted living b) Adult day care c) Advance directives d) Monitor for behavioral changes

B

A 38-yr-old patient who has had a spinal cord injury returned home following a stay in a rehabilitation facility. The home care nurse notes the spouse is performing many of the activities that the patient had been managing unassisted during rehabilitation. The appropriate nursing action at this phase of rehabilitation is to a) remind the patient about the importance of independence in daily activities. b) tell the spouse to stop helping because the patient is able to perform activities independently. c) develop a plan to increase the patient's independence in consultation with the patient and the spouse. d) recognize that it is important for the spouse to be involved in the patient's care and encourage participation.

C

A 40-yr-old patient is diagnosed with early Huntington's disease (HD). When teaching the patient, spouse, and adult children about this disorder, the nurse will provide information about the a) use of levodopa-carbidopa (Sinemet) to help reduce HD symptoms. b) prophylactic antibiotics to decrease the risk for aspiration pneumonia. c) option of genetic testing for the patient's children to determine their own HD risks. d) lifestyle changes of improved nutrition and exercise that delay disease progression.

C

A 65-yr-old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is a. searching the Internet for educational videos. b. evaluating the home for environmental safety. c. promoting physical exercise and a well-balanced diet. d. designing an exercise program to strengthen and stretch specific muscles.

C

Which information about a patient who has a new prescription for phenytoin (Dilantin) indicates that the nurse should consult with the health care provider before administration of the medication? a) Patient has tonic-clonic seizures. b) Patient experiences an aura before seizures. c) Patient has minor elevations in the liver function tests. d) Patient's most recent blood pressure is 156/92 mm Hg.

C

Which intervention should the nurse perform first in the acute care of a patient with autonomic dysreflexia? a) Urinary catheterization b) Check for bowel impaction c) Elevate the head of the bed d) Administer intravenous hydralazine

C

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

C

Which nursing diagnosis is a priority in the care of a patient with myasthenia gravis (MG)? a. Acute confusion b. Bowel incontinence c. Activity intolerance d. Disturbed sleep pattern

C

Which nursing intervention is most appropriate when caring for patients with dementia? a) Avoid direct eye contact. b) Lovingly call the patient "honey" or "sweetie." c) Give simple directions, focusing on one thing at a time. d) Treat the patient according to his or her age-related behavior.

C

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

Which prescribed intervention will the nurse implement first for a patient in the emergency department who is experiencing continuous tonic-clonic seizures? a) Give phenytoin (Dilantin) 100 mg IV. b) Monitor level of consciousness (LOC). c) Administer lorazepam (Ativan) 4 mg IV. d) Obtain computed tomography (CT) scan.

C

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 patient with peripheral facial paresis on the left side is diagnosed with Bell's palsy. What should the nurse teach regarding self-care (select all that apply.)? a) Administration of antiseizure medications b) Preparing for a nerve block to manage pain c) Administration of corticosteroid medications d) Surgery if conservative therapy is not effective e) Dark glasses and artificial tears to protect the eyes f) A facial sling to support the muscles and facilitate eating

C, E, F

When establishing a diagnosis of multiple sclerosis (MS), which diagnostic tests will the nurse expect (select all that apply.)? a. EEG b. ECG c. CT scan d. Carotid duplex scan e. Evoked response testing f. Cerebrospinal fluid analysis

C, E, F

A nurse is caring for a client who has a history of status epilepticus and requires seizure precautions. Which of the following actions should the nurse take? a. Assess hourly for a spike in blood pressure b. Keep the client on bed rest c. Keep a padded tongue blade at the bedside d. Establish IV access

D

A nurse is caring for a client who is recovering from a stroke and has right-sided homonymous hemianopsia. To help the client adapt to the hemianopsia, the nurse should take which of the following actions? a. Check the client's cheek on the affected side after meals to be sure no food remains there b. Encourage the client to sit upright with their head tilted slightly forward during meals c. Provide the client with eating utensils that have large handles d. Remind the client to look consciously at both sides of their meal tray

D

A nurse is performing a pain assessment for a client who is postoperative. Which of the following findings should the nurse use to determine the severity of the client's pain? a. Client's vital sign changes b. Client's report of the type of pain c. Client's nonverbal communication d. Client's report of pain on a pain scale

D

A nurse is planning to teach a client who has epilepsy and a new prescription for phenytoin. Which of the following instruction should the nurse plan to include? a. Rinse with antiseptic mouthwash instead of using dental floss b. Use an over-the-counter antihistamine if a rash develops c. Slowly taper the medication after consecutive months without seizure activity d. Take medications at a consistent time each day to maintain therapeutic blood levels

D

A nurse is teaching a client and her family about the diagnosis and treatment of Alzheimer's disease. Which of the following statements should the nurse identify as an indication that the family understands the teaching? a. "There is a test for Alzheimer's disease that can establish a reliable diagnosis" b. "The goal of medication therapy is to reverse the degenerative changes that can occur in brain tissue" c. "Early manifestations of Alzheimer's disease include mild tremors and muscular rigidity" d. "The medications that treat Alzheimer's disease can help delay cognitive changes"

D

A nurse is teaching an assistive personnel (AP) about providing care to a client following a total hip arthroplasty. Which of the following instructions should the nurse include? a. Avoid applying antiembolism stocking to the affected leg b. Have the client lean forward when moving from a sitting to a standing position c. Discourage the client from sitting in a wheelchair with the back reclined d. Place an abductor pillow between the client's legs when turning the client

D

A patient learns about rehabilitation for a spinal cord tumor. Which statement by the patient reflects appropriate understanding of this process? a) "I want to be rehabilitated for my daughter's wedding in 2 weeks." b) "Rehabilitation will be more work done by me alone to try to get better." c) "I will be able to do all my normal activities after I go through rehabilitation." d) "With rehabilitation, I will be able to function at my highest level of wellness."

D

The client diagnosed with a brain abscess is experiencing a tonic-clonic seizure. Which interventions should the nurse implement? Rank in order of performance. 1. Assess the client's mouth. 2. Loosen restrictive clothing. 3. Administer phenytoin IVP. 4. Turn the client to the side. 5. Protect the client's head from injury.

4, 5, 2, 3, 1

Which is a common cognitive problem associated with Parkinson's disease? 1. Emotional lability. 2. Depression. 3. Memory deficits. 4. Paranoia.

3

Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis? a) Pupil size b) Respiratory effort c) Grip strength d) Level of consciousness

B

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

A patient with a history of epilepsy is taking Phenytoin. The patient's morning labs are back, and the patient's Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will?* A. Assess the patient for a rash B. Initiate seizure precautions C. Hold the next dose of Phenytoin D. Continue to monitor the patient

B

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) Severe, sharp, penetrating head pain d) Abrupt onset lasting 5 to 180 minutes e) Bilateral pressure or tightness sensation f) May be accompanied by unilateral ptosis or lacrimation

B, C, D, F

When providing community health care teaching regarding the early warning signs of Alzheimer's disease (AD), which signs should the nurse ask family members to report (select all that apply.)? a) Misplacing car keys b) Losing sense of time c) Difficulty performing familiar tasks d) Problems with performing basic calculations e) Momentarily forgets an acquaintance's name f) Becoming lost in a usually familiar environment

B, C, D, F

A patient is diagnosed with moderate dementia after multiple strokes. During assessment of the patient, the nurse would expect to find a) excessive nighttime sleepiness. b) difficulty eating and swallowing. c) loss of recent and long-term memory. d) fluctuating ability to perform simple tasks.

C

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

What should the nurse do when providing care for a patient with an acute attack of trigeminal neuralgia? a) Carry out all hygiene and oral care for the patient. b) Use conversation to distract the patient from pain. c) Maintain a quiet, comfortable, draft-free environment. d) Have the patient examine the mouth after each meal for residual food.

C

When administering a mental status examination to a patient with delirium, the nurse should a) wait until the patient is well-rested. b) administer an anxiolytic medication. c) choose a place without distracting stimuli. d) reorient the patient during the examination.

C

The health care provider has prescribed IV norepinephrine (Levophed) for a patient in the ED with SCI. The nurse determines that the drug is having the desired effect when what is observed in patient assessment? a) Heart rate of 68 bpm b) Respiratory rate of 24 c) Temperature of 96.8°F (36.0°C) d) Blood pressure of 106/82 mm Hg

D

The home care nurse is visiting patients in the community. Which patient is exhibiting an early warning sign of Alzheimer's disease (AD)? a) A 65-yr-old male patient does not recognize his family members and close friends b) A 59-yr-old female patient misplaces her purse and jokes about having memory loss c) A 79-yr-old male patient is incontinent and not able to perform hygiene independently d) A 72-yr-old female patient is unable to locate the address where she has lived for 10 years

D

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

The nurse finds an 87-yr-old woman with Alzheimer's disease is continually rubbing, flexing, and kicking her legs throughout the day. The night shift reports this same behavior escalates at night, preventing her from obtaining her required sleep. The next step the nurse should take is to a. ask the physician for a daytime sedative for the patient. b. request soft restraints to prevent her from falling out of her bed. c. ask the physician for a nighttime sleep medication for the patient. d. assess the patient more closely, suspecting a disorder such as restless legs syndrome.

D

The nurse identifies a patient with type 1 diabetes and a history of herpes simplex infection as being at risk for Bell's palsy. Which information should the nurse include in teaching the patient? a) "You may be able to prevent Bell's palsy by doing facial exercises regularly." b) "Prophylactic treatment of herpes with antiviral agents prevents Bell's palsy." c) "Medications to treat Bell's palsy work only if started before paralysis onset." d) "Call the doctor if you experience pain or develop herpes lesions near the ear."

D

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

D

Which patient should receive a depression assessment first? a) A patient in the early stages of Alzheimer's disease b) A patient who is in the final stages of Alzheimer's disease c) A patient experiencing delirium secondary to dehydration d) A patient who has become delirious following an atypical drug response

A

Which statement by the wife of a patient with Alzheimer's disease (AD) demonstrates an accurate understanding of her husband's medication regimen? a) "I'm really hoping his medications will slow down his mental losses." b) "We're both holding out hope that this medication will cure his disease." c) "I know that this won't cure him, but we learned that it might prevent a bodily decline while he declines mentally." d) "I learned that if we are vigilant about his medication schedule, he may not experience the physical effects of his disease."

