Quiz 8 Ch 21, 22, 12,14,18

Patients taking phenytoin (Dilantin) for control of seizures must be aware of the risk for which adverse effect(s)? (Select all that apply.) a. Blood dyscrasias b. Hyperglycemia c. Urinary retention d. Gingival hyperplasiae. e.Insomnia f. Sedation

A,B,D,F

Which neurotransmitters support smooth neural transmission? (Select all that apply.) a. Acetylcholine b. CSF c. Dopamine d. Dendrite e. Epinephrine

A,C,E

The nurse is caring for a patient with symptoms of a migraine headache. What assessment information supports this diagnosis? (Select all that apply.) a. Bilateral pain in temples b. Nausea c. Photosensitivity d. Elevated WBC count e. Tearing

B,C,E

Which instruction(s) given by the nurse will assist a patient to cope with the common adverse effects of anticholinergic medications? (Select all that apply.) a. "Take the medication with meals." b. "Increase fluids daily." c. "Decrease fiber in the diet." d. "Suck on candy or ice chips." e. "Monitor blood glucose."

B,D

A patient is stuporous but reacts by withdrawing from painful stimuli. What term is most appropriate for this patient? a. Comatose b. Lethargic c. Semicomatose d. Somnolent

ANS: C A stuporous patient who reacts to pain is semicomatose. The patient with no reaction to pain is comatose.

Which are normal brain alterations associated with age? (Select all that apply.) a. Decrease in brain weight b. Pigmentation of brain with lipofuscin c. Present of amyloid d. Tiny clot formation e. Tangled nerve fibers

A,B,C,E

A patient on anticonvulsant therapy confides to the nurse at an outpatient clinic that she suspects she may be pregnant. The nurse should encourage the patient to take which action(s)? (Select all that apply.) a. Consult an obstetrician. b. Discontinue medications. c. Carry an identification card. d. Provide a list of seizure medications. e. Consider oral contraception.

A,C,D

Which adverse effect(s) is/are common when a patient is receiving a cholinergic agent? (Select all that apply.) a. Nausea b. Hypertension c. Dizziness d. Bradycardia e. Constipation

A,C,D

A nurse caring for an immobilized patient with a brain tumor stimulates the patient several times a day with range-of-motion exercises and changes his position every 2 hours to try to prevent a disuse syndrome. What signs and symptoms does disuse syndrome include? (Select all that apply.) a. Pooling of pulmonary secretions b. Paralysis c. Muscle tremor d. Pressure ulcers e. Altered visual perceptions

A,D

The nurse is preparing to administer zonisamide (Zonegran) to a newly admitted patient with the diagnosis of adult partial seizures. The nurse should hold this medication if the patient has which sign(s) or symptom(s)? (Select all that apply.) a. Skin rash b. Urinary frequency c. Drowsiness d. Allergy to Bactrim e. Pruritus

A,D,E

A patient with a severe head injury begins to assume a posture of flexed upper extremities, with plantarflexed lower extremities. What do these assessments indicate? a. Increasing intracranial pressure (ICP) with decorticate posturing b. Decreasing ICP with decerebrate posturing c. Decreasing ICP with decorticate posturing d. Increasing ICP with decerebrate posturing

ANS: A Increasing pressure on the tissue above the midbrain results in abnormal flexion (decorticate posturing).

What information would be most important for the nurse to provide to a patient when teaching about the adverse effects of succinimide therapy? a. Nausea, vomiting, and indigestion are common during the initiation of therapy. b. Avoid taking the medication with food or milk to minimize adverse effects. c. Sedation, drowsiness, and dizziness tend to worsen with continued therapy. d. Reducing the dosage of medication will relieve symptoms of nausea.

ANS: A Nausea, vomiting, and indigestion are common during initiation of therapy. Taking the medicine with food or milk reduces the nausea and indigestion. Sedation, drowsiness, and dizziness tend to disappear with continued therapy. Gradual increases in dosage tend to decrease nausea and vomiting.

