CH 69 PrepU: Neurologic Infections, Autoimmune Disorders, and Neuropathies

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

a. Alternatively patch one eye every 2 hours. Rationale: 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.

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

a. Approximately 60% to 75% of clients recover completely. Rationale: Results of studies on Guillain-Barre syndrome indicate that 60% to 75% of clients recover completely.

Which drug should be available to counteract the effect of edrophonium chloride? a. Atropine b. Pyridostigmine bromide c. Prednisone d. Azathioprine

a. Atropine Rationale: Atropine should be available to control the side effects of edrophonium chloride. Prednisone, azathioprine, and pyridostigmine bromide are not used to counteract these effects.

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

a. Facial distortion and pain Rationale: Bell's palsy is manifested by facial distortion, increased tearing, and painful sensations in the face, behind the ear, and in the eye. Ptosis and diplopia are associated with myasthenia gravis. Hyporeflexia and weakness of the lower extremities are associated with Guillain-Barre syndrome. Fatigue and depression are associated with multiple sclerosis.

A client with Guillain-Barre syndrome cannot swallow and has a paralytic ileus; the nurse is administering parenteral nutrition intravenously. The nurse is careful to assess which of the following related to intake of nutrients? a. Gag reflex and bowel sounds b. Condition of skin c. Respiratory status d. Urinary output and capillary refill

a. Gag reflex and bowel sounds Rationale: Paralytic ileus may result from insufficient parasympathetic activity. The nurse may administer parenteral nutrition and IV fluids. The nurse carefully assesses for the return of the gag reflex and bowel sounds before resuming oral nutrition. The other three choices are important assessment items, but not necessarily related to the intake of nutrients.

The most common cause of cholinergic crisis includes which of the following? a. Overmedication b. Compliance with medication c. Undermedication d. Infection

a. Overmedication Rationale: 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 assessing a newly admitted client with meningitis. Which of the following findings in this client is most likely? a. Positive Brudzinski's sign b. Negative Kernig's sign c. Increased intake d. Hyper-alertness

a. Positive Brudzinski's sign Rationale: A positive Brudzinski's sign is a common finding in the client with meningitis. When the client's neck is flexed, flexion of the knees and hips is produced. A positive Kernig's sign is usual with meningitis. The client will develop lethargy as the illness progresses, not increased intake or hyper-alertness.

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

a. Providing supportive care Rationale:

A client with herpes simplex virus (HSV) encephalitis is receiving acyclovir. To ensure early intervention, the nurse monitors laboratory values and urine output for which type of adverse reactions? a. Renal b. Integumentary c. Hepatic d. Musculoskeletal

a. Renal Rationale: Monitoring of blood chemistry test results and urinary output will alert the nurse to the presence of renal complications related to acyclovir therapy. Complications with the integumentary system will can be observed by the nurse; it is not necessary to review laboratory results or urine output for integumentary reactions. Urine output is not monitored for musculoskeletal or hepatic adverse reactions.

Which of the following tests confirms the diagnosis of myasthenia gravis (MG)? a. Tensilon test b. Serum studies c. Electromyogram (EMG) d. Computed tomography (CT) scan

a. Tensilon test Rationale: 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.

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

a. complications. Rationale:

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. "Limit your fruit and vegetable intake." d. "Restrict fluid intake to 1,500 ml/day."

b. "Avoid hot baths and showers." Rationale: 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 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 viral infections in the last month?" c. "Have you experienced any ptosis in the last few weeks?" d. "Have you developed any new allergies in the last year?"

b. "Have you experienced any viral infections in the last month?" Rationale: 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 nurse is caring for a patient in the emergency department with an onset of pain related to trigeminal neuralgia. What subjective data stated by the patient does the nurse determine triggered the paroxysms of pain? a. "I was taking a bath." b. "I was brushing my teeth." c. "I was sitting at home watching television." d. "I was putting my shoes on."

b. "I was brushing my teeth." Rationale: Trigeminal neuralgia is a condition of the fifth cranial nerve that is characterized by paroxysms of sudden pain in the area innervated by any of the three branches of the nerve. Paroxysms can occur with any stimulation of the terminals of the affected nerve branches, such as washing the face, shaving, brushing the teeth, eating, and drinking.