A

You're preparing to help the neurologist with conducting a Tensilon test. Which antidote will you have on hand in case of an emergency?* A. Atropine B. Protamine sulfate C. Narcan D. Leucovorin

A

Teamwork and Collaboration: 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

You're assessing your patient load for the patients who are at MOST risk for seizures. Select all the patients below that are at risk: (Select all that apply)* A. A 32-year-old with a blood glucose of 20 mg/dL. B. A 63-year-old whose CT scan shows an ischemic stroke. C. A 72-year-old who is post opt day 5 from open heart surgery. D. A 16-year-old with bacterial meningitis. E. A 58-year-old experiencing ETOH withdrawal.

A, B, D, E

Which actions could the nurse delegate to a licensed practical/vocational nurse (LPN/LVN) who is part of the team caring for a patient with Alzheimer's disease (select all that apply)? a) Develop a plan to minimize difficult behavior. b) Administer the prescribed memantine (Namenda). c) Remove potential safety hazards from the patient's environment. d) Refer the patient and caregivers to appropriate community resources. e) Help the patient and caregivers choose memory enhancement methods. f) Evaluate the effectiveness of the prescribed enteral feedings on patient nutrition.

B, C

During your discharge teaching to a patient with multiple sclerosis, you educate the patient on how to avoid increasing symptoms and relapses. You tell the patient to avoid: (Select all that apply)* A. Cold temperatures B. Infection C. Overexertion D. Salt E. Stress

B, C, E

You're providing free education to a local community group about the signs and symptoms of Parkinson's Disease. Select all the signs and symptoms a patient could experience with this disease: (Select all that apply)* A. Increased Salivation B. Loss of smell C. Constipation D. Tremors with purposeful movement E. Shuffling of gait F. Freezing of extremities G. Euphoria H. Coordination issues

B, C, E, F, H

You're developing a plan of care for a patient with multiple sclerosis who presents with Uhthoff's Sign. What interventions will you include in the patient's plan of care? Select all that apply:* A. Avoid movements of the head and neck downward B. Keep room temperature cool C. Encourage patient to use warm packs and heating pads for symptoms D. Educate the patient on three ways to avoid overheating during exercise

B, D

Which information about a 60-yr-old patient with multiple sclerosis indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a) The patient walks a mile each day for exercise. b) The patient complains of pain with neck flexion. c) The patient has an increased serum creatinine level. d) The patient has the relapsing-remitting form of MS.

C

After change-of-shift report on the Alzheimer's disease/dementia unit, which patient will the nurse assess first? a) Patient who has not had a bowel movement for 5 days b) Patient who has a stage II pressure ulcer on the coccyx c) Patient who is refusing to take the prescribed medications d) Patient who developed a new cough after eating breakfast

D

Dementia is defined as a a) syndrome that results only in memory loss. b) disease associated with abrupt changes in behavior. c) disease that is always due to reduced blood flow to the brain. d) syndrome characterized by cognitive dysfunction and loss of memory.

D

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

In planning community education for prevention of spinal cord injuries, the nurse should target what group? a) Older men b) Teenage girls c) Elementary school-age children d) Adolescent and young adult men

D

The classic manifestations associated with Parkinson's disease is tremor, rigidity, akinesia, and postural instability. 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 nurse is concerned about a postoperative patient's risk for injury during an episode of delirium. The most appropriate action by the nurse is to a) secure the patient in bed using a soft chest restraint. b) ask the health care provider to order an antipsychotic drug. c) instruct family members to remain at the patient's bedside and prevent injury. d) assign unlicensed assistive personnel (UAP) to stay with and reorient the patient.

D

What is one indication for early surgical therapy of the patient with SCI? a) There is incomplete cord lesion involvement. b) The ligaments that support the spine are torn. c) A high cervical injury causes loss of respiratory function. d) Evidence of continued compression of the cord is apparent.

D

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

Which priority goal would the nurse identify for a client diagnosed with Parkinson's Disease (PD)? 1. The client will be able to maintain mobility and swallow without aspiration. 2. The client will verbalize feelings about the diagnosis of Parkinson's Disease. 3. The client will understand the purpose of medications administered for PD. 4. The client will have a home health agency for monitoring at home.

1

In assessing a client with a Thoracic SCI, which clinical manifestation would the nurse expect to find to support the diagnosis of neurogenic shock? 1. No reflex activity below the waist. 2. Inability to move upper extremities. 3. Complaints of a pounding headache. 4. Hypotension and bradycardia.

1

The charge nurse is making assignments. Which client should be assigned to the new graduate nurse? 1. The client diagnosed with aseptic meningitis who is complaining of a headache and the light bothering his eyes. 2. The client diagnosed with Parkinson's disease who fell during the night and is complaining of difficulty walking. 3. The client diagnosed with a cerebrovascular accident whose vitals signs are P 60, R 14, and BP 198/68. 4. The client diagnosed with a brain tumor who has a new complaint of seeing spots before the eyes.

1

The client with end-stage ALS requires a gastrostomy tube feeding. Which finding would require the nurse to hold a bolus tube feeding? 1. A residual of 125 mL. 2. The abdomen is soft. 3. Three episodes of diarrhea. 4. The potassium level is 3.4 mEq/L.

1

The home health nurse is caring for a 28-year-old client with a T10 SCI who says, "I can't do anything. Why am I so worthless?" Which statement by the nurse would be the most therapeutic? 1. "This must be very hard for you. You're feeling worthless?" 2. "You shouldn't feel worthless—you are still alive." 3. "Why do you feel worthless? You still have the use of your arms." 4. "If you attended a work rehab program you wouldn't feel worthless."

1

The nurse asks the male client with epilepsy if he has auras with his seizures. The client says, "I don't know what you mean. What are auras?" Which statement by the nurse would be the best response? 1. "Some people have a warning that the seizure is about to start." 2. "Auras occur when you are physically and psychologically exhausted." 3. "You're concerned that you do not have auras before your seizures?" 4. "Auras usually cause you to be sleepy after you have a seizure."

1

The nurse enters the room as the client is beginning to have a tonic-clonic seizure. What action should the nurse implement first? 1. Note the first thing the client does in the seizure. 2. Assess the size of the client's pupils. 3. Determine if the client is incontinent of urine or stool. 4. Provide the client with privacy during the seizure.

1

Your patient is scheduled for a lumbar puncture to help diagnose multiple sclerosis. The patient wants clarification about what will be found in the cerebrospinal fluid during the lumbar puncture to confirm the diagnosis of MS. You explain that ____________ will be present in the fluid if MS is present.* A. high amounts of IgM B. oligoclonal bands C. low amounts of WBC D. oblong red blood cells and glucose

B

When administering the Mini-Cog exam to a patient with possible Alzheimer's disease, which action will the nurse take? a) Check the patient's orientation to time and date. b) Obtain a list of the patient's prescribed medications. c) Ask the person to use a clock drawing to indicate a specific time. d) Determine the patient's ability to recognize a common object such as a pen.

C

Which action will help the nurse determine whether a new patient's confusion is caused by dementia or delirium? a) Ask about a family history of dementia. b) Administer the Mini-Mental Status Exam. c) Use the Confusion Assessment Method tool. d) Obtain a list of the patient's usual medications.

C

Which characteristic will the nurse associate with a focal seizure? a. The patient lost consciousness during the seizure. b. The seizure involved both sides of the patient's brain. c. The seizure involved lip smacking and repetitive movements. d. The patient fell to the ground and became stiff for 20 seconds.

C

The clinical diagnosis of dementia is based on a) CT or MRS. b) brain biopsy. c) electroencephalogram. d) patient history and cognitive assessment.

D

Which diagnostic test is used to confirm the diagnosis of Amyotropic Lateral Sclerosis (ALS)? 1. Electromyogram (EMG). 2. Muscle biopsy. 3. Serum creatine kinase (CK). 4. Pulmonary function test.

2

The client is prescribed phenytoin (Dilantin), an anticonvulsant, for a seizure disorder.Which statement indicates the client understands the discharge teaching concerning this medication? 1. "I will brush my teeth after every meal." 2. "I will check my Dilantin level daily." 3. "My urine will turn orange while on Dilantin." 4. "I won't have any seizures while on this medication."

1

The nurse is caring for clients on the rehabilitation unit. Which clients should the nurse assess first after receiving the change-of-shift report? 1. The client with a C6 SCI who is complaining of dyspnea and has crackles in the lungs. 2. The client with an L4 SCI who is crying and very upset about being discharged home. 3. The client with an L2 SCI who is complaining of a headache and feeling very hot. 4. The client with a T4 SCI who is unable to move the lower extremities.

1

The occupational health nurse is concerned about preventing occupation-related acquired seizures. Which intervention should the nurse implement? 1. Ensure that helmets are worn in appropriate areas. 2. Implement daily exercise programs for the staff. 3. Provide healthy foods in the cafeteria. 4. Encourage employees to wear safety glasses.

1

A construction worker arrives at an urgent care center with a deep puncture wound from a rusty nail. The patient reports having had a tetanus booster 6 years ago. The nurse will anticipate a) IV infusion of tetanus immune globulin (TIG). b) administration of the tetanus-diphtheria (Td) booster. c) intradermal injection of an immune globulin test dose. d) initiation of the tetanus-diphtheria immunization series.

B

A 70-yr-old patient is admitted after falling from his roof. He has a spinal cord injury (SCI) at the C7 level. What findings during the assessment identify the presence of spinal shock? a) Paraplegia with a flaccid paralysis b) Tetraplegia with total sensory loss c) Total hemiplegia with sensory and motor loss d) Spastic tetraplegia with loss of pressure sensation

B

A 72-yr-old patient is brought to the clinic by the patient's spouse, who reports that the patient is unable to solve common problems around the house. To obtain information about the patient's current mental status, which question should the nurse ask the patient? a) "Are you sad right now?" b) "What did you eat for lunch?" c) "How is your self-image?" d) "Where were you were born?"

B

A male patient with a diagnosis of Parkinson's disease (PD) is admitted to a long-term care facility. Which action should the health care team take to promote adequate nutrition for this patient? a. Provide multivitamins with each meal. b. Provide a diet that is low in complex carbohydrates and high in protein. c. Provide small, frequent meals throughout the day that are easy to chew and swallow. d. Provide the patient with a minced or pureed diet that is high in potassium and low in sodium.