What is the drug of choice when treating a generalized tonic-clonic seizure? a. Diazepam (Valium) b. Haloperidol (Haldol) c. Valproic acid (Depakene) d. Risperidone (Risperdal)

ANS: C Anticonvulsant therapy should start with the use of a single agent selected from a group of first-line agents based on the type of seizure. Valproic acid is indicated for generalized tonic-clonic seizures. Diazepam is not the drug of choice for treatment of tonic-clonic seizures. Haloperidol is an antipsychotic medication. Risperidone is an antipsychotic agent.

The ______ of the seizure is characterized by stiffening of the muscles or extremities with loss of consciousness.

tonic phase

A(n) ______ hematoma forms in the space between the inner surface of the skull and the outermost meningeal covering of the brain.

epidural

The healthcare provider orders diazepam (Valium) 10 mg IV stat for a patient who was admitted with status epilepticus. What important nursing interventions(s) associated with administration of this medication IV should the nurse perform? (Select all that apply.) a. Apply a cardiac monitor to the patient to assess for continuous heart rate, if not already done. b. Administer the prescribed dosage over 1 minute. c. Mix diazepam in a primary IV solution to avoid overdosing. d. Continuously assess the patient's airway. e. Obtain the correct dose (10 mg) and administer over slow IV push.

A,D,E

A nurse is careful about limb position in caring for an unconscious patient who sustained a head injury 10 days ago. What is the nurse trying to prevent? a. Flexion deformities b. Atrophy c. Paralysis d. Pathologic fracture

ANS: A An unconscious patient should be positioned in anatomic alignment to prevent flexion deformities. Passive range of motion and frequent position changes are essential to maintain the limbs in a functional position.

What should a nurse instruct a patient after a lumbar puncture to prevent a headache? a. Lie flat. b. Lie on left side. c. Stay in semi-Fowler position. d. Ambulate in the room with assistance.

ANS: A Lying flat for a prescribed period will allow the loss of cerebrospinal fluid during the procedure to replenish.

What should the nurse assess when a patient is scheduled for an angiogram? a. Dizziness b. Allergy to shrimp c. Increased BP d. Irregular heartbeat

ANS: B Allergy to shrimp and other shellfish also indicates a probable allergy to contrast medium.

Which assessment on a patient on mannitol therapy for cerebral edema indicates the medication is effective in decreasing ICP? a. Increased BP b. Increased urinary output c. Decreased pulse d. Widening pulse pressure

ANS: B Mannitol is a hyperosmolar diuretic that draws fluid from brain tissue into the bloodstream, which is then excreted by the kidneys. Decreasing pulse and widening pulse pressure indicate increased ICP.

Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity? a. Oculogyric crisis b. Nystagmus c. Strabismus d. Amblyopia

ANS: B Nystagmus (involuntary rhythmic, uncontrollable movements of one or both eyes) may be a sign of phenytoin toxicity. Oculogyric crisis is an adverse effect of some antipsychotic medications. Strabismus is a visual disorder in which the eyes are misaligned and point in different directions. Amblyopia is a loss of visual acuity in the nondominant eye caused by lack of use of the eye in early childhood.

A patient with Parkinson's disease asks the nurse why anticholinergics are used in the treatment. Which response by the nurse is most accurate? a. "These drugs help you urinate." b. "These drugs will decrease your eye pressure." c. "These drugs inhibit the action of acetylcholine." d. "These drugs will assist in lowering your heart rate."

ANS: C Anticholinergic agents inhibit the action of acetylcholine in the parasympathetic nervous system. These drugs occupy receptor sites at the parasympathetic nerve endings, preventing the action of acetylcholine. Inhibition of acetylcholine facilitates stimulation of the dopaminergic receptors, which relieves the symptoms associated with Parkinson's disease. Anticholinergic agents cause urinary retention, increase intraocular pressure, and increase the heart rate

For which condition may carbamazepine (Tegretol) be used? a. Tardive dyskinesia b. Psychotic episodes c. Trigeminal neuralgia pain d. Sedation

ANS: C Carbamazepine has been used successfully to treat pain associated with trigeminal neuralgia and for bipolar disorders when lithium therapy has not been optimal. Carbamazepine does not have antidepressant, antipsychotic, or sedative effects.

