Chapter 40: Caring for Clients with Neurologic Deficits

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding? a. Dysphagia b. Dysphonia c. Hypokinesia d. Micrographia

b Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.

A client with a brain tumor is exhibiting papilledema. When reviewing the client's history, which information would the nurse correlate with this finding? Select all that apply. a. Enhanced visual acuity b. Double vision c. Visual field deficit d. Swaying gait e. Aphasia

b, c Papilledema is associated with visual disturbances, such as decreased visual acuity, diplopia (double vision), and visual field deficits. It is not associated with a swaying gait or aphasia.

The nurse caring for a client diagnosed with Guillain-Barré syndrome is planning care with regard to the clinical manifestations associated this syndrome. The nurse's communication with the client should reflect the possibility of what sign or symptom of the disease? a. Intermittent hearing loss b. Tinnitus c. Tongue enlargement d. Vocal paralysis

d Guillain-Barré syndrome is a disorder of the vagus nerve. Clinical manifestations include vocal paralysis, dysphagia, and voice changes (temporary or permanent hoarseness). Hearing deficits, tinnitus, and tongue enlargement are not associated with the disease.

The nurse is planning the care of a client who has been recently diagnosed with a cerebellar tumor. Due to the location of this client's tumor, the nurse should implement measures to prevent what complication? a. Falls b. Audio hallucinations c. Respiratory depression d. Labile BP

a A cerebellar tumor causes dizziness, an ataxic or staggering gait with a tendency to fall toward the side of the lesion, and marked muscle incoordination. Because of this, the client faces a high risk of falls. Hallucinations and unstable vital signs are not closely associated with cerebellar tumors.

A nurse is providing care to a client who has been diagnosed with metastatic brain cancer. When developing the client's plan of care, which outcome would the nurse most likely identify? a. Improved quality of life b. Elimination of distressing signs and symptoms c. Removal of all or part of the tumor d. Reduced incidence of recurrence

a The treatment of metastatic brain cancer is palliative and involves eliminating or reducing serious symptoms. Even when palliation is the goal, distressing signs and symptoms can be relieved, thereby improving the quality of life for both client and family. Removal of all or part of the tumor is the goal of surgery. Radiation therapy attempts to decrease the incidence of recurrence of incompletely resected tumors.

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

a 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 73-year-old man comes to the clinic complaining of weakness and loss of sensation in his feet and legs. Assessment of the client shows decreased reflexes bilaterally. Why would it be a challenge to diagnose a peripheral neuropathy in this client? a. Older adults are often vague historians. b. The elderly have fewer peripheral nerves than younger adults. c. Many older adults are hesitant to admit that their body is changing. d. Many symptoms can be the result of normal aging process.

d The diagnosis of peripheral neuropathy in the geriatric population is challenging because many symptoms, such as decreased reflexes, can be associated with the normal aging process. In this scenario, the client has come to the clinic seeking help for his problem; this does not indicate a desire on the part of the client to withhold information from the health care giver. The normal aging process does not include a diminishing number of peripheral nerves.

A client with suspected Parkinson disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor? a. When the client is resting b. When the client is ambulating c. When the client is preparing his or her meal tray to eat d. When the client is participating in occupational therapy

a The tremor is present while the client is at rest; it increases when the client is walking, concentrating, or feeling anxious. Resting tremor characteristically disappears with purposeful movement, but is evident when the extremities are motionless. Consequently, the nurse should assess for the presence of a tremor when the client is not performing deliberate actions.

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

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

A client with neurologic disorder is at risk for disuse syndrome due to musculoskeletal inactivity and neuromuscular impairment. Which nursing intervention facilitates the functional use of the limbs? a. Keep extremities at neutral position. b. Remove and reapply elastic stockings. c. Change client's position. d. Use a flotation mattress.

a A neutral position facilitates the functional use of the limbs.

A nurse is providing care to a client recently diagnosed with a brain tumor. When planning this client's care, the nurse anticipates which therapy as providing the best outcome for the client? a. Surgery b. Radiation therapy c. Chemotherapy d. Immunotherapy

a A variety of medical treatment modalities, including chemotherapy and external-beam radiation therapy, radiosurgery, or radiotherapy are used alone or in combination with surgical resection. However, surgical intervention provides the best outcome for most brain tumor types.

The nurse is caring for a patient with Huntington's disease in the long-term care facility. What does the nurse recognize as the most prominent symptom of the disease that the patient exhibits? a. Rapid, jerky, involuntary movements b. Slow, shuffling gait c. Dysphagia and dysphonia d. Dementia

a The most prominent clinical features of the disease are chorea (rapid, jerky, involuntary, purposeless movements), impaired voluntary movement, intellectual decline, and often personality changes (Aubeeluck & Wilson, 2008).

