NCLEX Neuro disorders

When providing discharge teaching for a client with multiple sclerosis (MS), the nurse should include which instruction?

"Avoid hot baths and showers."

What is sensory aphasia?

Also known as RECEPTIVE APHASIA, a patient cannot understand oral or written forms of communication.

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?

Edrophonium (Tensilon)

A client undergoes a craniotomy with supratentorial surgery to remove a brain tumor. On the first postoperative day, the nurse notes the absence of a bone flap at the operative site. How should the nurse position the client's head?

Elevated 30 degrees

What are the risk factors for Guillain Barre Syndrome?

More common among the 20-50 age group, associated with swine flu immunizations, frequently preceded by mild respiratory or intestinal infection.

What kind of death does a person with multiple sclerosis normally die from?

Respiratory. Watch for hypoxia, restlessness, and agitation.

When teaching a client about levodopa and carbidopa (Sinemet) therapy for Parkinson's disease, the nurse should include which instruction?

"Be aware that your urine may appear darker than usual."

How should you assist with lumbar puncture?

1) Obtain informed consent 2) Have patient empty bladder 3) Explain that she will be injected with a local anesthetic and she may feel pressure during the procedure. 4) Place patient in lateral recumbent position with knees flexed toward abdomen. Help patient to remain in that position. 5) When procedure is over, change to dorsal recumbent and monitor 6) Encourage fluids to reduce headache. 7) You should also label the tubes removed from the body. Discard 1st and 2nd tubes, 3rd tube goes to lab because it does not have any contamination.

What nursing interventions should be implemented for someone with aphasia?

1) Stand in front of client 2) Speak clearly, slowly. 3) Do not shout or speak loudly. They can hear. 4) Be patient and give client time to respond 5) Use nonverbal communication, e.g. touche, smile 6) Assist client with motor aphasia to practice simple words, 7) Listen carefully 8) Provide simple directions 9) Involve family in practice 10) Show picture cards to help convey a message

What is AMYOTROPHIC LATERAL SCLEROSIS? What is important to know about it?

Also known as Lou Gehrig's Disease, it is a progressive neurological disease characterized by neuron death resulting in muscle weakness and eventually paralysis. The patient will die when respiratory paralysis reaches diaphragm so discuss advance directives and make sure to check gag reflex before feeding this patient.

What is autonomic dysreflexia? What is the cause? What are the signs and symptoms?

Also known as hyperreflexia, it is a potentially life threatening condition involving exaggeration of the sympathetic response to stimulation. The condition occurs in people with spinal cord injuries at T-6 or higher. It is triggered by a sustained stimuli such as restrictive clothing, pressure areas, FULL BLADDER, UTI or FECAL IMPACTION. Signs and symptoms above the level of injury: 1) flushed face 2) increased blood pressure 200/100 3) headache 4) distended neck veins 5) decreased heart rate 6) increased sweating, vasodilation Signs and symptoms below level of injury: 1. Pale 2. Cool 3. No sweating, vasoconstriction

What is Guillain Barre Syndrome?

An autoimmune disease of the nervous system due to damage of myelin sheath around the nerves., progresses rapidly or over 2-3 weeks, characterized by muscle weakness or symmetrical paralysis. Pig Head. Also, Landry's paralysis, an acute polyneuropathy affecting the PNS. The most typical symptoms cause change in sensation or pain, as well as dysfunction of the ANS. It can cause complications, in particularly in the respiratory muscles if the ANS is involved. It is usually triggered by an infection.

A client undergoes cerebral angiography to evaluate for neurologic deficits. Afterward, the nurse checks frequently for signs and symptoms of complications associated with this procedure. Which findings indicate spasm or occlusion of a cerebral vessel by a clot?

Hemiplegia, seizures, and decreased level of consciousness (LOC)

When evaluating for hypovolemic shock, the nurse should be aware of which of the following clinical manifestations? a) Hypertension b) Bradycardia c) Bounding pulse d) Hypotension

Hypotension Explanation: The nurse should be alert to a weak pulse (thread), decreased blood pressure, decreased urine output, rapid, shallow respirations, and elevated heart rate.

What is the proper way to give DILANTIN?