A client is suspected to have bacterial meningitis. What is the priority nursing intervention? a. Assess the CSF fluid laboratory test results. b. Administer prescribed antibiotics. c. Prepare the client for a CT scan. d. Encourage oral fluid intake.

b. Administer prescribed antibiotics. Rationale: A client with suspected bacterial meningitis should receive antibiotic therapy within 30 minutes of arrival. Outcomes are usually better with early administration of antibiotics. Although the nurse should assess the CSF laboratory test results, antibiotic therapy should not be delayed waiting for the results. Encouraging oral fluids and preparing for a CT scan are appropriate interventions depending on the client, but the priority intervention is the early administration of antibiotics.

A nurse is assisting with a neurological examination of a client who reports a headache in the occipital area and shows signs of ataxia and nystagmus. Which of the following conditions is the most likely reason for the client's problems? a. Wernicke's abscess b. Cerebellar abscess c. Temporal lobe abscess d. Frontal lobe abscess

b. Cerebellar abscess Rationale: Indicators of a cerebellar abscess include occipital headache, ataxia, and nystagmus.

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

b. Creutzfeldt-Jakob disease Rationale: Creutzfeldt-Jakob disease causes severe dementia and myoclonus. Multiple sclerosis 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. Parkinson disease is associated with decreased levels of dopamine due to 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 nurse is caring for a patient with MS who is having spasticity in the lower extremities that decreases physical mobility. What interventions can the nurse provide to assist with relieving the spasms? Select all that apply. a. Have the patient take a hot tub bath to allow muscle relaxation. b. Demonstrate daily muscle stretching exercises. c. Apply warm compresses to the affected areas. d. Assist with a rigorous exercise program to prevent contractures. e. Allow the patient adequate time to perform exercises

b. Demonstrate daily muscle stretching exercises. c. Apply warm compresses to the affected areas. e. Allow the patient adequate time to perform exercises Rationale: Warm packs may be beneficial for relieving spasms, but hot baths should be avoided because of risk of burn injury secondary to sensory loss and increasing symptoms that may occur with elevation of the body temperature. Daily exercises for muscle stretching are prescribed to minimize joint contractures. The patient should not be hurried in any of these activities, because this often increases spasticity.

Bell palsy is a disorder of which cranial nerve? a. Vestibulocochlear (VIII) b. Facial (VII) c. Vagus (X) d. Trigeminal (V)

b. Facial (VII) Rationale: Bell palsy is characterized by facial dysfunction, weakness, and paralysis. Trigeminal neuralgia is a disorder of the trigeminal nerve and causes facial pain. Meniere syndrome is a disorder of the vestibulocochlear nerve. Guillain-Barre syndrome is a disorder of the vagus nerve.

Which is often the most disabling clinical manifestation of multiple sclerosis? a. Spasticity b. Fatigue c. Pain d. Ataxia

b. Fatigue Rationale: 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 other clinical manifestations of MS, but are not the most disabling.

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

b. Initiate isolation precautions. Rationale:

The diagnosis of multiple sclerosis is based on which test? a. Cerebrospinal fluid (CSF) electrophoresis b. Magnetic resonance imaging (MRI) c. Evoked potential studies d. Neuropsychological testing

b. Magnetic resonance imaging (MRI) Rationale: The diagnosis of MS is based on the presence of multiple plaques in the central nervous system observed on 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.

Which reflects basic nursing measures in the care of the client with viral encephalitis? a. Monitoring cardiac output b. Providing comfort measures c. Administering narcotic analgesics d. Administering amphotericin B

b. Providing comfort measures Rationale: Providing comfort measures to reduce headache, including dimmed lights, limited noise, and analgesics, are the basic nursing measures in the care of the client with viral encephalitis. Narcotic analgesics may mask neurologic symptoms; therefore, they are used cautiously. Acyclovir therapy is commonly prescribed for viral encephalitis. Amphotericin B is used in the treatment of fungal encephalitis. Nursing management of the client with viral encephalitis includes monitoring of blood chemistry test results and urinary output to alert the nurse to the presence of renal complications related to acyclovir therapy.

The nurse is performing an initial assessment on a client who is admitted to rule out myasthenia gravis. Which of the following findings would the nurse expect to observe? a. Difficulty with urination b. Ptosis and diplopia c. Facial distortion and pain d. Muscle weakness and hyporeflexia of the lower extremities

b. Ptosis and diplopia Rationale: The initial manifestation of myasthenia gravis in two-thirds of clients involves the ocular muscles; diplopia and ptosis are common. Muscle weakness and hyporeflexia of the lower extremities are associated with Guillain-Barre syndrome. Facial distortion and pain are associated with Bell's palsy and tic douloureux.