The nurse is assessing a client with a confirmed spinal cord tumor. The client states, "I've been too embarrassed to tell anyone but, I have been awakened at night because I've wet the bed." It would be a priority for the nurse to further assess the client for which complication? a. Spinal cord compression b. Urinary tract infection c. Knowledge deficit d. Impaired skin integrity

a With spinal tumors, there is the risk of compression from the tumor on structures and organs surrounding the spinal cord. Urinary incontinence indicates decreased spinal cord function due to spinal cord injury related to compression from the tumor. Although the nurse may include further assessment for urinary tract infection, knowledge deficit and impaired skin integrity, these would not be the priority assessment. Spinal chord compression is considered a medical emergency and requires immediate treatment to prevent permanent neurologic damage.

A client with a brain tumor is experiencing changes in cognition that require the nurse to reorient the client frequently. When performing this task, which devices would be appropriate for the nurse to use? Select all that apply. a. Client's clothing b. Picture of the client's family c. Clock d. Calendar e. Common words

a, b, c, d Clients with changes in cognition caused by their lesions require frequent reorientation and the use of orienting devices (e.g., personal possessions, photographs, lists, and a clock). Words would not be as helpful as items that are familiar to the client.

The nurse is caring for a 77-year-old woman with MS. She states that she is very concerned about the progress of her disease and what the future holds. The nurse should know that elderly clients with MS are known to be particularly concerned about what variables? Select all that apply. a. Possible nursing home placement b. Pain associated with physical therapy c. Increasing disability d. Becoming a burden on the family e. Loss of appetite

a, c, d Elderly clients with MS are particularly concerned about increasing disability, family burden, marital concern, and the possible future need for nursing home care. Older adults with MS are not noted to have particular concerns regarding the pain of therapy or loss of appetite.

The nurse teaches the client with which disorder that the disease is due to decreased levels of dopamine in the basal ganglia of the brain? a. Multiple sclerosis b. Parkinson disease c. Huntington disease d. Creutzfeldt-Jakob disease

b In some patients, Parkinson disease can be controlled; however, it cannot be cured. Multiple sclerosis is a chronic, degenerative, progressive disease of the central nervous system (CNS) characterized by the occurrence of small patches of demyelination in the brain and spinal cord. 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 and fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.

To alleviate pain associated with trigeminal neuralgia, a client is taking carbamazepine. What health education should the nurse provide to the client before initiating this treatment? a. Concurrent use of calcium supplements is contraindicated. b. Blood levels of the drug must be monitored. c. The drug is likely to cause hyperactivity and agitation. d. Carbamazepine can cause tinnitus during the first few days of treatment.

b Side effects of carbamazepine include nausea, dizziness, drowsiness, and aplastic anemia. The client must also be monitored for bone marrow depression during long-term therapy. Skin discoloration, insomnia, and tinnitus are not side effects of the drug.

A client with Parkinson disease is undergoing a swallowing assessment because she has recently developed adventitious lung sounds. The client's nutritional needs should be met by what method? a. Total parenteral nutrition (TPN) b. Provision of a low-residue diet c. Semisolid food with thick liquids d. Minced foods and a fluid restriction

c A semisolid diet with thick liquids is easier for a client with swallowing difficulties to consume than is a solid diet. Low-residue foods and fluid restriction are unnecessary and counterproductive to the client's nutritional status. The client's status does not warrant TPN until all other options have been ruled out.

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

c Bell palsy is characterized by facial dysfunction, weakness, and paralysis. Trigeminal neuralgia, a disorder of the trigeminal nerve, causes facial pain. Ménière syndrome is a disorder of the vestibulocochlear nerve. Guillain-Barré syndrome is a disorder of the vagus nerve.

Following a traumatic brain injury, a client has been in a coma for several days. Which of the following statements is true of this client's current LOC? a. The client occasionally makes incomprehensible sounds. b. The client's current LOC will likely become a permanent state. c. The client may occasionally make nonpurposeful movements. d. The client is incapable of spontaneous respirations.

c Coma is a clinical state of unarousable unresponsiveness in which no purposeful responses to internal or external stimuli occur, although nonpurposeful responses to painful stimuli and brain stem reflexes may be present. Verbal sounds, however, are atypical. Ventilator support may or may not be necessary. Comas are not permanent states.