Which neurologic finding would be considered abnormal in an 88-year-old patient? a. Slow papillary response to light b. Jerky eye movements c. Dizziness and problems with balance d. Absence of the Achilles tendon jerk

ANS: C Dizziness and vertigo, although common, are considered abnormal

What diagnostic test might be contraindicated for a patient who has a pacemaker? a. Computed tomography (CT) b. Electromyography (EMG) c. Magnetic resonance imaging (MRI) d. Electroencephalography (EEG)

ANS: C Metal appliances may be affected by the magnetic field during MRI.

What should the nurse implement before giving an enteral feeding to a patient? a. Palpate the abdomen to check for residual feeding. b. Warm the feeding. c. Elevate the head of the bed 30 degrees. d. Ask the patient to tip his head forward.

ANS: C The head of the bed should be elevated 30 degrees to prevent aspiration.

.An older adult patient is experiencing extreme stress related to an admission to the hospital. What should the nurse expect the patient to demonstrate? a. Decreased heart rate b. Decreased blood pressure (BP) c. Irregular respiration d. Dilation of the pupils

ANS: D Stress stimulates the fight-or-flight reaction with the release of epinephrine and norepinephrine, which causes increased heart rate and BP, reduced peristalsis, and pupil dilation.

A nurse is evaluating the effectiveness of teaching for a patient with multiple sclerosis (MS). Which statement by the patient indicates that accurate patient learning has taken place? a. "Now that I am taking steroids, I will be able to work like I used to." b. "I'm making a list of things that are important and things I will simply have to let go." c. "I will make a plan to allow for long rest periods at least four times a day." d. "I am working on balancing time among rest, work, and family time."

ANS: D Balancing time between various activities indicates that the patient with MS understands the need to conserve energy, not just to give up things or attempt to perform at a preillness level.

What is a guideline for the nurse when administering phenytoin (Dilantin) intravenously? a. Deliver rapidly. b. Monitor for signs of tachycardia. c. Assess for hypertensive crisis. d. Administer without mixing with other medications.

ANS: D Phenytoin should not be mixed in the same syringe with other medications or added to other intravenous (IV) solutions because a precipitate will form. Phenytoin should be administered slowly at a rate of 25 to 50 mg/min. Patients should be monitored with an ECG closely for bradycardia. Patients should be monitored for hypotension.

A family member asks the nurse what would be an appropriate gift for a patient with Parkinson disease. What is the most useful suggestion? a. Soft-soled house shoes b. Jigsaw puzzle c. Set of card games d. Satin sheets

ANS: D Satin sheets make moving in bed easier. Card games and jigsaw puzzles are frustrating because of the palsy. Hard-soled shoes provide better support than soft-soled shoes.

Which disorder(s) would indicate the use of anticholinergic agents? (Select all that apply.) a. Glaucoma b. Benign prostatic hypertrophy c. Bradycardia d. Parkinson's disease e. Preparation for surgery f. Stimulation of the vagus nerve

C,D,E

What action should the nurse implement when a patient falls to the floor in a generalized seizure? a. Cradle the head to prevent injury. b. Insert an object between the teeth to prevent the patient from biting the tongue. c. Manually restrain the limbs. d. Keep the patient on his or her back to prevent aspiration.

ANS: A Cradling the head and turning it to the side prevents injury and aspiration; restraint of limbs and insertion of an object into a patient's mouth often result in injury.

A patient with generalized convulsive disorder is unaware about the side effects of phenytoin (Dilantin). Which instruction would be most appropriate? a. Take medication with food. b. Brush teeth vigorously to encourage gingival growth. c. Limit fluids and eats foods that reduce diarrhea. d. Reduce stimuli and take warm baths to induce drowsiness.

ANS: A Dilantin is irritating to GI tissues. Dilantin causes gingival hyperplasia, constipation, and drowsiness.