C

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?* A. The patient experiences worsening of the muscle weakness. B. The patient experiences wheezing along with facial flushing. C. The patient reports a tingling sensation in the eyelids and sudden ringing in the ears. D. The patient experiences improved muscle strength.

D

When planning care for a patient with a cervical spinal cord injury (C5), which nursing diagnosis has the highest priority? a) Impaired urinary elimination related to tetraplegia b) Risk for impaired tissue integrity related to paralysis c) Disabled family coping related to the extent of trauma d) Ineffective airway clearance related to cervical spinal cord injury

D

The client has been newly diagnosed with epilepsy. Which discharge instructions should be taught to the client? Select all that apply. 1. Keep a record of seizure activity. 2. Take tub baths only; do not take showers. 3. Avoid over-the-counter medications. 4. Have anticonvulsant medication serum levels checked regularly. 5. Do not drive alone; have someone in the car.

1, 3, 4

The nurse in the neurointensive care unit is caring for a client with a new Cervical SCI who is breathing independently. Which nursing interventions should be implemented? Select all that apply. 1. Monitor the pulse oximetry reading. 2. Provide pureed foods six (6) times a day. 3. Encourage coughing and deep breathing. 4. Assess for autonomic dysreflexia. 5. Administer intravenous corticosteroids.

1, 3, 5

The 34-year-old male client with an SCI is sharing with the nurse that he is worried about finding employment after being discharged from the rehabilitation unit. Which intervention should the nurse implement? 1. Refer the client to the American Spinal Cord Injury Association (ASIA). 2. Refer the client to the state rehabilitation commission. 3. Ask the social worker (SW) about applying for disability. 4. Suggest that the client talk with his significant other about this concern.

2

The client diagnosed with ALS asks the nurse, "I know this disease is going to kill me. What will happen to me in the end?" Which statement by the nurse would be most appropriate? 1. "You are afraid of how you will die?" 2. "Most people with ALS die of respiratory failure." 3. "Don't talk like that. You have to stay positive." 4. "ALS is not a killer. You can live a long life."

2

The client diagnosed with Parkinson's disease (PD) is being admitted with a fever and patchy infiltrates in the lung fields on the chest x-ray. Which clinical manifestations of PD would explain these assessment data? 1. Masklike facies and shuffling gait. 2. Difficulty swallowing and immobility. 3. Pill rolling of fingers and flat affect. 4. Lack of arm swing and bradykinesia.

2

The client newly diagnosed with Parkinson's Disease (PD) asks the nurse, "Why can't I control these tremors?" Which is the nurse's best response? 1. "You can control the tremors when you learn to concentrate and focus on the cause." 2. "The tremors are caused by a lack of the chemical dopamine in the brain; medication may help." 3. "You have too much acetylcholine in your brain causing the tremors but they will get better with time." 4. "You are concerned about the tremors? If you want to talk I would like to hear how you feel."

2

The client with ALS is admitted to the medical unit with shortness of breath, dyspnea, and respiratory complications. Which intervention should the nurse implement first? 1. Elevate the head of the bed 30 degrees. 2. Administer oxygen via nasal cannula. 3. Assess the client's lung sounds. 4. Obtain a pulse oximeter reading.

2

The client with a cervical fracture is being discharged in a halo device. Which teaching instruction should the nurse discuss with the client? 1. Discuss how to correctly remove the insertion pins. 2. Instruct the client to report reddened or irritated skin areas. 3. Inform the client that the vest liner cannot be changed. 4. Encourage the client to remain in the recliner as much as possible.

2

The nurse is conducting a support group for clients diagnosed with Parkinson's disease and their significant others. Which information regarding psychosocial needs should be included in the discussion? 1. The client should discuss feelings about being placed on a ventilator. 2. The client may have rapid mood swings and become easily upset. 3. Pill-rolling tremors will become worse when the medication is wearing off. 4. The client may automatically start to repeat what another person says.

2

The unlicensed assistive personnel (UAP) is attempting to put an oral airway in the mouth of a client having a tonic-clonic seizure. Which action should the primary nurse take? 1. Help the UAP to insert the oral airway in the mouth. 2. Tell the UAP to stop trying to insert anything in the mouth. 3. Take no action because the UAP is handling the situation. 4. Notify the charge nurse of the situation immediately.

2

The 28-year-old client is on the rehabilitation unit post spinal cord injury at level T10. Which collaborative team members should participate with the nurse at the case conference? Select all that apply. 1. Occupational Therapist (OT). 2. Physical therapist (PT). 3. Registered dietitian (RD). 4. Rehabilitation physician. 5. Social Worker (SW). 6. Patient care tech (PCT).

2, 3, 4, 5

The 80-year-old male client on an Alzheimer's unit is agitated and asking the nurse to get his father to come and see him. Which is the nurse's best response? 1. Tell the client his father is dead and cannot come to see him. 2. Give the client the phone and have him attempt to call his father. 3. Ask the client to talk about his father with the nurse. 4. Call the family so they can tell the client why his father cannot come to see him.

3

The client diagnosed with PD is being discharged on carbidopa/levodopa (Sinemet), an antiparkinsonian drug. Which statement is the scientific rationale for combining these medications? 1. There will be fewer side effects with this combination than with carbidopa alone. 2. Dopamine D requires the presence of both of these medications to work. 3. Carbidopa makes more levodopa available to the brain. 4. Carbidopa crosses the blood-brain barrier to treat Parkinson's disease.

3

The client diagnosed with Parkinson's disease is being discharged. Which statement made by the significant other indicates an understanding of the discharge instructions? 1. "All of my spouse's emotions will slow down now just like his body movements." 2. "My spouse may experience hallucinations until the medication starts working." 3. "I will schedule appointments late in the morning after his morning bath." 4. "It is fine if we don't follow a strict medication schedule on weekends."

3

The client is admitted to the intensive care unit (ICU) experiencing status epilepticus. Which collaborative intervention should the nurse anticipate? 1. Assess the client's neurological status every hour. 2. Monitor the client's heart rhythm via telemetry. 3. Administer an anticonvulsant medication by intravenous push. 4. Prepare to administer a glucocorticosteroid orally.

3

The client is diagnosed with ALS. As the disease progresses, which intervention should the nurse implement? 1. Discuss the need to be placed in a long-term care facility. 2. Explain how to care for a sigmoid colostomy. 3. Assist the client to prepare an advance directive. 4. Teach the client how to use a motorized wheelchair.

3

The client is scheduled for an electroencephalogram (EEG) to help diagnose a seizure disorder. Which preprocedure teaching should the nurse implement? 1. Tell the client to take any routine antiseizure medication prior to the EEG. 2. Tell the client not to eat anything for eight (8) hours prior to the procedure. 3. Instruct the client to stay awake for 24 hours prior to the EEG. 4. Explain to the client that there will be some discomfort during the procedure.

3

The client who just had a three (3)-minute seizure has no apparent injuries and is oriented to name, place, and time but is very lethargic and just wants to sleep. Which intervention should the nurse implement? 1. Perform a complete neurological assessment. 2. Awaken the client every 30 minutes. 3. Turn the client to the side and allow the client to sleep. 4. Interview the client to find out what caused the seizure.

3

The client with a C6 SCI is admitted to the emergency department complaining of a severe pounding headache and has a BP of 180/110. Which intervention should the emergency department nurse implement? 1. Keep the client flat in bed. 2. Dim the lights in the room. 3. Assess for bladder distention. 4. Administer a narcotic analgesic.

3

The nurse arrives at the site of a one-car motor-vehicle accident and stops to render aid. The driver of the car is unconscious. After stabilizing the client's cervical spine, which action should the nurse take next? 1. Carefully remove the driver from the car. 2. Assess the client's pupils for reaction. 3. Assess the client's airway. 4. Attempt to wake the client up by shaking him.

3

The nurse educator is presenting an in-service on seizures. Which disease process is the leading cause of seizures in the elderly? 1. Alzheimer's disease. 2. Parkinson's disease (PD). 3. Cerebral Vascular Accident (CVA, stroke). 4. Brain atrophy due to aging.

3

The nurse is caring for clients on a medical-surgical floor. Which clients should be assessed first? 1. The 65-year-old client diagnosed with seizures who is complaining of a headache that is a "2" on a 1-to-10 scale. 2. The 24-year-old client diagnosed with a T10 spinal cord injury who cannot move his toes. 3. The 58-year-old client diagnosed with Parkinson's disease who is crying and worried about her facial appearance. 4. The 62-year-old client diagnosed with a cerebrovascular accident who has a resolving left hemiparesis.

3

The nurse is caring for several clients on a medical unit. Which client should the nurse assess first? 1. The client with ALS who is refusing to turn every two (2) hours. 2. The client with abdominal pain who is complaining of nausea. 3. The client with pneumonia who has a pulse oximeter reading of 90%. 4. The client who is complaining about not receiving any pain medication.

3

The son of a client diagnosed with ALS asks the nurse, "Is there any chance that I could get this disease?" Which statement by the nurse would be most appropriate? 1. "It must be scary to think you might get this disease." 2. "No, this disease is not genetic or contagious." 3. "ALS does have a genetic factor and runs in families." 4. "If you are exposed to the same virus, you may get the disease."

3

Which nursing task would be most appropriate for the nurse to delegate to the unlicensed assistive personnel? 1. Teach Credé's maneuver to the client needing to void. 2. Administer the tube feeding to the client who is quadriplegic. 3. Assist with bowel training by placing the client on the bedside commode. 4. Observe the client demonstrating self-catheterization technique.

3

Which statement by the female client indicates that the client understands factors that may precipitate seizure activity? 1. "It is all right for me to drink coffee for breakfast." 2. "My menstrual cycle will not affect my seizure disorder." 3. "I am going to take a class in stress management." 4. "I should wear dark glasses when I am out in the sun."

3

The client diagnosed with ALS is prescribed an antiglutamate, riluzole (Rilutek). Which instruction should the nurse discuss with the client? 1. Take the medication with food. 2. Do not eat green, leafy vegetables. 3. Use SPF 30 when going out in the sun. 4. Report any febrile illness.