A nurse is planning the care of a 28-year-old woman hospitalized with a diagnosis of myasthenia gravis. What approach would be most appropriate for the care and scheduling of diagnostic procedures for this client? a. All at one time, to provide a longer rest period b. Before meals, to stimulate her appetite c. In the morning, with frequent rest periods d. Before bedtime, to promote rest

c Procedures should be spaced to allow for rest in between. Procedures should be avoided before meals, or the client may be too exhausted to eat. Procedures should be avoided near bedtime if possible.

A client with a metastatic brain tumor of the frontal lobe experiences a generalized seizure for the first time. The nurse should prepare for what action? a. Intubation b. STAT computed tomography (CT) health care provider c. A STAT MRI d. Administration of anticonvulsants

d Seizure activity necessitates anticonvulsants. In most cases, the development of seizure activity does not require immediate diagnostic imaging. Intubation is unnecessary except in cases of respiratory failure.

A client's spouse relates how the client reported a severe headache and then was unable to talk or move their right arm and leg. After diagnostics are completed and the client is admitted to the hospital, when would basic rehabilitation begin? a. immediately b. in 2 to 3 days c. after 1 week d. upon transfer to a rehabilitation unit

a Beginning basic rehabilitation during the acute phase is an important nursing function. Measures such as position changes and prevention of skin breakdown and contractures are essential aspects of care during the early phase of rehabilitation. The nursing goal is to prevent complications that may interfere with the client's potential to recover function.

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 Measures such as position changes and prevention of skin breakdown and contractures are essential aspects of care during the early phase of rehabilitation. The nursing goal is to prevent complications that may interfere with the client's potential to recover function.

A client diagnosed with MS has been admitted to the medical unit for treatment of an MS exacerbation. Included in the admission orders is baclofen. What should the nurse identify as an expected outcome of this treatment? a. Reduction in the appearance of new lesions on the MRI b. Decreased muscle spasms in the lower extremities c. Increased muscle strength in the upper extremities d. Decreased severity and duration of exacerbations

b Baclofen, a γ-aminobutyric acid (GABA) agonist, is the medication of choice in treating spasms. It can be given orally or by intrathecal injection. Avonex and Betaseron reduce the appearance of new lesions on the MRI. Corticosteroids limit the severity and duration of exacerbations. Anticholinesterase agents increase muscle strength in the upper extremities.

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

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

A client is scheduled to receive Gamma Knife therapy. The nurse interprets this as which form of therapy? a. Stereotactic radiosurgery b. Surgical resection c. External beam radiation therapy d. Open biopsy

a Gamma Knife is a form of stereotactic radiosurgery, where precise beams of radiation produce a targeted approach of concentrated radiation for the brain, head, and neck. It is not considered surgical resection, external beam radiation therapy, or an open biopsy.

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. Soft, nondistended abdomen d. Uneven, labored respirations

d 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 client, diagnosed with cancer of the lung, has just been told he has metastases to the brain. What change in health status would the nurse attribute to the client's metastatic brain disease? a. Chronic pain b. Respiratory distress c. Fixed pupils d. Personality changes

d Neurologic signs and symptoms include headache, gait disturbances, visual impairment, personality changes, altered mentation (memory loss and confusion), focal weakness, paralysis, aphasia, and seizures. Pain, respiratory distress, and fixed pupils are not among the more common neurologic signs and symptoms of metastatic brain disease.

A nurse knows that a patient exhibiting seizure-like movements localized to one side of the body most likely has what type of tumor? a. A cerebellar tumor b. A frontal lobe tumor c. A motor cortex tumor d. An occipital lobe tumor

c A tumor in the motor cortex of the frontal lobe produces hemiparesis and partial seizures on the opposite side of the body or generalized seizures. A frontal lobe tumor may also produce changes in emotional state and behavior, as well as an apathetic mental attitude. A cerebellar tumor causes dizziness; an ataxic or staggering gait with a tendency to fall toward the side of the lesion; marked muscle incoordination; and nystagmus (involuntary rhythmic eye movements), usually in the horizontal direction. An occipital lobe tumor produces visual manifestations: contralateral homonymous hemianopsia (visual loss in half of the visual field on the opposite side of the tumor) and visual hallucinations.

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

a 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.

A patient suspected of having Guillain-Barré syndrome has had a lumbar puncture for cerebrospinal fluid (CSF) evaluation. When reviewing the laboratory results, what does the nurse find that is diagnostic for this disease? a. Glucose in the CSF b. Elevated protein levels in the CSF c. Red blood cells present in the CSF d. White blood cells in the CSF

b Serum laboratory tests are not useful in the diagnosis. However, elevated protein levels are detected in CSF evaluation, without an increase in other cells.