IV Push: (not compatible with IV solutions), give closest insertion site, flush/push/flush

A patient with Parkinson's disease has decreased tongue mobility and an inability to move the facial muscles. Which nursing diagnosis is of highest priority?

Imbalanced nutrition: less than body requirements rational: The data about the patient indicate that poor nutrition will be a concern because of decreased swallowing. The other diagnoses also may be appropriate for a patient with Parkinson's disease, but the data do not indicate they are current problems for this patient.

Shortly after admission to an acute care facility, a client with a seizure disorder develops status epilepticus. The physician orders diazepam (Valium), 10 mg I.V. stat. How soon can the nurse administer a second dose of diazepam, if needed and prescribed?

In 10 to 15 minutes

A client with weakness and tingling in both legs is admitted to the medical-surgical unit with a tentative diagnosis of Guillain-Barré syndrome. In this syndrome, polyneuritis leads to progressive motor, sensory, and cranial nerve dysfunction. On admission, which assessment is most important for this client?

Lung auscultation and measurement of vital capacity and tidal volume

A client with tonic-clonic seizure disorder is being discharged with a prescription for phenytoin (Dilantin). Which instructions about phenytoin should the nurse give this client?

Monitor for skin rash. Perform good oral hygiene, including daily brushing and flossing., Periodic follow-up blood work is necessary. Report to the physician problems with walking and coordination, slurred speech, or nausea.

Following 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?

Notify the patient's health care provider. rational: The patient's history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed. The other actions will be appropriate if the patient is not experiencing a cholinergic crisis.

When the nurse is assessing a patient with myasthenia gravis, which action will be most important to take?

Observe respiratory effort. rational: Because respiratory insufficiency may be life threatening, it will be most important to monitor respiratory function. The other data also will be assessed but are not as critical.

What are the people with myasthenia gravis always at risk for?

Respiratory Distress

A client is scheduled for an EEG after having a seizure for the first time. Client preparation for this test should include which instruction?

"Avoid stimulants and alcohol for 24 to 48 hours before the test."

The nurse is administering neostigmine to a client with myasthenia gravis. Which nursing intervention should the nurse implement?

Schedule the medication before meals.

What is DILANTIN used for?

Seizure prevention

The nurse is preparing a client for a computed tomography (CT) scan, which requires infusion of radiopaque dye. Which question is important for the nurse to ask?

"Are you allergic to seafood or iodine?"

What is the therapeutic level of DILANTIN?

"Dial at Ten" 10-20 = therapeutic level

A client with epilepsy is having a seizure. During the active seizure phase, the nurse should:

place the client on his side, remove dangerous objects, and protect his head.

What makes someone with myasthenia gravis worse?

Exercise and Infection

What should you document for a seizure occurrence?

The time it occurred and lasted and what parts of the body were affected.

A client is sitting in a chair and begins having a tonic-clonic seizure. The most appropriate nursing response is to:

carefully move him to a flat surface and turn him on his side.

The client asks the nurse, "How does ergotamine (Ergostat) relieve migraine headaches?" The nurse should respond that it:

constricts cerebral blood vessels.

The nurse is teaching a client who has facial muscle weakness and has recently been diagnosed with myasthenia gravis. The nurse should teach the client that myasthenia gravis is caused by:

destruction of acetylcholine receptors.

A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order:

electromyography (EMG).

When caring for a client with the nursing diagnosis Impaired swallowing related to neuromuscular impairment, the nurse should:

elevate the head of the bed 90 degrees during meals.

The nurse is working on a surgical floor. The nurse must logroll a client following a:

laminectomy.

What kind of shoes should you recommend for a patient with Parkinson's Disease?

Shoes with 1 thread so they can slide through lie. No tennis shoes or leather bottom shoes. Slippers are good.

What is the short term treatment for diagnosis of myasthenia gravis? And for long term?

Short term is TENSILON. Long term treatment is PROSTIGMIN, an airway medication and MESTINON.

How does GBS progress?

Begins in lower extremities and ascends bilaterally starting with weakness, then ataxia, then bilateral paresthesia progressing in paralysis.

How is the diagnosis of myasthenia gravis made versus cholinergic crisis?