4

The client is being evaluated to rule out ALS. Which signs/symptoms would the nurse note to confirm the diagnosis? 1. Muscle atrophy and flaccidity. 2. Fatigue and malnutrition. 3. Slurred speech and dysphagia. 4. Weakness and paralysis.

4

The client is diagnosed with an SCI and is scheduled for a magnetic resonance imaging (MRI) scan. Which question would be most appropriate for the nurse to ask prior to taking the client to the diagnostic test? 1. "Do you have trouble hearing?" 2. "Are you allergic to any type of dairy products?" 3. "Have you eaten anything in the last eight (8) hours?" 4. "Are you uncomfortable in closed spaces?"

4

The intensive care nurse is caring for a client with a T1 SCI. When the nurse elevates the head of the bed 30 degrees, the client complains of light-headedness and dizziness. The client's vital signs are T 99.2°F, P 98, R 24, and BP 84/40. Which action should the nurse implement? 1. Notify the health-care provider as soon as possible (ASAP). 2. Calm the client down by talking therapeutically. 3. Increase the IV rate by 50 mL/hour. 4. Lower the head of the bed immediately.

4

The male client is sitting in the chair and his entire body is rigid with his arms and legs contracting and relaxing. The client is not aware of what is going on and is making guttural sounds. Which action should the nurse implement first? 1. Push aside any furniture. 2. Place the client on his side. 3. Assess the client's vital signs. 4. Ease the client to the floor.

4

The nurse caring for a client diagnosed with Parkinson's disease writes a problem of "impaired nutrition." Which nursing intervention would be included in the plan of care? 1. Consult the occupational therapist for adaptive appliances for eating. 2. Request a low-fat, low-sodium diet from the dietary department. 3. Provide three (3) meals per day that include nuts and whole-grain breads. 4. Offer six (6) meals per day with a soft consistency.

4

The nurse is admitting a client with the diagnosis of Parkinson's disease. Which assessment data support this diagnosis? 1. Crackles in the upper lung fields and jugular vein distention. 2. Muscle weakness in the upper extremities and ptosis. 3. Exaggerated arm swinging and scanning speech. 4. Masklike facies and a shuffling gait.

4

The nurse is planning the care for a client diagnosed with Parkinson's disease. Which would be a therapeutic goal of treatment for the disease process? 1. The client will experience periods of akinesia throughout the day. 2. The client will take the prescribed medications correctly. 3. The client will be able to enjoy a family outing with the spouse. 4. The client will be able to carry out activities of daily living.

4

The nurse researcher is working with clients diagnosed with Parkinson's disease. Which is an example of an experimental therapy? 1. Stereotactic pallidotomy/thalamotomy. 2. Dopamine receptor agonist medication. 3. Physical therapy for muscle strengthening. 4. Fetal tissue transplantation.

4

A 38-yr-old woman has newly diagnosed multiple sclerosis (MS) and asks the nurse what is going to happen to her. What is the best response by the nurse? a) "You will have either periods of attacks and remissions or progression of nerve damage over time." b) "You need to plan for a continuous loss of movement, sensory functions, and mental capabilities." c) "You will most likely have a steady course of chronic progressive nerve damage that will change your personality." d) "It is common for people with MS to have an acute attack of weakness and then not to have any other symptoms for years."

A

A 48-yr-old man was just diagnosed with Huntington's disease. His 20-yr-old son is upset about his father's diagnosis. What is the nurse's best response? a. Provide emotional and psychologic support. b. Encourage him to get diagnostic genetic testing. c. Explain that cognitive deterioration will be treated with counseling. d. Instruct that chorea and psychiatric disorders can be treated with haloperidol (Haldol).

A

A 50-yr-old man complains of recurring headaches. He describes these as sharp, stabbing, and located around his left eye. He also reports that his left eye seems to swell and get teary when these headaches occur. Based on this history, you suspect that he has a. cluster headaches. b. tension headaches. c. migraine headaches. d. medication overuse headaches.

A

A 78-yr-old woman was transferred to the intensive care unit after emergency abdominal surgery. The nurse notes the patient is disoriented and confused, has incoherent speech, is restless, and agitated. Which action by the nurse is most appropriate? a) Reorient the patient. b) Notify the physician. c) Document the findings. d) Administer lorazepam (Ativan).

A

A nurse in an emergency department is assessing a client who reports sudden, severe eye pain with blurry vision. The provider determines that the client has primary angle-closure glaucoma. Which of the following medication should the nurse expect to administer? a. Osmotic diuretics via IV bolus b. Mydriatic ophthalmic drops c. Corticosteroid ophthalmic drops d. Epinephrine via IV bolus

A

A nurse in an emergency department is caring for a client who suddenly lost consciousness and fell while at home. The provider determines that the client had an embolic stroke. Which of the following medications should the nurse expect to administer? a. Tissue plasminogen activator b. Recombinant factor VIII c. Nitroglycerin d. Lidocaine

A

A nurse is assessing a client who has a head injury following a motor-vehicle crash. The nurse should identify that which of the following findings indicates increasing intracranial pressure? a. Restlessness b. Dizziness c. Hypotension d. Fever

A

A nurse is developing a teaching plan for a client who has Meniere's disease. Which of the following instructions should the nurse include? a. "Move your head slowly to decrease vertigo" b. "Apply warm packs to the affected ear during acute attacks" c. "Increase your intake of foods and fluids high in salt" d. "Take corticosteroids during acute attacks"

A

A nurse is planning care for a client who has a closed traumatic brain injury from a fall and is receiving mechanical ventilation. Which of the following interventions is the nurse's priority? a. Maintain a PaCO2 of approximately 35 mm Hg b. Provide small doses of fentanyl via IV bolus for pain management c. Measure body temperature every 1 to 2 hours d. Reposition the client every 2 hours

A

A nurse is reviewing postoperative instructions with a client following cataract surgery. Which of the following client statements indicates an understanding of the instructions? a. "I should call my doctor if my vision gets worse" b. "I will take aspirin for eye discomfort" c. "I can blow my nose to clear out any drainage" d. "I can lift objects up to 20 pounds"

A

A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the nurse take when evaluating for adverse effects of the medication? a) Inspect the oral mucosa. b) Auscultate the bowel sounds. c) Listen to the lung sounds. d) Check pupil reaction to light.

A

A patient is admitted with possible botulism poisoning after eating home-canned green beans. Which intervention ordered by the health care provider will the nurse question? a) Encourage oral fluids to 3 L/day. b) Document neurologic symptoms. c) Position patient lying on the side. d) Observe respiratory status closely.

A

A patient is being evaluated for a possible spinal cord tumor. Which finding by the nurse requires the most immediate action? a) The patient has new-onset weakness of both legs. b) The patient complains of chronic severe back pain. c) The patient starts to cry and says, "I feel hopeless." d) The patient expresses anxiety about having surgery.

A

A patient is taking Phenytoin for treatment of seizures. Which statement by the patient requires you to re-educate the patient about this medication?* A. "Every morning I take this medication with a full glass of milk with my breakfast." B. "I know it is important to have my drug levels checked regularly." C. "I will report a skin rash immediately to my doctor." D. "This medication can lower my body's ability to clot and fight infection."

A

A patient reports feeling numbness and tingling of the left arm before experiencing a seizure. The nurse determines that this history is consistent with what type of seizure? a) Focal b) Absence c) Atonic d) Myoclonic

A

A patient tells the nurse about using acetaminophen (Tylenol) several times every day for recurrent bilateral headaches. Which action will the nurse plan to take first? a) Discuss the need to stop taking the acetaminophen. b) Suggest the use of biofeedback for headache control. c) Describe the use of botulism toxin (Botox) for headaches. d) Teach the patient about magnetic resonance imaging (MRI).

A

A patient who is hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information indicates that the patient is experiencing delirium rather than dementia? a) The patient was oriented and alert when admitted. b) The patient's speech is fragmented and incoherent. c) The patient is oriented to person but disoriented to place and time. d) The patient has a history of increasing confusion over several years.

A

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

A patient with Bell's palsy refuses to eat while others are present because of embarrassment about drooling. The best response by the nurse is to a) respect the patient's feelings and arrange for privacy at mealtimes. b) teach the patient to chew food on the unaffected side of the mouth. c) offer the patient liquid nutritional supplements at frequent intervals. d) discuss the patient's concerns with visitors who arrive at mealtimes.

A

A patient with Parkinson Disease is experiencing weight loss due to difficulty chewing and swallowing. Which meal option below is the best for this patient?* A. Scrambled eggs with a side of cottage cheese B. Grilled cheese with apple slices C. Baked chicken with bacon slices D. Tacos with refried beans

A

A patient with a metastatic tumor of the spinal cord is scheduled for removal of the tumor by a laminectomy. In planning postoperative care for the patient, what should the nurse recognize? a) Most cord tumors cause autodestruction of the cord as in traumatic injuries. b) Metastatic tumors are commonly extradural lesions that are treated palliatively. c) Radiation therapy is routinely administered following surgery for all malignant spinal cord tumors. d) Because complete removal of intramedullary tumors is not possible, the surgery is considered palliative.

A

A physician orders a patient to take Benztropine (Cogentin). The patient has never taken this medication before and is due to take the first dose at 1000. What statement by the patient requires you to hold the dose and notify the physician?* A. "I forgot to tell the doctor I take eye drops for my glaucoma." B. "I had a PET scan last week." C. "I take aspirin once day." D. "My hands are experiencing tremors at rest."

A

A priority goal of treatment for the patient with AD is to a) maintain patient safety. b) maintain or increase body weight. c) return to a higher level of self-care. d) enhance functional ability over time.

A

A woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate? a) "MS symptoms may be worse after the pregnancy." b) "Women with MS frequently have premature labor." c) "MS is associated with an increased risk for congenital defects." d) "Symptoms of MS are likely to become worse during pregnancy."

A

After change-of-shift report, which patient should the nurse assess first? a) Patient with myasthenia gravis who is reporting increased muscle weakness b) Patient with a bilateral headache described as "like a band around my head" c) Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin) d) Patient with Parkinson's disease who has developed cogwheel rigidity of the arms

A

During the patient's process of grieving for the losses resulting from SCI, what should the nurse do? a) Help the patient to understand that working through the grief will be a lifelong process. b) Assist the patient to move through all stages of the mourning and grief process to acceptance. c) Let the patient know that anger directed at the staff or the family is not a positive coping mechanism. d) Facilitate the grieving process so that it is completed by the time the patient is discharged from rehabilitation.

