MedSurg Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies

Myasthenia gravis occurs when antibodies attack which receptor sites? A. Acetylcholine B. Serotonin C. Gamma-aminobutyric acid D. Dopamine

A

Which of the following is considered a central nervous system (CNS) disorder? A. Myasthenia gravis B. Multiple sclerosis C. Guillain-Barré D. Bell's palsy

B

Which well-recognized sign of meningitis is exhibited when the client's neck is flexed and flexion of the knees and hips is produced? A. Nuchal rigidity B. Positive Brudzinski sign C. Positive Kerning sign D. Photophobia

B

At what rate (in drops per minute) should a nurse start an IV infusion if the order is for 1 g of vancomycin (Vancocin) to be given in 180 ml of dextrose 5% in water over 60 minutes? The tubing delivers 15 drops/ml. Enter the correct number only.

45 drops/min

A client is diagnosed with meningococcal meningitis. The 22-year-old client shares an apartment with one other person. What would the nurse expect as appropriate care for the client's roommate? A. Treatment with antimicrobial prophylaxis as soon as possible B. No treatment unless the roommate begins to show symptoms C. Bedrest at home for 72 hours D. Admission to the nearest hospital for observation

A

Bell palsy is a disorder of which cranial nerve? A. Facial (VII) B. Vagus (X) C. Vestibulocochlear (VIII) D. Trigeminal (V)

A

The nurse is planning care of a client admitted to the neurologic rehabilitation unit following a cerebrovascular accident. Which nursing intervention would be of highest priority? A. Include client in planning of care and setting of goals. B. Provide instruction on blood-thinning medication. C. Assess client for ability to ambulate independently. D. Praise client when using adaptive equipment.

A

A client has been hospitalized for diagnostic testing. The client has just been diagnosed with multiple sclerosis, which the physician explains is an autoimmune disorder. How would the nurse explain an autoimmune disease to the client? A. A disorder in which the body has too many immunoglobulins B. A disorder in which killer T cells and autoantibodies attack or destroy natural cells—those cells that are "self" C. A disorder in which the body does not have enough immunoglobulins D. A disorder in which histocompatible cells attack the immunoglobulins

B

Guillain-Barré syndrome is an autoimmune attack on the peripheral myelin sheath. Which of the following is an action of myelin? A. Represents building block of nervous system B. Speeds nerve impulse transmission C. Acts as chemical messenger D. Carries message to the next nerve cell

B

The most common cause of cholinergic crisis includes which of the following? A. Undermedication B. Overmedication C. Compliance with medication D. Infection

B

The nurse is caring for a patient in the emergency department with an onset of pain related to trigeminal neuralgia. What subjective data stated by the patient does the nurse determine triggered the paroxysms of pain? A. "I was taking a bath." B. "I was brushing my teeth." C. "I was putting my shoes on." D. "I was sitting at home watching television."

B

The parents of a client intubated due to the progression of Guillain-Barré syndrome ask whether their child will die. What is the best response by the nurse? A. "Don't worry; your child will be fine." B. "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive." C. "Once Guillain-Barré syndrome progresses to the diaphragm, survival decreases significantly." D. "It's too early to give a prognosis."

B

Which condition is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain? A. Parkinson disease B. Creutzfeldt-Jakob disease C. Multiple sclerosis D. Huntington disease

B

Which nursing intervention is appropriate for a client with double vision in the right eye due to MS? A. Place needed items on the right side. B. Apply an eye patch to the right eye. C. Administer eye drops as needed. D. Exercise the right eye twice a day.

B

A client has been brought to the ED with altered LOC, high fever, and a purpura rash on the lower extremities. The family states the client was reporting neck stiffness earlier in the day. What action should the nurse do first? A. Administer prescribed antibiotics. B. Apply a cooling blanket. C. Initiate isolation precautions. D. Ensure the family receives prophylaxis antibiotic treatment.

C

Medical management of arthropod-borne virus (arboviral) encephalitis is aimed at A. preventing renal insufficiency. B. preventing muscular atrophy. C. controlling seizures and increased intracranial pressure. D. maintaining hemodynamic stability and adequate cardiac output.

