Neuro PrepU
A nurse is caring for a client with dementia. A family member of the client asks what the most common cause of dementia is. Which response by the nurse is most appropriate? A. "The most common cause of dementia in the elderly is Alzheimer's disease." B. "Drug interactions are the most common cause of dementia in the elderly." C. "Dementia is a terrible disease of the elderly." D. "Depression may manifest as dementia in elderly clients."
A. "The most common cause of dementia in the elderly is Alzheimer's disease."
Vagus nerve demyelinization, which may occur in Guillain-Barré syndrome, is manifested by which of the following? A Tachycardia B. Bulbar weakness C. Inability to swallow D. Blindness
A Tachycardia
A client is scheduled for an EEG after having a seizure for the first time. Client preparation for this test should include which instruction? A. "Avoid stimulants and alcohol for 24 to 48 hours before the test." B. "Don't shampoo your hair for 24 hours before the test." C. "Don't eat anything for 12 hours before the test." D. "Avoid thinking about personal matters for 12 hours before the test."
A. "Avoid stimulants and alcohol for 24 to 48 hours before the test."
The nurse has been educating a client newly diagnosed with MS. Which statement by the client indicates an understanding of the education? A. "I will stretch daily as directed by the physical therapist." B. "I should participate in non-weight-bearing exercises." C. "The exercises should be completed quickly to reduce fatigue." D. "I will take hot tub baths to decrease spasms."
A. "I will stretch daily as directed by the physical therapist." Explanation: A stretching routine should be established. Stretching can help prevent contractures and muscle spasticity. Hot baths are discouraged because of the risk of injury. Clients have sensory loss that may contribute to the risk of burns. In addition, hot temperatures may cause an increase in symptoms. Warm packs should be encouraged to provide relief. Progressive weight-bearing exercises are effective in managing muscle spasms. Clients should not hurry through the exercise activity because it may increase muscle spasticity.
A patient is newly diagnosed with relapsing-remitting multiple sclerosis (RRMS). Which instruction should the nurse provide? A. "You must avoid stress and extreme fatigue, because these can trigger a relapse." B. "Your type of MS is the least common, making it difficult to manage." C. "You will have a steady and gradual decline in function." D. "You should take your medications only during times of relapse."
A. "You must avoid stress and extreme fatigue, because these can trigger a relapse."
The causes of acquired seizures include what? (Select all that apply.) A. Metabolic and toxic conditions B. Cerebrovascular disease C. Hypernatremia D. Brain tumor E. Drug and alcohol withdrawal
A. Metabolic and toxic conditions B. Cerebrovascular disease D. Brain tumor E. Drug and alcohol withdrawal
When providing discharge teaching for a client with multiple sclerosis (MS), the nurse should include which instruction? A. "Avoid taking daytime naps." B. "Avoid hot baths and showers." C. "Restrict fluid intake to 1,500 ml/day." D. "Limit your fruit and vegetable intake."
B. "Avoid hot baths and showers." Explanation: The nurse should instruct a client with MS to avoid hot baths and showers because they may exacerbate the disease. The nurse should encourage daytime naps because fatigue is a common symptom of MS. A client with MS doesn't require food or fluid restrictions.
The nurse is performing stroke risk screenings at a hospital open house. The nurse has identified four clients who might be at risk for a stroke. Which client is likely at the highest risk for a hemorrhagic stroke? A. White female, age 60, with history of excessive alcohol intake B. Black male, age 60, with history of diabetes C. White male, age 60, with history of uncontrolled hypertension D. Black male, age 50, with history of smoking
C. White male, age 60, with history of uncontrolled hypertension
In myasthenia gravis (MG), there is a decrease in the number of receptor sites of which neurotransmitter? A. dopamine B. Epinephrine C. acetylcholine D. Norepinephrine
C. acetylcholine Explanation: In MG, there is a reduction in the number of acetylcholine receptor sites because antibodies directed at the acetylcholine receptor sites impair transmission of impulses across the neuromuscular junction. There are no decreased receptor sites of epinephrine, norepinephrine, or dopamine implicated in MG.