A

How is urinary function maintained during the acute phase of SCI? a) An indwelling catheter b) Intermittent catheterization c) Insertion of a suprapubic catheter d) Use of incontinent pads to protect the skin

A

Patient-Centered Care: A patient is admitted to the hospital with Guillain-Barré syndrome. She had weakness in her feet and ankles that has progressed to weakness with numbness and tingling in both legs. During the acute phase of the illness, what should the nurse know about Guillain-Barré syndrome? a) The most important aspect of care is to monitor the patient's respiratory rate and depth and vital capacity. b) Early treatment with corticosteroids can suppress the immune response and prevent ascending nerve damage. c) The most serious complication of this condition is ascending demyelination of the peripheral nerves and the cranial nerves. d) Although voluntary motor neurons are damaged by the inflammatory response, the autonomic nervous system is unaffected by the disease.

A

Patient-Centered Care: 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

Patient-Centered Care: What is a nursing intervention that is appropriate for the patient with a nursing diagnosis of anxiety related to lack of knowledge of the etiology and treatment of headache? a) Help the patient to examine lifestyle patterns and precipitating factors. b) Administer medications as ordered to relieve pain and promote relaxation. c) Provide a quiet, dimly lit environment to reduce stimuli that increase muscle tension and anxiety. d) Support the patient's use of counseling or psychotherapy to enhance conflict resolution and stress reduction.

A

Priority Decision: A patient is admitted to the ED with a possible cervical SCI following an automobile crash. During admission of the patient, what is the highest priority for the nurse? a) Maintaining a patent airway b) Assessing the patient for head and other injuries c) Maintaining immobilization of the cervical spine d) Assessing the patient's motor and sensory function

A

Priority Decision: The patient was in a traffic collision and is experiencing loss of function below C4. Which effect must the nurse be aware of to provide priority care for the patient? a) Respiratory diaphragmatic breathing b) Loss of all respiratory muscle function c) Decreased response of the sympathetic nervous system d) GI hypomotility with paralytic ileus and gastric distention

A

Surgical intervention is being considered for a patient with trigeminal neuralgia. The nurse recognizes that which procedure has the least residual effects with a positive outcome? a) Glycerol rhizotomy b) Gamma knife radiosurgery c) Microvascular decompression d) Percutaneous radiofrequency rhizotomy

A

The nurse advises a patient with myasthenia gravis (MG) to a) perform physically demanding activities early in the day. b) anticipate the need for weekly plasmapheresis treatments. c) do frequent weight-bearing exercise to prevent muscle atrophy. d) protect the extremities from injury due to poor sensory perception.

A

The nurse has administered a dose of risperidone (Risperdal) to a patient with delirium. What is the intended effect of the medication? a) Lying quietly in bed b) Alleviation of depression c) Reduction in blood pressure d) Disappearance of confusion

A

The nurse is caring for a patient with a halo vest after cervical spine injury. Which care instructions should the nurse include in the patient's discharge plan? a) Keep a wrench close or attached to the vest. b) Use the frame and vest to assist in positioning. c) Clean around the pins using betadine swab sticks. d) Loosen both sides of the vest to provide skin care.

A

The nurse is visiting the home of a client with Alzheimer's disease. What observation indicates that the family would benefit from teaching about home safety? a) House plants located in the living room b) Kitchen knives placed in a locked drawer c) Locking mechanism on the stove and oven controls d) Yellow tape on the floor outside of the client's bedroom

A

The patient with type 1 diabetes mellitus is having a seizure. Which medication should the nurse anticipate will be administered first? a. IV dextrose solution b. IV diazepam (Valium) c. IV phenytoin (Dilantin) d. Oral carbamazepine (Tegretol)

A

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 for it is higher for the children of parents of early onset AD. 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

Which condition is transmitted through wound contamination, causes painful tonic spasms or seizures, and can be prevented by immunization? a) Tetanus b) Botulism c) Neurosyphilis d) Systemic inflammatory response syndrome

A

Which manifestations in a patient with a thoracic spinal cord injury (T4) should alert the nurse to possible autonomic dysreflexia? a) Headache and rising blood pressure b) Irregular respirations and shortness of breath c) Decreased level of consciousness or hallucinations d) Abdominal distention and absence of bowel sounds

A

Which syndrome of incomplete SCI is described as cord damage common in the cervical region resulting in greater weakness in upper extremities than lower? a) Central cord syndrome b) Anterior cord syndrome c) Posterior cord syndrome d) Cauda equina and conus medullaris syndromes

A

You're caring for a patient with Parkinson's Disease that has tremors. Select the option that is INCORRECT about tremors experienced in this disease:* A. The tremors are most likely to occur with purposeful movements. B. A common term used to describe the tremors in the hands and fingers is called "pill-rolling". C. Tremors are one of the most common signs and symptoms in Parkinson's Disease. D. Tremors in this disease can occur in the hands, fingers, arms, legs and even the lips and tongue.

A

A spouse of a husband who has Parkinson's Disease explains to you that her husband experiences episodes while walking where he freezes and can't move. She asks what can be done to help with these types of episodes to prevent injury. Select all the options that are correct:* A. Have the husband try to change direction of movement by moving in the opposite direction when the freeze ups occur. B. Use a cane with a laser point while walking. C. Have the husband try to push through the freeze ups. D. Encourage the husband to consciously lift the legs while walking (as with marching).

A, B, D

When caring for a patient who experienced a T2 spinal cord transection 24 hours ago, which collaborative and nursing actions will the nurse include in the plan of care (select all that apply)? a) Urinary catheter care b) Nasogastric (NG) tube feeding c) Continuous cardiac monitoring d) Administration of H2 receptor blockers e) Maintenance of a warm room temperature

A, C, D, E

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.)? a) Urinalysis b) Chest x-ray c) MRI of the head d) Liver function tests e) Neuropsychologic testing f) Blood urea nitrogen and serum creatinine

A, C, D, E, F

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

A client with a C5-6 spinal cord injury is recovering from a cervical laminectomy. What should the nurse instruct unlicensed assistive personnel (UAP) to do when turning and repositioning this client? a) Keep the bed flat b) Place a small pillow under the neck c) Place a small pillow under the head d) Place a small pillow under the knees

B

A high school teacher who has been diagnosed with epilepsy after having a generalized tonic-clonic seizure tells the nurse, "I cannot teach any more. It will be too upsetting if I have a seizure at work." Which response by the nurse specifically addresses the patient's concern? a) "You might benefit from some psychologic counseling." b) "Epilepsy usually can be well controlled with medications." c) "You will want to contact the Epilepsy Foundation for assistance." d) "The Department of Vocational Rehabilitation can help with work retraining."

B

A hospitalized patient complains of a bilateral headache (4/10 on the pain scale) that radiates from the base of the skull. Which prescribed PRN medications should the nurse administer initially? a) Lorazepam (Ativan) b) Morphine sulfate (MS Contin) c) Acetaminophen (Tylenol) d) Butalbital and aspirin (Fiorinal)

B

A hospitalized patient with a history of cluster headache awakens during the night with a severe stabbing headache. Which action should the nurse take first? a) Put a moist hot pack on the patient's neck. b) Start the prescribed PRN O2 at 6 L/min. c) Give the ordered PRN acetaminophen (Tylenol). d) Notify the patient's health care provider immediately.

B

A nurse is assessing a client who has rheumatoid arthritis. Which of the following findings should the nurse expect? a. Unilateral joint involvement b. Ulnar deviation c. Fractures of the spine d. Decreased sedimentation rate

B

A nurse is caring for a client who has a spastic bladder following a spinal cord injury. Which of the following actions should the nurse take to help stimulate micturition? a. Encourage the client to use the Valsalva maneuver b. Stroke the client's inner thigh c. Perform the Crede maneuver d. Administer a diuretic

B

A nurse is caring for a client who is in balanced suspension skeletal traction and reports intermittent muscle spasms. Which of the following actions should the nurse take first? a. Reposition the client b. Check the position of the weights and ropes c. Administer a muscle relaxant d. Provide distraction

B

The nurse is ordered to administer Lorazepam to a patient experiencing status epilepticus. As a precautionary measure, the nurse will also have what reversal agent on standby?* A. Narcan B. Flumazenil C. Calcium Chloride D. Idarucizumab

B

A nurse is teaching a client who has multiple sclerosis and has a new prescription for glatiramer acetate. Which of the following statements indicates that the client understands the teaching? a. "I will ask my partner to give the injection in the same spot each time" b. "I will avoid going to the store when it is crowded" c. "I will see relief of my symptoms in about 1 week" d. "I will exercise rigorously while taking this medication"

B

A nurse is teaching a client who has osteoporosis and has a new prescription for alendronate. Which of the following information should the nurse include in the teaching? a. "Take this medication with 8 ounces of milk" b. "Remain upright for 30 minutes after taking this medication" c. "Wait 1 hour after taking other medications to take alendronate" d. "Take vitamin C to promote absorption of this medication"

B

A patient admitted with dermal ulcers who has a history of a T3 spinal cord injury tells the nurse, "I have a pounding headache and I feel sick to my stomach." Which action should the nurse take first? a) Check for a fecal impaction. b) Assess the blood pressure (BP). c) Give the prescribed antiemetic. d) Notify the health care provider.

B

A patient has been receiving scheduled doses of phenytoin (Dilantin) and begins to experience diplopia. Which additional findings would the nurse expect? a. An aura or focal seizure b. Nystagmus or confusion c. Abdominal pain or cramping d. Irregular pulse or palpitations

B

A patient is being evaluated for Alzheimer's disease (AD). The nurse explains to the patient's adult children that a) the most important risk factor for AD is a family history of the disorder. b) a diagnosis of AD is made only after other causes of dementia are ruled out. c) new drugs have been shown to reverse AD deterioration dramatically in some patients. d) brain atrophy detected by magnetic resonance imaging (MRI) would confirm the diagnosis of AD.