Since both are present with the same symptoms, administer TENSILON to differentiate one from the other. If the symptoms improve, then it is myasthenia gravis. A lack of medication, PROSTIGMIN, would then be the problem. So, increase medication. If the symptoms get worse, then it is a cholinergic crisis. Too much medication is the problem with increased Prostigmin. So provide an antidote which is ATROPIN.

What kinds of food or vitamins should someone with Parkinson's avoid? Why?

Spinach, bananas, fish and pepper. Also, Vitamin B6, because they all deactivate LEVODOPA, the precursor to the neurotransmitters dopamine, norepinephrine (noradrenaline), and epinephrine (adrenaline) collectively known as catecholamines

A client is scheduled for electroconvulsive therapy (ECT). Before ECT begins, the nurse expects which neuromuscular blocking agent to be administered?

Succinylcholine (Anectine)

A client with respiratory complications of multiple sclerosis (MS) is admitted to the medical-surgical unit. Which equipment is most important for the nurse to keep at the client's bedside?

Suction machine with catheters

A client is having a tonic-clonic seizure. What should the nurse do first?

Take measures to prevent injury.

The health care provider is considering the use of sumatriptan (Imitrex) for a patient with migraine headaches. Which information obtained by the nurse is most important to report to the health care provider?

The patient has a history of a recent acute myocardial infarction. rational: The triptans cause coronary artery vasoconstriction and should be avoided in patients with coronary artery disease. The other information will be reported to the health care provider, but none of it is an indication that sumatriptan would be an inappropriate treatment.

Which information about a patient who is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease is most important for the nurse to report to the health care provider?

Uncontrolled head movement rational: Dyskinesia is an adverse effect of the Sinemet, indicating a need for a change in medication or decrease in dose. The other findings are typical with Parkinson's disease.

The nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which finding should the nurse consider abnormal?

Urine retention or incontinence

What should you watch for with TEGETROL?

Used as an anticonvulsant for seizure prevention. Monitor CBC d/t bone marrow suppression and watch for infection

The nurse is collecting data on a 38-year-old client diagnosed with multiple sclerosis. Which of the following symptoms would the nurse expect to find?

Vision changes

The nurse is planning care for a client with multiple sclerosis. Which three problems should the nurse expect the client to experience?

Visual disturbances Balance problems Mood disorders

A client is hospitalized with Guillain-Barré syndrome. Which data collection finding is most significant?

Even, unlabored respirations

A client with seizure disorder comes to the physician's office for a routine checkup. Knowing that the client takes phenytoin (Dilantin) to control seizures, the nurse assesses for which common adverse drug reaction?

Excessive gum tissue growth

If someone with GBS has voiding problems, what should you be concerned about?

Get a vent in place because diaphragm is going to be affected next.

What are the adverse reactions from medication?

Gingival hyperplasia, GI disturbances, heptoxicity, ataxia, hypocalcemia, and decrease in vitamin D absorption

What should you teach a patient on DILANTIN?

Good oral hygiene and nutrition are important

How can you keep your patient safe during seizure?

Have airway open, clear harmful objects, assess respirations and then pulse. Do not restrain patient during seizure. Do not try to open clenched jaw. Do not move unless it is unsafe not to move. Do not suction until motor activity stops.

A client in the emergency department has a suspected neurologic disorder. To assess gait, the nurse asks the client to take a few steps; with each step, the client's feet make a half circle. To document the client's gait, the nurse should use which term?

Helicopod

In a client with amyotrophic lateral sclerosis and respiratory distress, which finding is the earliest sign of reduced oxygenation?

Increased restlessness

Which nursing diagnosis takes highest priority for a client with Parkinson's crisis?

Ineffective airway clearance

What drug is used by someone experiencing autonomic dysreflexia symptoms at home?

PROCARDIA to decrease BP. Prick and squeeze under tongue. Works quickly and raise head of bed.

What occurs in the post-ictal period?

Patient sleeps for several hours after seizure. Do not call physician because this is expected.

A client with Parkinson's disease visits the physician's office for a routine checkup. The nurse notes that the client takes benztropine (Cogentin), 0.5 mg by mouth daily, and asks when the client takes the drug each day. Which response indicates that the client understands when to take benztropine?

"I take the medication at bedtime."

The nurse is teaching a client with trigeminal neuralgia how to minimize pain episodes. Which comments by the client indicate that he understands the instructions?