A physician orders aspirin, 325 mg P.O. daily for a client who has experienced a transient ischemic attack (TIA). The nurse should teach the client that the physician has ordered this medication to: A. enhance the immune response B. control headache pain C. prevent intracranial bleeding D. reduce the chance of blood clot formation.
D. reduce the chance of blood clot formation. Explanation: TIAs are considered forerunners of stroke. Because strokes may result from clots in cerebral vessels, physicians order aspirin to prevent clot formation by reducing platelet agglutination. A 325-mg dose of aspirin is inadequate to relieve headache pain in an adult. Aspirin doesn't affect the body's immune response. Intracranial bleeding isn't associated with TIAs, and aspirin probably would worsen any existing bleeding.
A client experienced a stroke that damaged the hypothalamus. The nurse should anticipate that the client will have problems with:
body temperature control
A client diagnosed with Huntington's disease has developed severe depression. What would be most important for the nurse to assess for? answer choices A. Choreiform movements B. Suicidal ideations C. Emotional apathy D. Loss of bowel and bladder control
B. Suicidal ideations
A client with meningitis has a history of seizures. Which activity should the nurse do while the client is actively seizing? A. Suction the client's mouth and pharynx B. Turn the client to the side during a seizure and do not restrain movements C. Place a cooling blanket beneath the client D. Provide oxygen or anticonvulsants, whichever is available
B. Turn the client to the side during a seizure and do not restrain movements
Which insult or abnormality can cause an ischemic stroke? A. Cocaine use B. Arteriovenous malformation C. Intracerebral aneurysm rupture D. Trauma
A. Cocaine use
A nurse is providing care to a client with Parkinson's disease. The nurse understands the the client's signs and symptoms are related to a depletion of which of the following? answer choices A. Dopamine B. Serotonin C. Acetylcholine D. Norepinephrine
A. Dopamine
A nurse assesses the patient's level of consciousness using the Glasgow Coma Scale. What score indicates severe impairment of neurologic function? answer choices A. 3 B. 8 C. 6 D. 15
A. 3
During a client's recovery from stroke, the nurse should be aware of predictors of stroke outcome in order to help clients and families set realistic goals. What are the predictors of stroke outcome? Select all that apply. A. Age B. National Institutes of Health Stroke Scale (NIHSS) score C. Race D. Gender E. LOC at time of admission
A. Age B. National Institutes of Health Stroke Scale (NIHSS) score E. LOC at time of admission
A nurse is providing education to a client with newly diagnosed multiple sclerosis (MS). Which of the following will the nurse include? A. Avoid hot temperatures. B. Avoid physical activity. C. Avoid analgesic medication. D. Take moderate amounts of alcohol.
A. Avoid hot temperatures. Explanation: Fatigue affects most people with MS. Avoidance of hot temperatures may help control fatigue. A balance of rest and activity is a good strategy, but avoidance of any physical activity is not recommended. Avoidance of all alcohol is a good strategy. Analgesics may be required for pain management
A client who was diagnosed with Parkinson's disease several months ago recently began treatment with levodopa-carbidopa. The client and his family are excited that he has experienced significant symptom relief. The nurse should be aware of what implication of the client's medication regimen? A. Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment. B. Benefits of levodopa-carbidopa do not peak until 6 to 9 months after the initiation of treatment. C. The client's temporary improvement in status is likely unrelated to levodopa-carbidopa. D. The client is in a "honeymoon period" when adverse effects of levodopa-carbidopa are not yet evident.
A. Benefits of levodopa-carbidopa often diminish after 1 or 2 years of treatment.
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 B. Ambenonium C. Pyridostigmine D. Carbachol
A. Edrophonium Explanation: Edrophonium temporarily blocks the breakdown of acetylcholine, thus increasing acetylcholine level in the blood, and relieves weakness. Because of its short duration of action, edrophonium is the drug of choice for diagnosing myasthenia gravis. It's also used to differentiate myasthenia gravis from cholinergic toxicity. Ambenonium is used as an antimyasthenic. Pyridostigmine serves primarily as an adjunct in treating severe anticholinergic toxicity; it's also an antiglaucoma agent and a miotic. Carbachol reduces intraocular pressure during ophthalmologic procedures; topical carbachol is used to treat open-angle and closed-angle glaucoma.