B

A patient seen in the outpatient clinic is diagnosed with mild cognitive impairment (MCI). Which action will the nurse include in the plan of care? a) Suggest a move into an assisted living facility. b) Schedule the patient for more frequent appointments. c) Ask family members to supervise the patient's daily activities. d) Discuss the preventive use of acetylcholinesterase medications.

B

A patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care? a) Observe for agitation and paranoia. b) Assist with active range of motion (ROM). c) Give muscle relaxants as needed to reduce spasms. d) Use simple words and phrases to explain procedures.

B

A patient who has severe Alzheimer's disease (AD) is being admitted to the hospital for surgery. Which intervention will the nurse include in the plan of care? a) Encourage the patient to discuss events from the past. b) Maintain a consistent daily routine for the patient's care. c) Reorient the patient to the date and time every 2 to 3 hours. d) Provide the patient with current newspapers and magazines.

B

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

A patient with Parkinson's disease has bradykinesia. Which action will the nurse include in the plan of care? a) Instruct the patient in activities that can be done while lying or sitting. b) Suggest that the patient rock from side to side to initiate leg movement. c) Have the patient take small steps in a straight line directly in front of the feet. d) Teach the patient to keep the feet in contact with the floor and slide them forward.

B

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

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

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

A patient with myasthenia gravis is admitted to the hospital with respiratory insufficiency and severe weakness. What confirms a diagnosis of myasthenia gravis? a) History and physical examination reveal weakness. b) Serum acetylcholine receptor antibodies are present. c) The patient's respiration is impaired because of muscle weakness. d) EMG reveals an increased response with repeated stimulation of muscles.

B

A patient with newly diagnosed MS has been hospitalized for evaluation and initial treatment of the disease. Following discharge teaching, the nurse realizes that additional instruction is needed when the patient says what? a) "It is important for me to avoid exposure to people with upper respiratory infections." b) "When I begin to feel better, I should stop taking the prednisone to prevent side effects." c) "I plan to use vitamin supplements and a diet high in fiber to help manage my condition." d) "I must plan with my family how we are going to manage my care if I become more incapacitated."

B

A patient with paraplegia has developed an irritable bladder with reflex emptying. Along with possible use of medications, what will be most helpful for the nurse to teach the patient? a) Hygiene care for an indwelling urinary catheter b) How to perform intermittent self-catheterization c) To empty the bladder with manual pelvic pressure in coordination with reflex voiding patterns d) That a urinary diversion, such as an ileal conduit, is the easiest way to handle urinary elimination

B

A patient with paraplegia resulting from a T9 spinal cord injury has a neurogenic reflexic bladder. Which action will the nurse include in the plan of care? a) Teach the patient the Credé method. b) Instruct the patient how to self-catheterize. c) Catheterize for residual urine after voiding. d) Assist the patient to the toilet every 2 hours.

B

A week following SCI at T2, a patient experiences movement in his leg and tells the nurse that he is recovering some function. What is the nurse's best response to the patient? a) "It is really still too soon to know if you will have a return of function." b) "That could be a really positive finding. Can you show me the movement?" c) "That's wonderful. We will start exercising your legs more frequently now." d) "I'm sorry but the movement is only a reflex and does not indicate normal function."

B

After a thymectomy, a patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first? a) Auscultate the patient's bowel sounds. b) Notify the patient's health care provider. c) Administer the prescribed PRN antiemetic drug. d) Give the scheduled dose of prednisone (Deltasone).

B

After change-of-shift report on the neurology unit, which patient will the nurse assess first? a) Patient with Bell's palsy who has herpes vesicles in front of the ear b) Patient with botulism who is drooling and experiencing difficulty swallowing c) Patient with neurosyphilis who has tabes dorsalis and decreased deep tendon reflexes d) Patient with an abscess caused by injectable drug use who needs tetanus immune globulin

B

Before administering botulinum antitoxin to a patient in the emergency department, it is most important for the nurse to a) obtain the patient's temperature. b) administer an intradermal test dose. c) document the neurologic symptoms. d) ask the patient about an allergy to eggs.

B

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

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 counseling patients with SCIs regarding sexual function, how should the nurse advise a male patient with a complete lower motor neuron lesion? a) He may have uncontrolled reflex erections, but orgasm and ejaculation are usually not possible. b) He is most likely to have reflex erections and may experience orgasm if S2-S4 nerve pathways are intact. c) He has a lesion with the greatest possibility of successful psychogenic erection with ejaculation and orgasm. d) He will probably be unable to have either psychogenic or reflexogenic erections and no ejaculation or orgasm.

B

Myasthenia gravis occurs when antibodies attack the __________ receptors at the neuromuscular junction leading to ____________.* A. metabotropic; muscle weakness B. nicotinic acetylcholine; muscle weakness C. dopaminergic adrenergic; muscle contraction D. nicotinic adrenergic; muscle contraction

B

Patient-Centered Care: Two days following SCI, a patient asks continually about the extent of impairment that will result from the injury. What is the best response by the nurse? a) "You will have more normal function when spinal shock resolves and the reflex arc returns." b) "The extent of your injury cannot be determined until the secondary injury to the cord is resolved." c) "When your condition is more stable, MRI will be done to reveal the extent of the cord damage." d) "Because long-term rehabilitation can affect the return of function, it will be years before we can tell what the complete effect will be."

B

The day shift nurse at the long-term care facility learns that a patient with dementia experienced sundowning late in the afternoon on the previous two days. Which action should the nurse take? a) Have the patient take a mid-morning nap. b) Keep window blinds open during the day. c) Provide hourly orientation to time and place. d) Move the patient to a quiet room in the afternoon.

B

The health care provider is considering the use of sumatriptan (Imitrex) for a 54-yr-old male patient with migraine headaches. Which information obtained by the nurse is most important to report to the health care provider? a) The patient drinks 1 to 2 cups of coffee daily. b) The patient had a recent acute myocardial infarction. c) The patient has had migraine headaches for 30 years. d) The patient has taken topiramate (Topamax) for 2 months.

B

The home health registered nurse (RN) is planning care for a patient with a seizure disorder related to a recent head injury. Which nursing action can be delegated to a licensed practical/vocational nurse (LPN/LVN)? a) Make referrals to appropriate community agencies. b) Place medications in the home medication organizer. c) Teach the patient and family how to manage seizures. d) Assess for use of medications that may precipitate seizures.

B

The nurse in the long-term care facility cares for a 70-yr-old man with late-stage dementia who is undernourished and has problems chewing and swallowing. What should the nurse include in the plan of care for this patient? a) Turn on the television to provide a distraction during meals. b) Provide thickened fluids and moist foods in bite-size pieces. c) Limit fluid intake during scheduled meals to prevent aspiration. d) Allow the patient to select favorite foods from the menu choices.

B

The nurse is caring for a 63-yr-old woman taking prednisone (Deltasone) for Bell's palsy. Which statement by the patient requires correction by the nurse? a) "I can take the medication with food or milk." b) "The medication should be started 1 week after paralysis." c) "I can take acetaminophen with the prescribed medications." d) "Chances of a full recovery are good if I take the medication"

B

The nurse is caring for a patient admitted with a spinal cord injury after a motor vehicle accident. The patient exhibits a complete loss of motor, sensory, and reflex activity below the injury level. The nurse recognizes this condition as which of the following? a) Central cord syndrome b) Spinal shock syndrome c) Anterior cord syndrome d) Brown-Séquard syndrome

B

The nurse is visiting the home of a client experiencing paraplegia after a lumbar spinal cord injury. Which observation indicates that teaching provided regarding urinary self-catheterization has been effective? a) Withdraws and reinserts the catheter b) Cleans the catheter with warm soap and water after use c) Lubricates the catheter tip with petroleum jelly before inserting d) Removes the catheter after 400 mL of urine is removed from the bladder

B

The nurse observes a 74-yr-old man with Parkinson's disease rocking side to side while sitting in the chair. Which action by the nurse is most appropriate? a. Provide the patient with diversional activities. b. Document the activity in the patient's health record. c. Take the patient's blood pressure sitting and standing. d. Ask if the patient is feeling either anxious or depressed.

B

The nurse provides information to the caregiver of a 68-yr-old man with epilepsy who has tonic-clonic seizures. Which statement by the caregiver indicates a need for further teaching? a. "It is normal for a person to be sleepy after a seizure." b. "I should call 911 if breathing stops during the seizure." c. "The jerking movements may last for 30 to 40 seconds." d. "Objects should not be placed in the mouth during a seizure."

B

The nurse will explain to the patient who has a T2 spinal cord transection injury that a) use of the shoulders will be limited. b) function of both arms should be retained. c) total loss of respiratory function may occur. d) tachycardia is common with this type of injury.

B

The patient is diagnosed with Brown-Séquard syndrome after a knife wound to the spine. Which description accurately describes this syndrome? a) Damage to the most distal cord and nerve roots, resulting in flaccid paralysis of the lower limbs and areflexic bowel and bladder b) Spinal cord damage resulting in ipsilateral motor paralysis and contralateral loss of pain and sensation below the level of the injury c) Rare cord damage resulting in loss of proprioception below the lesion level with retention of motor control and temperature and pain sensation d) Often caused by flexion injury with acute compression of cord resulting in complete motor paralysis and loss of pain and temperature sensation below the level of injury

B

The patient is diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) after nerve conduction velocity test. How will this patient with CIDP be treated differently than a patient with Guillain-Barré syndrome? a) Rehabilitation b) Corticosteroids c) Plasmapheresis d) IV immunoglobulin

B

When a 74-yr-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling-type tremor, the nurse will anticipate teaching the patient about a) oral corticosteroids. b) antiparkinsonian drugs. c) magnetic resonance imaging (MRI). d) electroencephalogram (EEG) testing.

B

When obtaining a health history and physical assessment for a 36-yr-old female patient with possible multiple sclerosis (MS), the nurse should a) assess for the presence of chest pain. b) inquire about urinary tract problems. c) inspect the skin for rashes or discoloration. d) ask the patient about any increase in libido.