A nurse is caring for a patient with meningitis who has a positive Brudzinski sign. Which assessment led to this conclusion? a. Flexed hips when the neck is flexed by the nurse b. Inability to extend the flexed leg fully because of hamstring pain c. Resisting efforts of the nurse to flex his or her neck d. Flexing the big toe upward and fan out the other toes

ANS: A Inflamed meninges will stimulate hip flexion to reduce meningeal discomfort.

Which describes the Babinski reflex? a. Downward curl of the toes b. Big toe bending upward c. Spreading out of the toes d. Pain in the big toe

ANS: A Normal cortical function causes the toes to curl downward. Abnormal findings would be the toes turning up and spreading.

A patient with Parkinson disease is depressed because his drug protocol of L-dopa and Sinemet is no longer controlling his symptoms. What is the best response by the nurse? a. Other drugs can be combined with L-dopa to increase its effectiveness. b. The effect of these drugs has an uneven course; symptoms will begin to subside again soon. c. The two drugs can be given in higher doses to control the symptoms. d. Surgical interventions have been very effective in the control of parkinsonian symptoms.

ANS: A The addition of other drugs to L-dopa may improve the conversion of L-dopa to dopamine. Palliative surgical implementations all have had little effect on controlling the symptoms.

Why is a patient with amyotrophic lateral sclerosis (ALS) uniquely prone to depression? a. Nutritional intake is poor. b. Intellectual capacity is not affected. c. Mobility is limited. d. Communication is altered.

ANS: B Because of their unimpaired intellect, patients with ALS are able to assess their deterioration, which increases their risk for depression. Altered mobility, nutrition, and communication are common to many disorders.

How can the nurse help reduce ICP in caring for the patient after a craniotomy? a. Keeping the patient flat in bed b. Elevating the head of the bed 30 degrees c. Closely monitoring the IV rate d. Turning the patient to the right side

ANS: B Elevating the head of the bed at least 30 degrees helps reduce ICP.

Which response by the nurse is accurate when a patient who has been on lamotrigine (Lamictal) for seizure control reports a skin rash and urticaria? a. Reassure the patient that this is a common adverse effect of the medication and not to worry. b. Instruct the patient to discontinue use of the drug immediately. c. Instruct the patient to decrease the dosage of the medication until the rash disappears. d. Advise the patient that this adverse effect usually resolves but should be reported to the healthcare provider.

ANS: D

Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition? a. Hypertension b. Infectious diseases c. Diabetes d. Closed-angle glaucoma

ANS: D The inhibition of cholinergic activity (anticholinergic effects) causes pupil dilation, which increases intraocular pressure in patients with glaucoma. In patients with closed-angle glaucoma, anticholinergic medications can precipitate an acute attack. Anticholinergic agents may produce increased heart rate but not hypertension. Anticholinergic agents do not affect infections or diabetes.

The nurse assessing the level of consciousness in a patient will perform the following: ______ (Arrange in order from the simplest to the most complex. Do not separate answers with a space or punctuation. Example: ABCD.) a. Apply pressure to the nail bed. b. Shake the patient. c. Touch the patient. d. Call the patient's name. e. Approach the patient.

EDCBA

Which premedication assessment by the nurse is most important prior to the initiation of carbamazepine (Tegretol) therapy? a. Determine patient's ancestry. b. Monitor blood pressure (BP) lying, sitting, and standing. c. Auscultate lung sounds. d. Obtain smoking history.

ANS: A The nurse needs to review the patient's history to exclude Asian ancestry, including South Asian Indians. If the patient does have this ancestry, bring it to the prescriber's attention so that genetic testing may be completed. BP monitoring is important and hypotension is an adverse effect, but it is not as significant to monitor prior to the initiation of therapy. Lung sound assessment and smoking history assessment are important assessments, but not prior to the initiation of carbamazepine therapy.

What should be immediately reported by the nurse caring for a 90-year-old patient with a closed head injury? a. Blood pressure change from 147/72 to 176/70-mm Hg b. Respiration rate increase from 14 to 18 breaths/min c. Slow pupillary reaction bilaterally d. Temperature decrease from 100.2 F to 97.6 F

ANS: A The widening pulse pressure is an indicator of increased ICP. Respirations and temperature are returning to more normal levels. Older adults have a slowed pupillary response as they age.