C

The diagnosis of multiple sclerosis is based on which test? A. Evoked potential studies B. Neuropsychological testing C. Magnetic resonance imaging (MRI) D. Cerebrospinal fluid (CSF) electrophoresis

C

The nurse is caring for a client admitted with a diagnosis of septic meningitis. The nurse is aware that this infection is caused by which of the following? A. Lymphoma B. Virus C. Bacteria D. Leukemia

C

The nurse is caring for a client diagnosed with Guillain-Barre syndrome. His spouse asks about recovery rates. The nurse can correctly relate which of the following? A. Usually 100% of clients recover completely. B. No one with Guillain-Barre syndrome recovers completely. C. Approximately 60% to 75% of clients recover completely. D. Only a very small percentage (5% to 8%) of clients recover completely.

C

The nurse is caring for a client with Guillain-Barré syndrome (GBS). The client also has an ascending paralysis. Knowing the potential complications of the disorder, what should the nurse keep always ready at the bedside? A. Blood pressure apparatus B. Incentive spirometer C. Intubation tray and suction apparatus D. Nebulizer and thermometer

C

A client has been diagnosed with a frontal lobe brain abscess. Which nursing intervention is appropriate? A. Ensure that client takes nothing by mouth. B. Assess visual acuity. C. Assess for facial weakness. D. Initiate seizure precautions.

D

The client presents to the walk-in clinic with fever, nuchal rigidity, and headache. Which of the following assessment findings would be most significant in the diagnosis of this client? A. Seizures B. Vomiting C. Change in level of consciousness D. Vector bites

D

The nurse is caring for a client with trigeminal neuralgia (tic douloureux). The care plan for this client reflects the client's problem eating due to jaw pain. To assist the client in meeting the adequate nutritional needs, what should the nurse suggest? A. Increase the intake of calcium and proteins. B. Include fish, liver, and chicken in diet C. Include additional servings of fruits and raw vegetables D. Take small meals of soft consistency

D

Which drug should be available to counteract the effect of edrophonium chloride? A. Pyridostigmine bromide B. Azathioprine C. Prednisone D. Atropine

D

Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of small patches of demyelination in the brain and spinal cord? A. Creutzfeldt-Jakob disease B. Parkinson disease C. Huntington disease D. Multiple sclerosis

D

Which is a component of the nursing management of the client with new variant Creutzfeldt-Jakob disease (vCJD)? A. Providing supportive care B. Initiating isolation procedures C. Administering amphotericin B D. Preparing for organ donation

A

Which is the most common cause of acute encephalitis in the United States? A. Herpes simplex virus B. Western equine virus C. West Nile virus D. St. Louis virus

A

Which is the primary vector of arthropod-borne viral encephalitis in North America? A. Mosquitoes B. Ticks C. Spiders D. Birds

A

Which of the following tests confirms the diagnosis of myasthenia gravis (MG)? A. Computed tomography (CT) scan B. Tensilon test C. Serum studies D. Electromyogram (EMG)

B

A 45-year-old client is admitted to the facility with excruciating paroxysmal facial pain. He reports that the episodes occur most often after feeling cold drafts and drinking cold beverages. Based on these findings, the nurse determines that the client is most likely suffering from which neurologic disorder? A. Trigeminal neuralgia B. Migraine headache C. Angina pectoris D. Bell's palsy

A

A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease? A. Edrophonium (Tensilon) B. Ambenonium (Mytelase) C. Carbachol (Carboptic) D. Pyridostigmine (Mestinon)

A

The nurse is taking health history from a client admitted to rule out Guillain-Barre syndrome. An important question to ask related to the diagnosis is which of the following? A. "Have you experienced any viral infections in the last month?" B. "Have you had difficulty with urination in the last 6 weeks?" C. "Have you developed any new allergies in the last year?" D. "Have you experienced any ptosis in the last few weeks?"

A

A client who recently experienced a stroke tells the nurse that he has double vision. Which nursing intervention is most appropriate? A. Instill artificial tears. B. Alternatively patch one eye every 2 hours. C. Turn out the lights in the room. D. Encourage the client to close his eyes.

B

The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe? A. Patchy blindness B. Diplopia and ptosis C. Loss of proprioception D. Numbness

C

The nurse is assessing a client with meningitis. Which of the following signs would the nurse expect to observe? A. Numbness and vomiting B. Ptosis and diplopia C. Headache and nuchal rigidity D. Hyporeflexia in the lower extremities

C

The nurse is assisting with administering a Tensilon test to a patient with ptosis. If the test is positive for myasthenia gravis, what outcome does the nurse know will occur? A. Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes. B. The patient will have recovery of symptoms for at least 24 hours after the administration of the Tensilon. C. Eight hours after administration, the acetylcholinesterase begins to regenerate the available acetylcholine and will relieve symptoms. D. After administration of the medication, there will be no change in the status of the ptosis or facial weakness.