B

When providing care for a patient with ALS, the nurse recognizes what as one of the most distressing problems experienced by the patient? a) Painful spasticity of the face and extremities b) Retention of cognitive function with total degeneration of motor function c) Uncontrollable writhing and twisting movements of the face, limbs, and body d) Knowledge that there is a 50% chance the disease has been passed to any offspring

B

When the nurse is developing a rehabilitation plan for a 30-yr-old patient with a C6 spinal cord injury, an appropriate goal is that the patient will be able to a) drive a car with powered hand controls. b) push a manual wheelchair on a flat surface. c) turn and reposition independently when in bed. d) transfer independently to and from a wheelchair.

B

Which action will the nurse plan to take for a patient with multiple sclerosis who has urinary retention caused by a flaccid bladder? a) Encourage a decreased evening intake of fluid. b) Teach the patient how to use the Credé method. c) Suggest the use of adult incontinence briefs for nighttime only. d) Assist the patient to the commode every 2 hours during the day.

B

Which action will the nurse take when caring for a patient who develops tetanus from injectable substance use? a) Avoid use of sedatives. b) Provide a quiet environment. c) Provide range-of-motion exercises daily. d) Check pupil reaction to light every 4 hours.

B

Which assessment data for a patient who has Guillain-Barré syndrome will require the nurse's most immediate action? a) The patient's sacral area skin is reddened. b) The patient is continuously drooling saliva. c) The patient complains of severe pain in the feet. d) The patient's blood pressure (BP) is 150/82 mm Hg.

B

Which finding below represents a positive Romberg Sign in a patient with multiple sclerosis?* A. The patient report dark spots in the visual fields during the confrontation visual field test. B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth. C. The patient's sign and symptoms increase when expose to hot temperatures. D. The patient reports an electric shock feeling when the head and neck are moved downward.

B

Which intervention will the nurse include in the plan of care for a patient with moderate dementia who had a fractured hip repair 2 days ago? a) Provide complete personal hygiene care for the patient. b) Remind the patient frequently about being in the hospital. c) Reposition the patient frequently to avoid skin breakdown. d) Place suction at the bedside to decrease the risk for aspiration.

B

Which intervention will the nurse include in the plan of care for a patient with primary restless legs syndrome (RLS) who is having difficulty sleeping? a) Teach about the use of antihistamines to improve sleep. b) Suggest that the patient exercise regularly during the day. c) Make a referral to a massage therapist for deep massage of the legs. d) Assure the patient that the problem is transient and likely to resolve.

B

Which nursing action has the highest priority for a patient who was admitted 16 hours earlier with a C5 spinal cord injury? a) Cardiac monitoring for bradycardia b) Assessment of respiratory rate and effort c) Administration of low-molecular-weight heparin d) Application of pneumatic compression devices to legs

B

Which nursing action will be most effective in ensuring daily medication compliance for a patient with mild dementia? a) Setting the medications up monthly in a medication box b) Having the patient's family member administer the medication c) Posting reminders to take the medications in the patient's house d) Calling the patient weekly with a reminder to take the medication

B

Which patient assessment will help the nurse identify potential complications of trigeminal neuralgia? a) Have the patient clench the jaws. b) Inspect the oral mucosa and teeth. c) Palpate the face to compare skin temperature bilaterally. d) Identify trigger zones by lightly touching the affected side.

B

Which statement(s) accurately describe(s) mild cognitive impairment (select all that apply)? a) Always progresses to AD b) Caused by variety of factors and may progress to AD c) Should be aggressively treated with acetylcholinesterase drugs d) Caused by vascular infarcts that, if treated, will delay progression to AD e) Patient is usually not aware that there is a problem with his or her memory

B

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

B

While assessing a patient with Parkinson's Disease, you note the patient's arms slightly jerk as you passively move them toward the patient's body. This is known as:* A. Lead Pipe Rigidity B. Cogwheel Rigidity C. Pronate Rigidity D. Flexor Rigidity

B

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

You're developing discharge instructions to the parents of a child who experiences atonic seizures. What information below is important to include in the teaching?* A. "This type of seizure is hard to detect because the child may appear like he or she is daydreaming." B. "Be sure your child wears a helmet daily." C. "It is common for the child to feel extremely tired after experiencing this type of seizure." D. "Avoid high fat and low carbohydrate diets."

B

You're educating a 25-year-old female about possible triggers for seizures. Which statement requires you to re-educate the patient about the triggers?* A. "I'm at risk for seizure activity during my menstrual cycle." B. "I will limit my alcohol intake to 2 glasses of wine per day." C. "It's important I get plenty of sleep." D. "I will be sure to stay hydrated, especially during hot weather."

B

You're performing a head-to-toe assessment on a patient with multiple sclerosis. When you ask the patient to move the head and neck downward the patient reports an "electric shock" sensation that travels down the body. You would report your finding to the doctor that the patient is experiencing:* A. Romberg's Sign B. Lhermitte's Sign C. Uhthoff's Sign D. Homan's Sign

B

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

B

Select all the TRUE statements about the pathophysiology of multiple sclerosis:* A. "The dendrites on the neuron are overstimulated leading to the destruction of the axon." B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon." C. "This disease affects the insulating structure found on the neuron in the central nervous system." D. "The dopaminergic neurons in the part of the brain called substantia nigra have started to die."

B, C

The spouse of a 67-yr-old male patient with early stage Alzheimer's disease (AD) tells the nurse, "I am exhausted from worrying all the time. I don't know what to do." Which actions are best for the nurse to take next (select all that apply)? a) Suggest that a long-term care facility be considered. b) Offer ideas for ways to distract or redirect the patient. c) Teach the spouse about adult day care as a possible respite. d) Suggest that the spouse consult with the physician for antianxiety drugs. e) Ask the spouse what she knows and has considered about dementia care options.

B, C, E

You're patient is scheduled for an EEG (electroencephalogram). As the nurse you will: (Select all that apply)* A. Keep the patient nothing by mouth. B. Hold seizure medications until after the test. C. Allow the patient to have coffee, milk, and juice only. D. Wash the patient's hair prior to the test. E. Administer a sedative prior to the test.

B, D

You're providing diet education to a patient with Parkinson's Disease. Which statement below demonstrates the patient understood your teaching? Select all that apply:* A. "I will limit foods high in fiber like fruits and vegetables in my diet." B. "I will be sure to drink 2 Liter of fluid per day." C. "It is very common for me to experience diarrhea with this disease." D. "I will avoid taking Carbidopa/Levodopa with a protein rich meal."

B, D

A 68-yr-old patient with a spinal cord injury has a neurogenic bowel. Beyond the use of bisacodyl suppositories and digital stimulation, which measures should the nurse teach the patient and caregiver to assist with bowel evacuation (select all that apply.)? a) Drink more milk. b) Eat 20-30 g of fiber per day. c) Use oral laxatives every day. d) Limit caffeinated beverages. e) Drink 1800 to 2800 mL of water or juice. f) Establish bowel evacuation time at bedtime.

B, D, E

A patient is taking Rasagiline "Azilect" for treatment of Parkinson's Disease. What foods do the patient want to limit in their diet? Select all that apply:* A. Liver B. Aged Cheese C. Sweetbread D. Beer E. Fermented foods F. Shellfish

B, D, E

A client with vertigo is surprised to learn of the diagnosis of multiple sclerosis. What should the nurse respond to this client? a) "Vertigo is a late sign of the disorder." b) "I would ask the health-care provider to run tests that focus on the ear." c) "The manifestations vary and will depend upon the area affected in the nervous system." d) "You can expect the exacerbations to occur more frequently because you have dizziness."

C

A nurse is caring for a client who has a retinal detachment. Which of the following findings should the nurse expect? a. Photophobia b. Complete vision loss c. Flashes of bright light d. Cloudiness of the lens

C

A nurse is caring for a client who has advancing amyotrophic lateral sclerosis. Which of the following interventions is the nurse's priority? a. Provide frequent rest periods throughout the day b. Administer pain medication on a regular schedule c. Monitor pulse oximetry findings d. Administer baclofen for spasticity

C

A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? a. Hypoactive deep-tendon reflexes b. Ascending paralysis c. Intention tremors d. Increased lacrimation

C

A nurse is caring for a client who has viral meningitis. Which of the following actions should the nurse take? a. Assess the client's neurologic status every 8 hours b. Initiate droplet precautions c. Check capillary refill at least every 4 hours d. Place the client in a well-lit environment

C

A nurse is caring for a client who is 72 hours postoperative following an above-the-knee amputation and reports phantom limb pain. Which of the following actions should the nurse take? a. Remind the client that the surgery removed the limb b. Change the dressing on the client's residual limb c. Request a prescription for gabapentin for the client d. Elevate the client's residual limb above heart level

C

A nurse is planning care for a client following a lumbar puncture. Which of the following actions should the nurse plan to take? a. Apply a pressure dressing to the site for 8 hours b. Restrict the client's fluid intake for 24 hours c. Ensure that the client lies flat for up to 12 hours d. Inform the client that neck stiffness is an expected outcome of the procedure

C

A nurse is teaching a client who has Parkinson's disease and is prescribed carbidopa-levodopa. Which of the following client statements indicates an understanding of the teaching? a. "I should expect an increase in my blood pressure while taking this medication" b. "I should take this medication 2 hours after meals to increase absorption" c. "I should expect that this medication can cause me to be drowsy" d. "I should expect this medication to be effective within 48 hours"

C

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 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

A patient has an incomplete left spinal cord lesion at the level of T7, resulting in Brown-Séquard syndrome. Which nursing action should be included in the plan of care? a) Assessment of the patient for right arm weakness b) Assessment of the patient for increased right leg pain c) Positioning the patient's left leg when turning the patient d) Teaching the patient to look at the right leg to verify its position

C

A patient is diagnosed with the mild cognitive impairment stage of Alzheimer's disease. What nursing intervention should the nurse use with the patient? a) Communicate using a letter or picture board. b) Treat disruptive behavior with antipsychotic drugs. c) Use a calendar and family pictures as memory aids. d) Apply a wander guard mechanism to keep the patient in the area.

C

A patient is hospitalized with new onset of Guillain-Barré syndrome. The most essential assessment for the nurse to complete is a) determining level of consciousness. b) checking strength of the extremities. c) observing respiratory rate and effort. d) monitoring the cardiac rate and rhythm.

C

A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is incorrect about this medication:* A. It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication. B. Body fluids can turn a dark color and stain clothes. C. This medication is most commonly prescribed with a vitamin B6 supplement. D. Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain.