Which medication is used to control seizures or prevent migraine headaches? a. Topiramate (Topamax) b. Zonisamide (Zonegran) c. Valproic acid (Depakene) d. Tiagabine (Gabitril)

ANS: A Topiramate has been approved for adults in the prevention (but not treatment) of migraine headaches. Zonisamide, valproic acid, and tiagabine do not affect migraine headaches.

Which nursing assessment would indicate a need for suctioning a patient with Guillain-Barré who is experiencing impaired breathing patterns because of neuromuscular failure? a. Decreased pulse rate and respiration of 20 breaths/min b. Increased pulse rate and adventitious breath sounds c. Increased pulse rate and respiration of 16 breaths/min d. Decreased pulse and abdominal breathing

ANS: B Increased pulse rate, adventitious breath sounds, and abdominal breathing indicate an impaired breathing pattern.

A patient in the emergency department states that she fell and hit her head and blacked out for a while but became alert again. The nurse suspects an epidural hematoma. For what should the nurse be diligent to assess? a. Headache b. Drowsiness c. Increasing respiration rate d. Vomiting

ANS: B Increasing BP, drowsiness, and a widening pulse pressure are indicators of increased ICP.

What dose is within the acceptable range for administering IV phenytoin (Dilantin) to a patient with a seizure disorder? a. 5 mg/min b. 30 mg/min c. 60 mg/min d. 100 mg/min

ANS: B Phenytoin is administered slowly at a rate of 25 to 50 mg/min. A rate of 5 mg/min is too slow. A rate of 60 mg/min or 100 mg/min is too fast.

Which intervention supports nutritional intake in a patient with Parkinson disease? a. Offer large meals with a variety of finger foods. b. Thicken liquids to make them easier to swallow. c. Puree all foods and drink through a straw. d. Offer a diet high in carbohydrates and fat and low in protein.

ANS: B Thickened feedings are easier to swallow. Several small, protein-rich meals are preferable to large ones. A pureed diet is unappealing.

The nurse is providing education to a patient recently prescribed pregabalin (Lyrica). Which statement by the patient indicates a need for further instruction? a. "I may feel tired at first, but this should improve with continued use." b. "Once my pain improves, I will stop taking this medication." c. "Taking sleeping aids will increase the sedative effect of this medication." d. "This drug may affect my mental alertness, so I need to be careful around machinery."

ANS: B When discontinuing therapy, taper over at least 1 week to minimize the potential for withdrawal symptoms. Drowsiness tends to disappear with continued use of the medication. Sleeping aids enhance the sedative effects of pregabalin. Pregabalin causes sedation, so people who work around machinery, drive a car, or perform other duties in which they must remain mentally alert should be particularly cautious.

The nurse is providing discharge teaching to a patient prescribed phenytoin (Dilantin) for management of a seizure disorder. Which patient statement indicates a need for further teaching? a. "I need to avoid or limit caffeine intake." b. "I will check with the pharmacist before taking over-the-counter medication." c. "If I develop enlarged gums, I will stop taking the medication." d. "It is important for me to take my medicine at the same time daily."

ANS: C Medications are not discontinued unless approved by the healthcare provider. Gingival hyperplasia is a common adverse effect that can be reduced by oral hygiene. Limiting caffeine intake, checking with the pharmacist about any additional over-the-counter medications, and taking the medication at the same time every day are appropriate actions by the patient

A long-term care resident is taking an anticholinergic agent. The nurse observes the resident to be disoriented and hallucinating. The priority nursing action is to: a. report development of alterations to the charge nurse. b. assess blood glucose. c. provide for resident's safety. d. medicate with antianxiety medication.

ANS: C Serious psychological side effects of anticholinergic agents include confusion, depression, nightmares, and hallucinations. The priority nursing action at onset of confusion and hallucinations is safety. Once the resident is safe, development of alterations may be reported. Blood glucose may be monitored once safety is established. If appropriate medications are ordered by the physician, they can be provided once the resident is calm and safe.