Which nursing interventions might need to be considered in a care plan for a client with advanced multiple sclerosis? Select all that apply. A. Encourage the client to walk with feet wide apart. B. Ensure access to a language board when communicating with the client. C. Establish a voiding time schedule. D. Obtain daily weights to monitor weight gain
A. Encourage the client to walk with feet wide apart. B. Ensure access to a language board when communicating with the client. C. Establish a voiding time schedule.
Level of consciousness (LOC) can be assessed based on criteria in the Glasgow Coma Scale (GCS). Which of the following indicators are assessed in the GCS? Select all that apply. A. Eye opening B. Muscle strength C. Intelligence D. Verbal response E. Motor response
A. Eye opening D. Verbal response E. Motor response
A nurse is communicating with a client who has aphasia after having a stroke. Which action should the nurse take? A. Face the client and establish eye contact. B. Keep the television on while she speaks. C. Use one long sentence to say everything that needs to be said. D. Talk in a louder than normal voice.
A. Face the client and establish eye contact.
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, abdominal breathing C. Decreased pulse rate, Respiratory Rate of 20 D. Increased pulse rate, abdominal breathing
A. Increased pulse rate, adventitious breath sounds Explaination: An increased pulse rate above baseline with adventitious breath sounds indicate compromised respirations and signal a need for airway clearance. A decrease in pulse rate is not indicative of airway obstruction. An increase of pulse rate with slight elevation of respirations (16 breaths/minute) is not significant for suctioning unless findings suggest otherwise.
A nurse is caring for an older client who has had a hemorrhagic stroke. The client has exhibited impulsive behavior and, despite reminders from the nurse, doesn't recognize his limitations. Which priority measure should the nurse implement to prevent injury? A. Install a bed alarm to remind the client to ask for assistance and to alert staff that the client is getting out of bed. B. Encourage the family to reprimand the client if he doesn't ask for help with transfers and mobility. C. Encourage the client to do as much as possible without assistance, and to use the call light only in emergencies. D. Ask a physician to order a vest and wrist restraints
A. Install a bed alarm to remind the client to ask for assistance and to alert staff that the client is getting out of bed.
Which of the following is the initial diagnostic in suspected stroke? A. Noncontrast computed tomography (CT) B. CT with contrast C. Cerebral angiography D> Magnetic resonance imaging (MRI)
A. Noncontrast computed tomography (CT) Explanation: An initial head CT scan will determine whether or not the patient is experiencing a hemorrhagic stroke. An ischemic infarction will not be readily visible on initial CT scan if it is performed within the first few hours after symptoms onset; however, evidence of bleeding will almost always be visible.
A client with lou gehrig's disease (ALS) tells the nurse, "Sometimes I feel so frustrated. I can't do anything without help!" This comment best supports which nursing diagnosis? A. Powerlessness B. Anxiety C. Risk for disuse syndrome D. Ineffective Denial
A. Powerlessness Explanation: The client's comment best supports a nursing diagnosis of Powerlessness because ALS may lead to locked-in syndrome, characterized by an active and functioning mind locked in a body that can't perform even simple daily tasks. Although Anxiety and Risk for disuse syndrome may be diagnoses associated with ALS, the client's comment specifically refers to an inability to act autonomously. A diagnosis of Ineffective denial would be indicated if the client didn't seem to perceive the personal relevance of symptoms or danger.
The nurse is reviewing the medical record of a client with glaucoma. Which of the following would alert the nurse to suspect that the client was at increased risk for this disorder? answer choices A. Prolonged use of corticosteroids B. Hyperopia since age 20 years C. History of respiratory disease D. Age younger than 40 years
A. Prolonged use of corticosteroids
A client the nurse is caring for experiences a seizure. What would be a priority nursing action? A. Protect the client from injury. B. Restrain the client during the seizure. C. Insert a tongue blade between the teeth. D. Suction the mouth during the convulsion.