C

A patient is receiving Interferon Beta for treatment of multiple sclerosis. As the nurse you will stress the importance of?* A. Physical exercise to improve fatigue B. Low fat diet C. Hand hygiene and avoiding infection D. Reporting ideation of suicide

C

A patient who had a C7 spinal cord injury 1 week ago has a weak cough effort and crackles. The initial intervention by the nurse should be to a) suction the patient's nasopharynx. b) notify the patient's health care provider. c) push upward on the epigastric area as the patient coughs. d) encourage incentive spirometry every 2 hours during the day.

C

A patient with Alzheimer's disease (AD) who is being admitted to a long-term care facility has had several episodes of wandering away from home. Which action will the nurse include in the plan of care? a) Reorient the patient several times daily. b) Have the family bring in familiar items. c) Place the patient in a room close to the nurses' station. d) Ask the patient why the wandering episodes have occurred.

C

A patient with Guillain-Barré syndrome asks whether he is going to die as the paralysis spreads toward his chest. In responding to the patient, what should the nurse know to be able to best answer this question? a) Patients who require ventilatory support almost always die. b) Death occurs when nerve damage affects the brain and meninges. c) Most patients with Guillain-Barré syndrome do not die, but recover. d) If death can be prevented, residual paralysis and sensory impairment are usually permanent.

C

A patient with Parkinson's Disease has slow movements that affects their swallowing, facial expressions, and ability to coordinate movements. As the nurse you will document the patient has:* A. Akinesia B. "Freeze up" tremors C. Bradykinesia D. Pill-rolling

C

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

A patient with SCI has spinal shock. The nurse plans care for the patient based on what knowledge? a) Rehabilitation measures cannot be initiated until spinal shock has resolved. b) The patient will need continuous monitoring for hypotension, tachycardia, and hypoxemia. c) Resolution of spinal shock is manifested by spasticity, reflex return, and neurogenic bladder. d) Patient will have complete loss of motor and sensory functions below the level of the injury, but autonomic functions are not affected.

C

A patient with a T4 spinal cord injury asks the nurse if he will be able to be sexually active. Which initial response by the nurse is best? a) Reflex erections frequently occur, but orgasm may not be possible. b) Sildenafil (Viagra) is used by many patients with spinal cord injury. c) Multiple options are available to maintain sexuality after spinal cord injury. d) Penile injection, prostheses, or vacuum suction devices are possible options.

C

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?* A. As soon as possible B. 1 hour after the patient has eaten (at 1300) C. 1 hour before the patient eats (at 1100) D. at 1200 right before the patient eats

C

An 8-year-old child, who is not responding to anti-seizure medications, is prescribed to start a ketogenic diet. This diet will include:* A. High carbohydrates and high fat B. Low fat, high salt, and high carbohydrates C. High fat and low carbohydrates D. High glucose, high fat, and low carbohydrates

C

As the nurse you know that Parkinson's Disease tends to affect the _____________ of the midbrain, which leads to the depletion of the neurotransmitter ________________.* A. red nucleus, acetylcholine B. leminisci, norepinephrine C. substantia nigra, dopamine D. tectum nigra, dopamine

C

Before surgical stabilization, what method of immobilization for the patient with a cervical SCI should the nurse expect to be used? a) Kinetic beds b) Hard cervical collar c) Skeletal traction with skull tongs d) Sternal-occipital-mandibular immobilizer brace

C

Dementia with Lewy bodies (DLB) is characterized by a) remissions and exacerbations over many years. b) memory impairment, muscle jerks, and blindness. c) parkinsonian symptoms, including muscle rigidity. d) increased intracranial pressure secondary to decreased CSF drainage.

C

During assessment of a patient admitted to the hospital with an acute exacerbation of MS, what should the nurse expect to find? a) Tremors, dysphasia, and ptosis b) Bowel and bladder incontinence and loss of memory c) Motor impairment, visual disturbances, and paresthesias d) Excessive involuntary movements, hearing loss, and ataxia

C

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) 15 years ago

C

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

Priority Decision: During assessment of a patient with SCI, the nurse determines that the patient has a poor cough with diaphragmatic breathing. Based on this finding, what should be the nurse's first action? a) Institute frequent turning and repositioning. b) Use tracheal suctioning to remove secretions. c) Assess lung sounds and respiratory rate and depth. d) Prepare the patient for endotracheal intubation and mechanical ventilation.

C

Priority Decision: During care of a patient in myasthenic crisis, maintenance of what is the nurse's first priority for the patient? a) Mobility b) Nutrition c) Respiratory function d) Verbal communication

C

Priority Decision: When teaching a patient with a seizure disorder about the medication regimen, what is it most important for the nurse to emphasize? a) The patient should increase the dosage of the medication if stress is increased. b) Most over-the-counter and prescription drugs are safe to take with antiseizure drugs. c) Stopping the medication abruptly may increase the intensity and frequency of seizures. d) If gingival hypertrophy occurs, the HCP should be notified and the drug may be changed.

C

Teamwork and Collaboration: 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) Assess the details of the seizure event. 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 nurse determines that teaching about management of migraine headaches has been effective when the patient says which of the following? a) "I can take the (Topamax) as soon as a headache starts." b) "A glass of wine might help me relax and prevent a headache." c) "I will lie down someplace dark and quiet when the headaches begin." d) "I should avoid taking aspirin and sumatriptan (Imitrex) at the same time."

C

The nurse expects the assessment of a patient who is experiencing a cluster headache to include a) nuchal rigidity. b) projectile vomiting. c) unilateral ptosis. d) throbbing, bilateral facial pain.

C

The nurse is administering a mental status examination to a patient who has hypertension. The nurse suspects depression when the patient responds to the nurse's questions with a) "Is that right?" b) "Wait, let me think about that." c) "I don't know." d) "Who are those people over there?"

C

The nurse is caring for a group of patients on a medical unit. After receiving report, which patient should the nurse see first? a. A 42-yr-old patient with multiple sclerosis who was admitted with sepsis b. A 72-yr-old patient with Parkinson's disease who has aspiration pneumonia c. A 38-yr-old patient with myasthenia gravis who declined prescribed medications d. A 45-yr-old patient with amyotrophic lateral sclerosis who refuses enteral feedings

C

The nurse provides dietary instructions to the in-home caregiver of a 45-yr-old man with Huntington's disease. The nurse is most concerned if the caregiver makes which statement? a. "Depression is common and may cause a decrease in appetite." b. "If swallowing becomes difficult, a feeding tube may be needed." c. "Calories should be restricted to prevent unnecessary weight gain." d. "Muscles in the face are affected, and chewing may become impossible."

C

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

The nurse's initial action for a patient with moderate dementia who develops increased restlessness and agitation should be to a) reorient the patient to time, place, and person. b) administer a PRN dose of lorazepam (Ativan). c) assess for factors that might be causing discomfort. d) assign unlicensed assistive personnel (UAP) to stay in the patient's room.

C

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 this patient's behavior? a) Sertraline (Zoloft) b) Donepezil (Aricept) c) Lorazepam (Ativan) d) Risperidone (Risperdal)

C

The patient's SCI is at T4. What is the highest-level goal of rehabilitation that is realistic for this patient to have? a) Indoor mobility in manual wheelchair b) Ambulate with crutches and leg braces c) Be independent in self-care and wheelchair use d) Completely independent ambulation with short leg braces and canes

C

To prevent autonomic hyperreflexia, which nursing action will the home health nurse include in the plan of care for a patient who has paraplegia at the T4 level ? a) Support selection of a high-protein diet. b) Discuss options for sexuality and fertility. c) Assist in planning a prescribed bowel program. d) Use quad coughing to strengthen cough efforts.

C

Unlicensed assistive personnel (UAP) working for a home care agency report a change in the alertness and language of an 82-yr-old female patient. The home care nurse plans a visit to evaluate the patient's cognitive function. Which assessment would be most appropriate? a) Glasgow Coma Scale (GCS) b) Confusion Assessment Method (CAM) c) Mini-Mental State Examination (MMSE) d) National Institutes of Health Stroke Scale (NIHSS)

C

Vascular dementia is associated with a) transient ischemic attacks. b) bacterial or viral infection of neuronal tissue. c) cognitive changes secondary to cerebral ischemia. d) abrupt changes in cognitive function that are irreversible.

C

What causes an initial incomplete SCI to result in complete cord damage? a) Edematous compression of the cord above the level of the injury b) Continued trauma to the cord resulting from damage to stabilizing ligaments c) Infarction and necrosis of the cord caused by edema, hemorrhage, and metabolites d) Mechanical transection of the cord by sharp vertebral bone fragments after the initial injury

C

Which chronic neurologic disorder involves a deficiency of the neurotransmitters acetylcholine and γ-aminobutyric acid (GABA) in the basal ganglia and extrapyramidal system? a) Myasthenia gravis b) Parkinson's disease c) Huntington's disease d) Amyotrophic lateral sclerosis (ALS)

C

Which finding in a patient with a spinal cord tumor requires an immediate report to the health care provider? a) Depression about the diagnosis b) Anxiety about scheduled surgery c) Decreased ability to move the legs d) Back pain that worsens with coughing

C

Which hospitalized patient will the nurse assign to the room closest to the nurses' station? a) Patient with Alzheimer's disease who has long-term memory deficit b) Patient with vascular dementia who takes medications for depression c) Patient with new-onset confusion, restlessness, and irritability after surgery d) Patient with dementia who has an abnormal Mini-Mental State Examination

C

The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by a) spinal x-ray findings. b) T-cell analysis of the blood. c) analysis of cerebrospinal fluid. d) history and clinical manifestations.

D

The nurse is reinforcing teaching with a patient newly diagnosed with amyotrophic lateral sclerosis (ALS). Which statement would be appropriate to include in the teaching? a. "ALS results from an excess chemical in the brain, and the symptoms can be controlled with medication." b. "Even though the symptoms you are experiencing are severe, most people recover with treatment." c. "You need to consider advance directives now, because you will lose cognitive function as the disease progresses." d. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."

D

When caring for a patient in the severe stage of AD, the nurse could use what diversion or distraction activities? a) Watching TV b) Books to read c) Playing games d) Mobiles or dangling ribbons

D