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

b. Trigeminal neuralgia Rationale:

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

b. may be controlled by the administration of diphenhydramine and acetaminophen approximately 30 minutes before administration of the amphotericin. Rationale:

A nurse is monitoring a client with Guillain-Barré syndrome. The nurse should assess the client for which responses? Select all that apply. a. increasing ICP b. respiratory distress c. difficulty swallowing d. seizure activity

b. respiratory distress c. difficulty swallowing Rationale: Respiratory muscles may become paralyzed, requiring endotracheal intubation and mechanical ventilation. If cranial nerve involvement develops, swallowing becomes difficult. Increasing ICP and seizure activity are not expected complications of Guillain-Barré syndrome.

The nurse is caring for a client with tetraplegia following a motor vehicle accident. A family member of the client states, "I know there is grief associated with the loss of independence, but how do I help my loved one to move past that?" The nurse is most helpful to say which of the following? a. "There is nothing you can do. It must come from the client." b. "Ask your loved one what you can do and decorate the room to elevate mood." c. "Grief is a normal process. Let's discuss offering support throughout the process." d. "Provide comfort foods, which expresses your love and support."

c. "Grief is a normal process. Let's discuss offering support throughout the process." Rationale: The best response by the nurse is to confirm that what the client is experiencing is a normal process and opening conversation. The nurse is also helpful to identify the upcoming process that the client will be experiencing. Stating that there is nothing that the family member can do closes communication and is inaccurate. The other responses may be helpful but are not the best.

The nurse has been educating a client newly diagnosed with MS. Which statement by the client indicates an understanding of the education? a. "The exercises should be completed quickly to reduce fatigue." b. "I will take hot tub baths to decrease spasms." c. "I will stretch daily as directed by the physical therapist." d. "I should participate in non-weight-bearing exercises."

c. "I will stretch daily as directed by the physical therapist." Rationale: 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 client has been hospitalized for diagnostic testing. The client has just been diagnosed with multiple sclerosis, which the physician explains is an autoimmune disorder. How would the nurse explain an autoimmune disease to the client? a. A disorder in which histocompatible cells attack the immunoglobulins b. A disorder in which the body does not have enough immunoglobulins c. A disorder in which killer T cells and autoantibodies attack or destroy natural cells—those cells that are "self" d. A disorder in which the body has too many immunoglobulins

c. A disorder in which killer T cells and autoantibodies attack or destroy natural cells—those cells that are "self" Rationale: Autoimmune disorders are those in which killer T cells and autoantibodies attack or destroy natural cells—those cells that are "self." Autoantibodies, antibodies against self-antigens, are immunoglobulins. They target histocompatible cells, cells whose antigens match the person's own genetic code. Autoimmune disorders are not caused by too many or too few immunoglobulins, and histocompatible cells do not attack immunoglobulins in an autoimmune disorder.

Myasthenia gravis occurs when antibodies attack which receptor sites? a. Serotonin b. Dopamine c. Acetylcholine d. GABA

c. Acetylcholine Rationale: In myasthenia gravis, antibodies directed at the acetylcholine receptor sites impair transmission of impulses across the myoneural junction. Serotonin, dopamine, and GABA are not receptor sites that are attacked in myasthenia gravis.

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

c. Administer atropine to control the side effects of edrophonium. Rationale: Atropine should be available to control the side effects of edrophonium, which include bradycardia, sweating, and cramping.

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

c. Assessing respiratory effort Rationale: 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.

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

c. Bacteria Rationale: Septic meningitis is caused by bacteria. In aseptic meningitis, the cause is viral or secondary to lymphoma, leukemia, or human immunodeficiency virus.

The nurse is preparing the client for an acetylcholinesterase inhibitor test to rule out myasthenia gravis. Which is the priority nursing action? a. Administer edrophonium chloride per orders. b. Assess facial weakness 5 minutes after injection. c. Ensure atropine is readily available. d. Document the results.

c. Ensure atropine is readily available. Rationale: Atropine should be ready before administration of edrophonium chloride so it is available if needed to control the side effects of the medication. Assessing facial weakness and documenting the results occur after the administration of edrophonium chloride; therefore, they are not the priority interventions.

Which is the most common cause of acute encephalitis in the United States? a. West Nile virus b. Western equine virus c. Herpes simplex virus d. St. Louis virus

c. Herpes simplex virus Rationale: Viral infection is the most common cause of encephalitis. Herpes simplex virus is the most common cause of acute encephalitis in the United States. The Western equine encephalitis virus, West Nile virus, and St. Louis virus are types of arboviral encephalitis that occur in North America, but they are not the most common causes of acute encephalitis.