A client is diagnosed with a brain angioma. When teaching the client about the risks associated with this type of brain tumor, the nurse would educate about signs and symptoms associated with which condition? a. Hemorrhagic stroke b. Thyroid disorders c. Hearing loss d. Visual loss

a Brain angiomas (masses composed largely of abnormal blood vessels) are found either in the brain or on its surface. Because the walls of the blood vessels in angiomas are thin, affected clients are at risk for hemorrhagic stroke. Pituitary adenomas that produce hormones can lead to endocrine disorders, such as thyroid disorders. In addition, they can exert pressure on the optic nerves and optic chiasm, leading to vision loss. Acoustic neuromas are associated with hearing loss.

A client diagnosed with Bell palsy is being cared for on an outpatient basis. During health education, the nurse should promote which of the following actions? a. Applying a protective eye shield at night b. Chewing on the affected side to prevent unilateral neglect c. Avoiding the use of analgesics whenever possible d. Avoiding brushing the teeth

a Corneal irritation and ulceration may occur if the eye is unprotected. While paralysis lasts, the involved eye must be protected. The client should be encouraged to eat on the unaffected side, due to swallowing difficulties. Analgesics are used to control the facial pain. The client should continue to provide self-care including oral hygiene.

A client with paralysis is disturbed by spontaneous erections. Which nursing action may help the client? a. Explain that it may occur when the bladder is full. b. Suggest the use of a disposable porous pad. c. Perform passive ROM exercise. d. Recommend medical assistance.

a Explain to the client that spontaneous erections may occur when the bladder is full. Spontaneous erections are unpredictable and sometimes circumstantially inconvenient.

A patient with a brain tumor is complaining of headaches that are worse in the morning. What does the nurse know could be the reason for the morning headaches? a. Increased intracranial pressure b. Dehydration c. Migraines d. The tumor is shrinking.

a Headache, although not always present, is most common in the early morning and is made worse by coughing, straining, or sudden movement. It is thought to be caused by the tumor invading, compressing, or distorting the pain-sensitive structures or by edema that accompanies the tumor, leading to increased intracranial pressure.

A client with Guillain-Barré syndrome has experienced a sharp decline in vital capacity. What is the nurse's most appropriate action? a. Administer bronchodilators as ordered. b. Remind the client of the importance of deep breathing and coughing exercises. c. Prepare to assist with intubation. d. Administer supplementary oxygen by nasal cannula.

c For the client with Guillain-Barré syndrome, mechanical ventilation is required if the vital capacity falls, making spontaneous breathing impossible and tissue oxygenation inadequate. Each of the other listed actions is likely insufficient to meet the client's oxygenation needs.

A male client presents at the free clinic with reports of erectile dysfunction. Upon physical examination, the nurse practitioner notes the presence of hypogonadism. What diagnosis should the nurse suspect? a. Prolactinoma b. Angioma c. Glioma d. Adrenocorticotropic hormone (ACTH)-producing adenoma

a Male clients with prolactinomas may present with impotence and hypogonadism. An ACTH-producing adenoma would cause acromegaly. The scenario contains insufficient information to know if the tumor is an angioma, glioma, or neuroma.

Clients who have suffered neurologic deficits from various causes, including cerebrovascular accidents, closed head injury, etc., have all experienced which phase of neurologic deficit? a. acute b. recovery c. chronic d. management

a Neurologic deficits are divided into three phases: acute, recovery, and chronic. Not all clients with a neurologic deficit experience all phases. Some clients have deficits that begin with an acute phase and move into a recovery phase or into a lifelong chronic phase. Some will have full recovery. Management is not one of the three phases of a neurologic deficit.

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

b A frontal lobe brain abscess produces seizures, hemiparesis, and frontal headache; therefore, the nurse should anticipate the need for seizure precautions. Facial weakness and visual disturbances are associated with a temporal lobe abscess. The client may experience expressive aphasia related to the abscess, but that does not indicate the need to ensure the client takes in nothing by mouth.

A client with herpes simplex virus encephalitis (HSV) has been admitted to the ICU. What medication would the nurse expect the health care provider to order for the treatment of this disease process? a. Cyclosporine b. Acyclovir c. Cyclobenzaprine d. Ampicillin

b Antiviral agents, acyclovir or ganciclovir, are the medications of choice in the treatment of HSV. The mode of action is the inhibition of viral DNA replication. To prevent relapse, treatment would continue for up to 3 weeks. Cyclosporine is an immunosuppressant and antirheumatic. Cyclobenzaprine is a centrally acting skeletal muscle relaxant. Ampicillin, an antibiotic, is ineffective against viruses.