A. Protect the client from injury.
A nurse is providing care to a client with a brain tumor. The client has experienced seizures as a result of the tumor. Which area would be a priority for this client? A. Safety B. Skin care C. Self-care D. Activity
A. Safety
When developing a care plan for a client who has recently suffered a stroke, a nurse includes the nursing diagnosis Risk for imbalanced body temperature. What is the rationale for this diagnosis? A. The stroke may have impacted the body's thermoregulation centers. B. An elevated body temperature indicates infection. C. An elevated temperature indicates cerebellum malfunction. D. A decreased body temperature will signal the need to cover the client
A. The stroke may have impacted the body's thermoregulation centers.
A client falls to the floor in a generalized seizure with tonic-clonic movements. Which is the first action taken by the nurse? A. Turn client to side-lying position. B. Insert an airway or bite block. C. Manually restrain the extremities. D. Monitor vital signs.
A. Turn client to side-lying position.
A client is suspected of having lou gehrig's disease (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order: A. electromyography (EMG) B. Doppler scanning. C. Doppler ultrasonography. D. quantitative spectral phonoangiography.
A. electromyography (EMG) Explanation: To help confirm ALS, the physician typically orders EMG, which detects abnormal electrical activity of the involved muscles. To help establish the diagnosis of ALS, EMG must show widespread anterior horn cell dysfunction with fibrillations, positive waves, fasciculations, and chronic changes in the potentials of neurogenic motor units in multiple nerve root distribution in at least three limbs and the paraspinal muscles. Normal sensory responses must accompany these findings. Doppler scanning, Doppler ultrasonography, and quantitative spectral phonoangiography are used to detect vascular disorders, not muscular or neuromuscular abnormalities.
You are caring for a client admitted with a stroke. Imaging studies indicate an embolus partially obstructing the right carotid artery. What type of stroke do you know this client has? A. ischemic B. hemorrhagic C. Right-sided D. Left-sided
A. ischemic
A nurse is assessing a client with Parkinson's disease. Which of the following would the nurse expect to find? A. Continuous tremors B. Slowing of activity C. Muscle flaccidity D. Gait with the body leaning backward
B. Slowing of activity
A client with myasthenia gravis is admitted with an exacerbation. The nurse is educating the client about plasmapheresis and explains this in which of the following statements? A. Mestinon therapy is initiated. B. Antibodies are removed from the plasma. C. Immune globulin is given intravenously. D. The thymus gland is removed.
B. Antibodies are removed from the plasma. Explanation: Plasmapheresis is a technique in which antibodies are removed from plasma and the plasma is returned to the client. The other three choices are appropriate treatments for myasthenia gravis, but are not related to plasmapheresis.
Which of the following nursing interventions is appropriate for a patient with double vision in the right eye due to MS? A. Administer eye drops as needed. B. Apply an eye patch to the right eye. C. Exercise the right eye twice a day (BID). D. Place needed items on the right side.
B. Apply an eye patch to the right eye.
Which nursing intervention is the priority for a client in myasthenic crisis? A. Ensuring adequate nutritional support B. Assessing respiratory effort C. Administering intravenous immunoglobin (IVIG) per orders D. Preparing for plasmapheresis
B. Assessing respiratory effort Explanation: A client in myasthenic crisis has severe muscle weakness, including the muscles needed to support respiratory effort. Myasthenic crisis can lead to respiratory failure and death if not recognized early. Administering IVIG, preparing for plasmapheresis, and ensuring adequate nutritional support are important and appropriate interventions, but maintaining adequate respiratory status or support is the priority during the crisis.