"I'll try to chew my food on the unaffected side." "Drinking fluids at room temperature should reduce pain.", "If brushing my teeth is too painful, I'll try to rinse my mouth instead."

A client with multiple sclerosis who is unable to bathe herself complains that other staff members haven't been bathing her. How should the nurse respond to this client's complaint?

"I'm sorry you haven't been bathed. I'm available to bathe you now."

A client who was diagnosed with multiple sclerosis 3 years ago now presents with lower extremity weakness and heaviness. During the admission process, the client presents her advance directive, which states that she doesn't want intubation, mechanical ventilation, or tube feedings should her condition deteriorate. How should the nurse respond?

"It's important for us to have this information. You should review the document with your physician at every admission."

A client has an exacerbation of multiple sclerosis accompanied by leg spasticity. The physician prescribes dantrolene sodium (Dantrium), 25 mg by mouth daily. How soon after administration can the nurse expect to see a significant reduction in spasticity?

1 to 2 weeks

What treatment is done for seizure patients?

1) Anticonvulsants: Phebobarbital, Carbamazepine (Tegretol) or Phenytoin (Dilantin). 2) Evaluate consciousness, safety, avoid alcohol. 3) Reduce activities that stimulate and reduce stimuli; no strobe lights because it is repetitive. 4) Reorient client after seizure.

What are the signs and symptoms of Parkinson's Disease?

1. Mask like blank expression 2. pill rolling 3. Shuffling gait 4. propulsive gait 5. tremors 6. bradykinesia 7. loss of ability to swallow 8. decreased blinking 9. muscle rigidity

What are the signs and symptoms of MYASTHENIA GRAVIS?

1. bobblehead 2. ptosis 3. diplopia 4. slow speech 5. frowning 6. decreased tongue movement 7. drooling 8. pupils slowly react 9. increased frowning 10. decreased chewing

What are the signs and symptoms of multiple sclerosis?

1. tinnitus 2. decreased hearing 3. urinary retention 4. spastic bladder 5. constipation 6. nystagmus 7. diplopia 8. blurred vision 9. dysarthria 10. dysphagia 11. numbness 12. tingling 13. weakness 14. paralysis 15. muscle spasticity 16. ataxia 17. vertigo

A client who's receiving phenytoin (Dilantin) to control seizures is admitted to the health care facility for observation. The physician orders measurement of the client's serum phenytoin level. Which serum phenytoin level is therapeutic?

10 to 20 mcg/ml

For a client with a head injury whose neck has been stabilized, the preferred bed position is:

30-degree head elevation.

Which of these prescribed interventions will the nurse implement first for a hospitalized patient who is experiencing continuous tonic-clonic seizures?

Administer lorazepam (Ativan) 4 mg IV. rational: To prevent ongoing seizures, the nurse should administer rapidly acting antiseizure medications such as the benzodiazepines. A CT scan is appropriate, but prevention of any seizure activity during the CT scan is necessary. Phenytoin also will be administered, but it is not rapidly acting. Patients who are experiencing tonic-clonic seizures are nonresponsive, although the nurse should assess LOC after the seizure.

What should you make sure to discuss with someone who has multiple sclerosis?

Advanced directives because patient will eventually end up on vent and the use of a peak flow meter.

Why should the patient with trigeminal neuralgia chew on the unaffected side? What is the outcome?

Because the unaffected side is painful. Patient would lose weight. The outcome should be weight gain as a result of chewing on unaffected side and eating a high calorie, high protein diet like custard, milk and eggs.

What is the medical treatment for TRIGEMINAL NEURALGIA? What is the surgical treatment?

DILANTIN or TEGRETOL. For surgical, local nerve blocks or slow nerve transmission to decrease pain.

What is important to teach pregnant women about DILANTIN?

DO NOT TAKE, because it causes birth defects.

A physician diagnoses a client with myasthenia gravis and prescribes pyridostigmine (Mestinon), 60 mg by mouth every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the client's history. Which preexisting condition would contraindicate the use of pyridostigmine?

Intestinal obstruction

What is PARKINSON'S DISEASE?

It is a progressive neurological disease with a slow onset that usually occurs after age 50, rarely occurring in the black population, and leading to a respiratory death. The motor symptoms of Parkinson's disease result from the death of dopamine-generating cells in the substantia nigra, a region of the midbrain; the cause of this cell death is unknown.