The pediatric nurse is caring for a patient diagnosed with refractory seizures. The physician orders a ketogenic diet. When the child receives his food tray, the nurse should remove any food containing high levels of: a. fat. b. salt. c. carbohydrates. d. vitamin K.

ANS: C The ketogenic diet is used in children and includes restriction of carbohydrate and protein intake. Fat is the primary fuel that produces acidosis and ketosis in the ketogenic diet. Salt and vitamin K are not restricted in the ketogenic diet.

Which three symptoms are characteristic of Cushing triad associated with increased ICP? a. Hypotension, tachycardia, and narrowing pulse pressure b. Hypertension, tachycardia, and headache c. Widening pulse pressure, headache, and seizure d. Bradycardia, hypertension, and widening pulse pressure

ANS: D Bradycardia, increasing BP, and widening pulse pressure are all signs of increased ICP.

Which condition is associated with hydantoin therapy? a. Postictal state b. Atonia c. Seizure threshold reduction d. Gingival hyperplasia

ANS: D Encouraging good oral hygiene practices is indicated when a patient is on hydantoin therapy because its use contributes to gingival hyperplasia. Postictal state is a characteristic of generalized tonic-clonic seizures. Atonia is not associated with hydantoin therapy. Hydantoin raises the seizure threshold.

A patient with Parkinson disease is considering taking St. John's wort, an herbal remedy for depression, in addition to Sinemet and L-dopa. What is the most appropriate nursing response? a. Depression is reduced by the use of herbal remedies such as St. John's wort. b. Doses of St. John's wort and parkinsonian drugs should be taken on alternate days. c. St. John's wort must be taken in large doses to reduce depression. d. Herbal remedies can interfere with the effectiveness of the parkinsonian drugs.

ANS: D Herbal remedies interfere with effectiveness of prescribed parkinsonian drugs.

The nurse is caring for a patient taking a cholinergic agent. When auscultating lung sounds, the nurse notes inspiratory and expiratory wheezing bilaterally. The best action for the nurse to take would be to: a. provide the next dose of the cholinergic agent immediately. b. assess heart rate and blood pressure. c. reposition the patient. d. withhold the next dose and notify the physician.

ANS: D Serious respiratory adverse effects of cholinergic agents include bronchospasm and wheezing. If these symptoms present, the next dose of the cholinergic agent should be withheld until the patient is evaluated by a healthcare provider.

What is included in the nursing management of the patient with generalized tonic-clonic seizure activity? (Select all that apply.) a. Restraining the patient's arms to avoid further injury b. Placing padding around or under the patient's head c. Attempting to insert a tongue depressor into the patient's mouth d. Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain e. Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over

B,D,E

The nurse conducting a Romberg test will ask the patient to do what? ______ (Arrange in the correct sequence. Do not separate answers with a space or punctuation. Example: ABCD.) a. Touch his or her nose with the index finger with the eyes open. b. Stand with eyes closed. c. Touch his or her nose with the index finger with the eyes closed. d. Touch his or her fingertip to nurse's fingertip. e. Pat the knees with the palms and then the back of the hands rapidly.

BEDAC

The nurse is preparing discharge instructions for a patient with a history of diabetes who has just been diagnosed with seizure disorder. The patient has been prescribed hydantoin therapy. What will the patient most likely experiencing? a. Hunger b. Hyperglycemia c. Diarrhea d. Pupil dilation

ANS: B Hydantoins may elevate blood sugar levels. Hunger, diarrhea, and pupil dilation are adverse effects of hydantoin therapy. Constipation and nystagmus are potential adverse effects.

To what does the neural synapse refer? a. Length of time it takes for afferent neurons to carry impulses to the central nervous system (CNS) b. Length of time it takes for efferent neurons to carry impulses to the motor neurons c. Space between the axons and the dendrites of a neuron d. Space between the axons of one neuron and the dendrites of the next

ANS: D Smooth, coordinated transmission must travel from one neuron to another across the neural synapse.

What is the most reliable indicator of neurologic status? a. Blood pressure b. Pulse rate c. Temperature d. Level of consciousness

ANS: D The ability to respond readily and correctly to person, place, and time is good evidence of intact sensorium.