A nurse is providing education to a community group about ischemic strokes. One group member asks if there are ways to reduce the risk for stroke. Which of the following is a risk factor that can be modified? A. Male gender B. Hypertension C. Advanced age D. African-American race
B. Hypertension Explanation: Modifiable risk factors for ischemic stroke include hypertension, atrial fibrillation, hyperlipidemia, diabetes mellitus, smoking, asymptomatic carotid stenosis, obesity, and excessive alcohol consumption. Non-modifiable risk factors include advanced age, gender, and race
The diagnosis of multiple sclerosis is based upon which of the following tests? A. Neuropsychological testing B. MRI C. CSF electrophoresis D. Evoked potential studies
B. MRI Explanation: The diagnosis of MS is based on the presence of multiple plaques in the CNS observed with MRI. Electrophoresis of CSF identifies the presence of oligoclonal banding. Evoked potential studies can help define the extent of the disease process and monitor changes. Neuropsychological testing may be indicated to assess cognitive impairment
A patient is diagnosed with amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig's disease. The nurse understands that the symptoms of the disease will begin in what way? A. Jerky, uncontrolled movements in the extremities B. Weakness starting in the muscles supplied by the cranial nerves C. Ascending paralysis D. Numbness and tingling in the lower extremities
B. Weakness starting in the muscles supplied by the cranial nerves
A nurse is providing care to a client who has had a stroke. Which symptoms are consistent with right-sided hemiplegia? A. short retention of information, deficits in left visual fields, misjudgement of distances B. expressive aphasia, defects in the right visual fields, problems with abstract thinking C. impulsive behavior, poor judgment, deficits in left visual fields D. problems with abstract thinking, impairment of short-term memory, poor judgment
B. expressive aphasia, defects in the right visual fields, problems with abstract thinking
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 had difficulty with urination in the last 6 weeks?" B. "Have you experienced any ptosis in the last few weeks?" C. "Have you experienced any viral infections in the last month?" D. "Have you developed any new allergies in the last year?"
C. "Have you experienced any viral infections in the last month?" Explanation: An antecedent event (most often a viral infection) precipitates clinical presentation. The antecedent event usually occurs about 2 weeks before the symptoms begin. Ptosis is a common symptom associated with myasthenia gravis. Urination and development of allergies are not associated with Guillain-Barre.
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. "It's too early to give a prognosis." C. "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive." D. "Once Guillain-Barré syndrome progresses to the diaphragm, survival decreases significantly."
C. "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive." Explanation: The survival rate of Guillain-Barré syndrome is approximately 90%. The client may make a full recovery or suffer from some residual deficits. Telling the parents not to worry dismisses their feelings and does not address their concerns. Progression of Guillain-Barré syndrome to the diaphragm does not significantly decrease the survival rate, but it does increase the chance of residual deficits. The family should be given information about Guillain-Barré syndrome and the generally favorable prognosis. With no prognosis offered, the parents are not having their concerns addressed.
A client who recently experienced a stroke tells the nurse that he has double vision. Which nursing intervention is most appropriate? A. Turn out the lights in the room. B. Encourage the client to close his eyes. C. Alternatively patch one eye every 2 hours. D. Instill artificial tears.
C. Alternatively patch one eye every 2 hours. Explanation: Patching one eye at a time relieves diplopia (double vision). Closing the eyes and making the room dark aren't the most appropriate options because they deprive the client of sensory input. Artificial tears relieve eye dryness but don't treat diplopia.
A client is diagnosed with a brain tumor. As the nurse assists the client from the bed to a chair, the client begins having a generalized seizure. Which action should the nurse take first? A. Record the type of seizure and the time that it occurred. B. Put a padded tongue blade into the client's mouth and restrain his extremities. C. Assist the client to the floor, in a side-lying position, and protect him with linens. D. Initiate the code team response.
C. Assist the client to the floor, in a side-lying position, and protect him with linens.
A 33-year-old client presents at the clinic with reports of weakness, incoordination, dizziness, and loss of balance. The client is hospitalized and diagnosed with MS. What sign or symptom, revealed during the initial assessment, is typical of MS? A. Hyperactive abdominal reflexes and history of unsteady gait and episodic paresthesia in both legs B. Flexor spasm, clonus, and negative Babinski reflex C. Blurred vision, intention tremor, and urinary hesitancy D. Diplopia, history of increased fatigue, and decreased or absent deep tendon reflexes
C. Blurred vision, intention tremor, and urinary hesitancy
Which of the following is the most common clinical manifestation of multiple sclerosis? A. Ataxia B. Spasticity C. Fatigue D. Pain
C. Fatigue Explanation: Fatigue affects 87% of people with MS and 40% of that group indicate that fatigue is the most disabling symptom. Pain, spasticity, and ataxia are clinical manifestations of MS.
A client with epilepsy is having a seizure. What intervention should the nurse do after the seizure? A. Pry the client's mouth open to allow a patent airway. B. Place a cooling blanket beneath the client. C. Help the client sit up. D. Keep the client on one side.