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

c. Initiate seizure precautions. Rationale:

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

c. Positive Kernig's sign Rationale: A positive Kernig's sign is a common finding in the client with meningitis. When the client is lying with the thigh flexed on the abdomen, the leg cannot be completely extended. A positive Brudzinski's sign is usual with meningitis. The Romberg sign would not be tested in this client. The client will develop lethargy as the illness progresses, not hyper-alertness.

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

c. Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone. Rationale: After the sensitivity of the nerve to touch decreases and the patient can tolerate touching the face, the nurse can suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone. Facial exercises, such as wrinkling the forehead, blowing out the cheeks, and whistling, may be performed with the aid of a mirror to prevent muscle atrophy. Exposure of the face to cold and drafts is avoided.

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

c. Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes. Rationale: Thirty seconds after injection, facial muscle weakness and ptosis should resolve for about 5 minutes (Hickey, 2009). Immediate improvement in muscle strength after administration of this agent represents a positive test and usually confirms the diagnosis.

A client is hospitalized with Guillain-Barré syndrome. Which nursing assessment finding is most significant? a. Warm, dry skin b. Urine output of 40 ml/hour c. Uneven, labored respirations d. Soft, nondistended abdomen

c. Uneven, labored respirations Rationale: A characteristic feature of Guillain-Barré syndrome is ascending weakness, which usually begins in the legs and progresses upward to the trunk, arms, and face. Respiratory muscle weakness, evidenced by uneven, labored respirations, is a particularly dangerous effect of this disease progression because it may lead to respiratory failure and death. Therefore, although warm, dry skin; urine output of 40 ml/hour; and a soft, nondistended abdomen are pertinent assessment data, those related to respiratory function and status are most significant.

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

c. Vision changes Rationale: Vision changes, such as diplopia, nystagmus, and blurred vision, are symptoms of MS. Deep tendon reflexes may be increased or hyperactive — not absent. Babinski's reflex may be positive. Tremors at rest aren't characteristic of MS; however, intentional tremors (those occurring with purposeful voluntary movement) are common in clients with MS. Affected muscles are spastic, rather than flaccid.

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. "Once Guillain-Barré syndrome progresses to the diaphragm, survival decreases significantly." d. "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive."

d. "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive." Rationale: 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.

The nurse caring for a patient with bacterial meningitis is administering dexamethasone (Decadron) that has been ordered as an adjunct to antibiotic therapy. When does the nurse know is the appropriate time to administer this medication? a. It can be administered every 6 hours for 10 days. b. 2 hours prior to the administration of antibiotics for 7 days c. 1 hour after the antibiotic has infused and daily for 7 days d. 15 to 20 minutes before the first dose of antibiotic and every 6 hours for the next 4 days

d. 15 to 20 minutes before the first dose of antibiotic and every 6 hours for the next 4 days Rationale: Dexamethasone (Decadron) has been shown to be beneficial as adjunct therapy in the treatment of acute bacterial meningitis and in pneumococcal meningitis if it is administered 15 to 20 minutes before the first dose of antibiotic and every 6 hours for the next 4 days. Research suggests that dexamethasone improves the outcome in adults and does not increase the risk of gastrointestinal bleeding (Bader & Littlejohns, 2010).

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. Immune globulin is given intravenously. b. The thymus gland is removed. c. Mestinon therapy is initiated. d. Antibodies are removed from the plasma.

d. Antibodies are removed from the plasma. Rationale: 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.

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. Relax in a hot bath. b. Exercise following a circuit training regimen. c. Avoid swimming and any weight-bearing activity. d. Apply warm packs to the affected area.

d. Apply warm packs to the affected area. Rationale: Warm packs to the affected area may be beneficial. The client should avoid hot baths because of risk of burn injury secondary to sensory loss and increasing symptoms that may occur with elevation of the body temperature. Swimming and stationary bicycling are useful, and progressive weight-bearing can relieve spasticity in the legs. The client should not be hurried in exercise (as can occur in circuit training), because rushing often increases spasticity.

Which is the primary vector of arthropod-borne viral encephalitis in North America? a. Spiders b. Birds c. Ticks d. Mosquitoes

d. Mosquitoes Rationale: The primary vector in North America related to anthropoid-borne virus encephalitis is a mosquito. Birds are associated with the West Nile virus. Spiders and ticks are not vectors for arthropod-borne virus encephalitis.

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. Creutzfeldt-Jakob disease c. Huntington disease d. Multiple sclerosis

d. Multiple sclerosis Rationale: 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. Creutzfeldt-Jakob disease is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain.