What is multiple sclerosis?

It is a progressive neurological disease with an onset among those who are at their 20's through 40's. It has a hereditary link and occurs most commonly among women. It involves the hardening of multiple nerves, and is aggravated by stress. It limits changes.

What is myasthenia gravis?

It is an autoimmune neuromuscular disease that affects the motor cranial nerves. It is the GRAVE MUSCLE WEAKNESS. Exacerbation and remissions are parts of the disease which tend to be progressive over time.

A client with amyotrophic lateral sclerosis (ALS) tells the nurse, "Sometimes I feel so frustrated. I can't do anything without help!" This comment best supports which nursing diagnosis?

Powerlessness

How is multiple sclerosis treated?

With steroids when active. Patient then becomes immunocompromised.

Is someone with aphasia still considered competent?

YES

A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by:

a positive edrophonium (Tensilon) test.

The nurse is teaching a client with multiple sclerosis. When teaching the client how to reduce fatigue, the nurse should tell the client to:

rest in a room set at a comfortable temperature.

A client with idiopathic seizure disorder is being discharged with a prescription for phenytoin (Dilantin). Client teaching about this drug should include which instruction?

"Schedule follow-up visits with your physician for blood tests."

A client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. What should the nurse tell the client about the paralysis?

"The paralysis caused by this disease is temporary."

What is TRIGEMINAL NEURALGIA? What are the considerations?

A cranial nerve disorder affecting sensory branches of the trigeminal nerve (CN V). Lukewarm food, chew on unaffected side, eye care, tearing, blinking, oral hygiene, increased protein, calories, room temperature and avoid touching client.

What is motor aphasia?

Also known as EXPRESSIVE APHASIA, Broca's area, it is the inability to speak or write. However, patient can comprehend the spoken or written form of communication.

A client diagnosed with a brain tumor experiences a generalized seizure while sitting in a chair. How should the nurse intervene first?

Assist the client to a side-lying position on the floor, and protect her with linens.

A client with a history of epilepsy is admitted to the medical-surgical unit. While assisting the client from the bathroom, the nurse observes the start of a tonic-clonic seizure. Which nursing interventions are appropriate for this client?

Assist the client to the floor. Turn the client to his side. Place a pillow under the client's head.

A patient found in a tonic-clonic seizure reports afterward that the seizure was preceded by numbness and tingling of the arm. The nurse knows that this finding indicates what type of seizure?

Atonic rational: The initial symptoms of a partial seizure involve clinical manifestations that are localized to a particular part of the body or brain. Symptoms of an absence seizure are staring and a brief loss of consciousness. In an atonic seizure, the patient loses muscle tone and (typically) falls to the ground. Myoclonic seizures are characterized by a sudden jerk of the body or extremities.

What is BELLS PALSY? What are the considerations?

Bell's palsy is a form of facial paralysis resulting from a dysfunction of the cranial nerve VII (the facial nerve) causing an inability to control facial muscles on the affected side. The biggest complications are pain and an eyelid that won't shut. To protect the eyes from corneal abrasions, use drops and eye patches at night or tape shut to protect.

A client with a suspected brain tumor is scheduled for computed tomography (CT). What should the nurse do when preparing the client for this test?

Determine whether the client is allergic to iodine, contrast dyes, or shellfish.

What drug is commonly taken to help Parkinson's symptoms? What are the Considerations?

LEVODOPA. Watch for hypotension and place TED hose on your patient to prevent further complications.

Which nursing intervention can prevent a client from experiencing autonomic dysreflexia?

Monitoring the patency of an indwelling urinary catheter

The physician suspects myasthenia gravis in a client with chronic fatigue, muscle weakness, and ptosis. Myasthenia gravis is associated with:

thymus gland hyperplasia.

A client has a history of painful, continuous muscle spasms. He has taken several skeletal muscle relaxants without experiencing relief. His physician prescribes diazepam (Valium), 2 mg by mouth twice daily. In addition to being used to relieve painful muscle spasms, diazepam also is recommended for:

treatment of spasticity associated with spinal cord lesions.

When communicating with a client who has sensory (receptive) aphasia, the nurse should:

use short, simple sentences.