C. Help the client sit up.
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. Incentive spirometer B. Blood pressure apparatus C. Intubation tray and suction apparatus D. Nebulizer and thermometer
C. Intubation tray and suction apparatus
You are taking care of a client who is taking an anticonvulsant. Why should you advise the client not to stop taking the drug abruptly? A. It may cause alopecia. B. It may cause severe and ugly skin rashes. C. It may trigger status epilepticus. D. It may cause loss in appetite.
C. It may trigger status epilepticus. Explanation: Abrupt withdrawal of any anticonvulsant may cause status epilepticus or continuous seizure activity. Therefore, the drug should be withdrawn gradually and not abruptly. Abrupt withdrawal of any anticonvulsant does not cause loss of appetite, alopecia, or rashes.
Which of the following medications is the most effective agent in the treatment of Parkinson's disease (PD)? A. Benztropine (Cogentin) B. Bromocriptine mesylate (Parlodel) C. Levodopa (Larodopa) D. Amantadine (Symmetrel)
C. Levodopa (Larodopa)
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. Parkinson disease B. Huntington disease C. Multiple sclerosis D. Creutzfeldt-Jakob disease
C. Multiple sclerosis Explanation: The cause of MS is not known, and the disease affects twice as many women as men. Parkinson disease is associated with decreased levels of dopamine caused by destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia.
The most common cause of cholinergic crisis includes which of the following? A. Undermedication B. Infection C. Overmedication D. Compliance with medication
C. Overmedication Explanation: A cholinergic crisis, which is essentially a problem of overmedication, results in severe generalized muscle weakness, respiratory impairment, and excessive pulmonary secretion that may result in respiratory failure. Myasthenic crisis is a sudden, temporary exacerbation of MG symptoms. A common precipitating event for myasthenic crisis is infection. It can result from undermedication.
A nurse is planning care for a client who experienced a stroke in the right hemisphere of his brain. What should the nurse do? A. Anticipate the client will exhibit some degree of expressive or receptive aphasia. B. Support the right arm with a sling or pillow to prevent subluxation. C. Provide close supervision because of the client's impulsiveness and poor judgment. D. Place the wheelchair on the client's left side when transferring him into a wheelchair
C. Provide close supervision because of the client's impulsiveness and poor judgment.
A client has an exacerbation of multiple sclerosis. The physician orders dantrolene (Dantrium), 25 mg P.O. daily. Which assessment finding indicates the medication is effective? answer choices A. Increased ability to sleep B. Relief from constipation C. Reduced muscle spasticity D. Relief from pain
C. Reduced muscle spasticity
Which of the following tests confirms the diagnosis of myasthenia gravis (MG)? A. Computed tomography (CT) scan B. Electromyogram (EMG) C. Tensilon test D. Serum studies
C. Tensilon test Explanation: Edrophonium chloride (Tensilon) is an acetylcholinesterase inhibitor that stops the breakdown of acetylcholine. The drug is used because it has a rapid onset of 30 seconds and a short duration of 5 minutes. Immediate improvement in muscle strength after administration of this agent represents a positive test and usually confirms the diagnosis. The presence of acetylcholine receptor antibodies is identified in serum. Repetitive nerve stimulation demonstrates a decrease in successive action potentials. The thymus gland may be enlarged in MG, and a T scan of the mediastinum is performed to detect thymoma or hyperplasia of the thymus.
A client is hospitalized with Guillain-Barré syndrome. Which nursing assessment finding is most significant? A. Urine output of 40 ml/hour B. Soft, nondistended abdomen C. Uneven, labored respirations D. Warm, dry skin
C. Uneven, labored respirations
A 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: A. decreased conduction of impulses in an upper motor neuron lesion. B. genetic dysfunction. C. a lower motor neuron lesion. D. upper and lower motor neuron lesions.
C. a lower motor neuron lesion. Explanation: Myasthenia gravis is characterized by a weakness of muscles, especially in the face and throat, caused by a lower motor neuron lesion at the myoneural junction. It isn't a genetic disorder. A combined upper and lower motor neuron lesion generally occurs as a result of spinal injuries. A lesion involving cranial nerves and their axons in the spinal cord would cause decreased conduction of impulses at an upper motor neuron.