A

The nurse is assessing a newly admitted client with a diagnosis of meningitis. On assessment, the nurse expects to find which of the following? A. Positive Romberg sign B. Negative Brudzinski's sign C. Positive Kernig's sign D. Hyper-alertness

C

Vagus nerve demyelinization, which may occur in Guillain-Barré syndrome, would not be manifested by which of the following? A. Blindness B. Inability to swallow C. 20/20 vision D. Bulbar weakness

C

Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of demyelination in the brain and spinal cord? A. Huntington disease B. Creutzfeldt-Jakob disease C. Multiple sclerosis D. Parkinson disease

C

A patient with Bell's palsy says to the nurse, "It doesn't hurt anymore to touch my face. How am I going to get muscle tone back so I don't look like this anymore?" What interventions can the nurse suggest to the patient? A. Suggest applying cool compresses on the face several times a day to tighten the muscles. B. Inform the patient that the muscle function will return as soon as the virus dissipates. C. Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone. D. Tell the patient to smile every 4 hours.

C

Bell's palsy is a paralysis of which of the following cranial nerves? A. Optic B. Otic C. Facial D. Trigeminal

C

The primary arthropod vector in North America that transmits encephalitis is the A. tick. B. flea. C. mosquito. D. horse.

C

Which nursing intervention is the priority for a client in myasthenic crisis? A. Preparing for plasmapheresis B. Ensuring adequate nutritional support C. Assessing respiratory effort D. Administering intravenous immunoglobin (IVIG) per orders

C

While caring for clients who have suffered neurologic deficits from causes such as cerebrovascular accident and closed head injury, an important nursing goal that motivates nurses to offer the best care possible is preventing: A. choking. B. infection. C. complications. D. falls.

C

A nurse is assessing a client diagnosed with multiple sclerosis (MS). Which symptom does the nurse expect to find? A. Absent deep tendon reflexes B. Flaccid muscles C. Tremors at rest D. Vision changes

D

A client has a neurological defect and will be transferred to a nursing home because family members are unable to care for the client at home. While receiving a bed bath, the client yells at the nurse, "You don't know what you are doing!" What is the best reaction by the nurse? A. Accept the patient's behavior and do not take it personally. B. Discontinue the bath and resume it later. C. Explain that the client is getting good care. D. Request that the patient be cared for by another nurse.

A

The nurse is caring for a client with Guillain-Barré syndrome. Which assessment finding would indicate the need for oral suctioning? A. Increased pulse rate, adventitious breath sounds B. Decreased pulse rate, respirations of 20 breaths/minute C. Increased pulse rate, respirations of 16 breaths/minute D. Decreased pulse rate, abdominal breathing

A

During a Tensilon test to determine if a patient has myasthenia gravis, the patient complains of cramping and becomes diaphoretic. Vital signs are BP 130/78, HR 42, and respiration 18. What intervention should the nurse prepare to do? A. Place the patient in the supine position. B. Administer diphenhydramine (Benadryl) for the allergic reaction. C. Administer atropine to control the side effects of edrophonium. D. Call the rapid response team because the patient is preparing to arrest.

A

A client with fungal encephalitis receiving amphotericin B reports fever, chills, and body aches. The nurse knows that these symptoms A. are primarily associated with infection with Coccidioides immitis and Aspergillus. B. indicate renal toxicity and a worsening condition. C. indicate the need for immediate blood and cerebral spinal fluid (CSF) cultures. D. may be controlled by the administration of diphenhydramine and acetaminophen approximately 30 minutes before administration of the amphotericin.

D

The nurse is performing an initial assessment on a client with suspected Bell's palsy. Which of the following findings would the nurse be most focused on related to this medical diagnosis? A. Fatigue and depression B. Ptosis and diplopia C. Hyporeflexia and weakness of the lower extremities D. Facial distortion and pain

D

A patient has been diagnosed with meningococcal meningitis at a community living home. When should prophylactic therapy begin for those who have had close contact with the patient? A. Within 48 hours after exposure B. Therapy is not necessary prophylactically and should only be used if the person develops symptoms. C. Within 24 hours after exposure D. Within 72 hours after exposure

C