The nurse is performing an initial nursing assessment on a client with possible Guillain-Barre syndrome. Which of the following findings would be most consistent with this diagnosis? a. Hyporeflexia and skin rash b. Ptosis and muscle weakness of upper extremities c. Fever and cough d. Muscle weakness and hyporeflexia of the lower extremities

d. Muscle weakness and hyporeflexia of the lower extremities Rationale: Guillain-Barre syndrome typically begins with muscle weakness and diminished reflexes of the lower extremities. Fever, skin rash, cough, and ptosis are not signs/symptoms associated with Guillain-Barre.

Which well-recognized sign of meningitis is exhibited when the client's neck is flexed and flexion of the knees and hips is produced? a. Nuchal rigidity b. Photophobia c. Positive Kerning sign d. Positive Brudzinski sign

d. Positive Brudzinski sign Rationale: A positive Brudzinski sign occurs when the client's neck is flexed (after ruling out cervical trauma or injury), and flexion of the knees and hips is produced. Photophobia is sensitivity to light. A positive Kerning sign occurs when the client is lying with the thigh flexed on the abdomen and the leg cannot be completely extended. Nuchal rigidity is neck stiffness.

Which is a component of the nursing management of the client with variant Creutzfeldt-Jakob disease (vCJD)? a. Administering amphotericin B b. Initiating isolation procedures c. Preparing for organ donation d. Providing palliative care

d. Providing palliative care Rationale: vCJD is a progressive fatal disease; no treatment is available. Because of the fatal outcome of vCJD, nursing care is primarily supportive and palliative. Prevention of disease transmission is an important part of providing nursing care. Although client isolation is not necessary, use of standard precautions is important. Institutional protocols are followed for blood and body fluid exposure and decontamination of equipment. Organ donation is not an option because of the risk for disease transmission. Amphotericin B is used in the treatment of fungal encephalitis; no treatment is available for vCJD.

Which of the following is the first-line therapy for myasthenia gravis (MG)? a. Lioresal (Baclofen) b. Azathioprine (Imuran) c. Deltasone (Prednisone) d. Pyridostigmine bromide (Mestinon)

d. Pyridostigmine bromide (Mestinon) Rationale: 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.

The nurse is performing an initial assessment on a client admitted to rule out Guillain-Barre syndrome. On which of the following areas will the nurse focus most heavily? a. Urinary b. Gastrointestinal c. Skin d. Respiratory

d. Respiratory Rationale: Because of its possible rapid progression and neuromuscular respiratory failure, Guillain-Barre syndrome is a medical emergency. After baseline values are identified, assessment of changes in muscle strength and respiratory function alert the team to the physical and respiratory needs of the client. The other three choices may become problem areas later, but respiratory issues are always a priority.

Which of the following teaching points is a priority in the management of symptoms for a client with Bell's palsy? a. Complete the course of antibiotics as prescribed. b. Encourage semiannual dental exams. c. Avoid stimuli that trigger pain. d. Use ophthalmic lubricant and protect the eye.

d. Use ophthalmic lubricant and protect the eye. Rationale: The VII cranial nerve supplies muscles to the face. In Bell's palsy, the eye can be affected which results in incomplete closure and risk for injury. The eye can become dry and irritated unless eye moisturizing drops and ophthalmic ointment is applied. Avoiding stimuli that can trigger pain is specific to tic douloureux(cranial nerve V disorder). Encouraging dental exams is a part of care but not the priority. Antibiotics are not used in the treatment of Bell's palsy because it is thought to be caused by a virus.

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

d. Vector bites Rationale: Possible exposure to mosquito bites can be beneficial in the diagnosing of encephalitis secondary to West Nile virus. Change in level of consciousness (LOC), vomiting, and seizures are all symptoms of increased intracranial pressure (ICP) and do not assist in the differentiating of cause, diagnosis, or establishing nursing care.

A neurologic deficit is best defined as a deficit of the: a. central nervous system that affects one body system. b. peripheral nervous system with decreased or impaired functioning. c. central nervous system with absent functioning. d. central and peripheral nervous systems with decreased, impaired, or absent functioning.

d. central and peripheral nervous systems with decreased, impaired, or absent functioning. Rationale: A client with a neurologic deficit may have decreased, impaired, or absent functioning of the central and peripheral systems.

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

d. controlling seizures and increased intracranial pressure. Rationale: There is no specific medication for arbovirus encephalitis; therefore symptom management is key. Medical management is aimed at controlling seizures and increased intracranial pressure.