A nurse is assessing a client who will be discharged home after rehabilitation for a stroke. The nurse is questioning the client about his instrumental activities of daily living (IADLs). Which of the following would the nurse address? A. bathing B. dressing C. cooking D. brushing teeth
C. cooking
A nurse is teaching a client with multiple sclerosis (MS). When teaching the client how to reduce fatigue, the nurse should tell the client to: A. avoid naps during the day. B. take a hot bath. C. rest in an air-conditioned room. D. increase the dose of muscle relaxants
C. rest in an air-conditioned room.
A nurse is teaching a client who was recently diagnosed with myasthenia gravis. Which statement should the nurse include in her teaching? A. "You'll need to take edrophonium (Tensilon) to treat the disease." B. "The disease is a disorder of motor and sensory dysfunction." C. "You'll continue to experience progressive muscle weakness and sensory deficits." D. "This disease doesn't cause sensory impairment."
D. "This disease doesn't cause sensory impairment."
A client with Parkinson's disease asks the nurse what their treatment is supposed to do since the disease is progressive. What would be the nurse's best response? A. "Treatment really doesn't matter; the disease is going to progress anyway." B. "Treatment for Parkinson's is only palliative; it keeps you comfortable." C. "Treatment aims at keeping you emotionally healthy by making you think you are doing something to fight this disease." D. "Treatment aims at keeping you independent as long as possible."
D. "Treatment aims at keeping you independent as long as possible."
Thrombolytic therapy should be initiated within what time frame of an ischemic stroke for best functional outcome? A. 12 hours B. 2 hours C. 24 hours D. 4 hours
D. 4 hours Explanation: Rapid diagnosis of stroke and initiation of thrombolytic therapy (within 4 hours) in patients with ischemic stroke lead to a decrease in the size of the stroke and an overall improvement in functional outcome after 3 months.
A nurse is assisting with a community screening for people at high risk for stroke. To which of the following clients would the nurse pay most attention? A. A 62-year-old Caucasian woman B. A 40-year-old Caucasian woman C. A 28-year-old pregnant African-American woman D. A 60-year-old African-American man
D. A 60-year-old African-American man Explanation: The 60-year-old African-American man has three risk factors: gender, age, and race. African Americans have almost twice the incidence of first stroke compared with Caucasians.
The nurse is advising a client with multiple sclerosis on methods to minimize spasticity and contractures. Which of the following techniques would the nurse instruct the client to perform? A. Exercise following a circuit training regimen. B. Avoid swimming and any weight-bearing activity. C. Relax in a hot bath. D. Apply warm packs to the affected area
D. Apply warm packs to the affected area
A client who just experienced a suspected ischemic stroke is brought to the ED by ambulance. On what should the nurse's primary assessment focus? A. Fluid and electrolyte balance B. Seizure activity C. Pain D. Cardiac and respiratory status
D. Cardiac and respiratory status
A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following? answer choices A. Dysphonia B. Micrographia C. Bradykninesia D. Dyskinesia
D. Dyskinesia
A client is undergoing testing to confirm a diagnosis of myasthenia gravis. The nurse explains that a diagnosis is made if muscle function improves after the client receives an IV injection of a medication. What is the medication the nurse tells the client he'll receive during this test? A. Cyclosporine (Sandimmune) B. Immunoglobulin G (Iveegam EN) C. Azathioprine (Imuran) D. Edrophonium (Tensilon)
D. Edrophonium (Tensilon) Explanation: The most useful and reliable diagnostic test for myasthenia gravis is the edrophonium (Tensilon) test. Within 30 to 60 seconds after injection of edrophonium, most clients with myasthenia gravis will demonstrate a marked improvement in muscle tone that lasts about 4 to 5 minutes. Cyclosporine, an immunosuppressant, is used to treat myasthenia gravis, not to diagnose it. Immunoglobulin G is used during acute relapses of the disorder. Azathioprine is an immunosuppressant that's sometimes used to control myasthenia gravis symptoms.
After a stroke, a client is admitted to the facility. The client has left-sided weakness and an absent gag reflex. He's incontinent and has a tarry stool. His blood pressure is 90/50 mm Hg, and his hemoglobin is 10 g. Which nursing intervention is a priority for this client? A. Performing range-of-motion (ROM) exercises on the left side B. Checking stools for occult blood C. Keeping skin clean and dry D. Elevating the head of the bed to 30 degrees
D. Elevating the head of the bed to 30 degrees
A client is brought by ambulance to the ED after suffering what the family thinks is a stroke. The nurse caring for this client is aware that an absolute contraindication for thrombolytic therapy is what? A. Previous thrombolytic therapy within the past 12 months B. Blood pressure of ≥ 180/110 mm Hg C. Evidence of stroke evolution D. Evidence of hemorrhagic stroke
D. Evidence of hemorrhagic stroke
An 83-year-old woman suffers a stroke at home and is hospitalized for treatment and management. Which of the following diagnostic procedures would be best to visualize the extent of damage? A. Computed tomography (CT) B. Magnetic resonance imaging (MRI) C. Diffusion-weighted imaging (DWI) D. Magnetic resonance angiography (MRA)
D. Magnetic resonance angiography (MRA)
The nurse is educating a client with myasthenia gravis about medications. The nurse is sure to include which of the following? A. Medications are best taken while the client is in a reclining position. B. There is no conflict with the disorder and dental work. C. Medications can be taken whenever convenient. D. Medications must be taken on time.
D. Medications must be taken on time.
Which of the following is considered a central nervous system (CNS) disorder? A. Myasthenia Gravis B. Parkinsons disease C. Huntington's Disease D. Multiple Sclerosis
D. Multiple Sclerosis
Which of the following is the first-line therapy for myasthenia gravis (MG)? answer choices A. Azathioprine (Imuran) B. Lioresal (Baclofen) C. Deltasone (Prednisone) D. Pyridostigmine bromide (Mestinon)
D. Pyridostigmine bromide (Mestinon) Explanation: Mestinon, an anticholinesterase medication, is the first-line therapy in MG. It provides symptomatic relief by inhibiting the breakdown of acetylcholine and increasing the relative concentration of available acetylcholine at the neuromuscular junction. If Mestinon does not improve muscle strength and control fatigue, the next agents used are immunosuppressant agents. Imuran is an immunosuppressive agent that inhibits T lymphocytes and reduces acetylcholine receptor antibody levels. Baclofen is used in the treatment of spasticity in MG.
An emergency department nurse is interviewing a client with signs of an ischemic stroke that began 2 hours ago. The client reports that she had a cholecystectomy 6 weeks ago and is taking digoxin, coumadin, and labetelol. This client is not eligible for thrombolytic therapy for which of the following reasons? A. She had surgery 6 weeks ago. B. She is taking digoxin C. She is not within the treatment time window. D. She is taking coumadin
D. She is taking coumadin Explanation: To be eligible for thrombolytic therapy, the client cannot be taking coumadin. Initiation of thrombolytic therapy must be within 4 hours in clients with ischemic stroke. The client is not eligible for thrombolytic therapy if she has had surgery within 14 days. Digoxin and labetelol do not prohibit thrombolytic therapy.
Guillain-Barré syndrome is an autoimmune attack on the peripheral myelin sheath. Which of the following is an action of myelin? A. Carries message to the next nerve cell B. Represents building block of nervous system C. Acts as chemical messenger D. Speeds nerve impulse transmission
D. Speeds nerve impulse transmission Explanation: Myelin is a complex substance that covers nerves, providing insulation and speeding the conduction of impulses from the cell body to the dendrites. The axon carries the message to the next nerve cell. The neuron is the building block of the nervous system. A neurotransmitter is a chemical messenger.
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? A. Padded tongue blade B. Sphygmomanometer C. Nasal cannula and oxygen D. Suction machine with catheters
D. Suction machine with catheters
A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by: answer choices A. Brudzinski's sign. B. Kernig's sign. C. a positive sweat chloride test. D. a positive edrophonium (Tensilon) test.
D. a positive edrophonium (Tensilon) test.
Huntington's disease is the development of ________ in clients with advanced Huntington's disease. A. bradykinesia B. depression C. muscle fasciculations D. hallucinations and delusions
D. hallucinations and delusions