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. Allow the patient adequate time to perform exercises e. Assist with a rigorous exercise program to prevent contractures.

b, c, d 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.

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. Positive Kerning sign b. Photophobia c. Positive Brudzinski sign d. Nuchal rigidity

c 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.

A health care provider asks a nurse to assess a patient being evaluated for aseptic meningitis for a positive Brudzinski sign. Which of the following actions should the nurse take? a. Assess the patient's sensitivity to light. b. Support the patient's neck through normal range of motion and evaluate stiffness. c. Help the patient flex his neck and observe for flexion of the hips and knees. d. Flex the patient's thigh on his abdomen and assess the extension of the leg.

c A positive Brudzinski sign: When the patient's neck is flexed (after ruling out cervical trauma or injury), flexion of the knees and hips is produced; when the lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity.

The nurse is caring for a client with Huntington disease who has been admitted to the hospital for treatment of malnutrition. What independent nursing action should be implemented in the client's plan of care? a. Firmly redirect the client's head when feeding. b. Administer phenothiazines after each meal as prescribed. c. Encourage the client to keep his or her feeding area clean. d. Apply deep, gentle pressure around the client's mouth to aid swallowing.

d Nursing interventions for a client who has inadequate nutritional intake should include the following: apply deep gentle pressure around the client's mouth to assist with swallowing, and administer phenothiazines prior to the client's meal as prescribed. The nurse should disregard the mess of the feeding area and treat the person with dignity. Stiffness and turning away by the client during feeding are uncontrollable choreiform movements and should not be interrupted.

A 37-year-old man is brought to the clinic by his wife because he is experiencing loss of motor function and sensation. The health care provider suspects the client has a spinal cord tumor and hospitalizes him for diagnostic testing. In light of the need to rule out spinal cord compression from a tumor, the nurse will most likely prepare the client for what test? a. Anterior-posterior x-ray b. Ultrasound c. Lumbar puncture d. MRI

d The MRI scan is the most commonly used diagnostic procedure. It is the most sensitive diagnostic tool that is particularly helpful in detecting epidural spinal cord compression and vertebral bone metastases.

A middle-aged woman has sought care from her primary provider and undergone diagnostic testing that has resulted in a diagnosis of MS. What sign or symptom is most likely to have prompted the woman to seek care? a. Cognitive declines b. Personality changes c. Contractures d. Difficulty in coordination

d The primary symptoms of MS most commonly reported are fatigue, depression, weakness, numbness, difficulty in coordination, loss of balance, spasticity, and pain. Cognitive changes and contractures usually occur later in the disease.

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

a People in close contact with patients with meningococcal meningitis should be treated with antimicrobial chemoprophylaxis using rifampin (Rifadin), ciprofloxacin hydrochloride (Cipro), or ceftriaxone sodium (Rocephin). Therapy should be started within 24 hours after exposure because a delay in the initiation of therapy limits the effectiveness of the prophylaxis.

The nurse is developing a plan of care for a client with Guillain-Barré syndrome. Which of the following interventions should the nurse prioritize for this client? a. Using the incentive spirometer as prescribed b. Maintaining the client on bed rest c. Providing aids to compensate for loss of vision d. Assessing frequently for loss of cognitive function

a Respiratory function can be maximized with incentive spirometry and chest physiotherapy. Nursing interventions toward enhancing physical mobility should be utilized. Nursing interventions are aimed at preventing a deep vein thrombosis. Guillain-Barré syndrome does not affect cognitive function or vision.

A client has just returned to the unit from the PACU after surgery for a tumor within the spine. The client complains of pain. When positioning the client for comfort and to reduce injury to the surgical site, the nurse will position to client in what position? a. In the high Fowler position b. In a flat side-lying position c. In the Trendelenburg position d. In the reverse Trendelenburg position

b After spinal surgery, the bed is usually kept flat initially. The side-lying position is usually the most comfortable because this position imposes the least pressure on the surgical site. The Fowler position, Trendelenburg position, and reverse Trendelenburg position are inappropriate for this client because they would result in increased pain and complications.

A 25-year-old female client with brain metastases is considering her life expectancy after her most recent meeting with her oncologist. Based on the fact that the client is not receiving treatment for her brain metastases, what is the nurse's most appropriate action? a. Promoting the client's functional status and ADLs b. Ensuring that the client receives adequate palliative care c. Ensuring that the family does not tell the client that her condition is terminal d. Promoting adherence to the prescribed medication regimen

b Clients with intracerebral metastases who are not treated have a steady downhill course with a limited survival time, whereas those who are treated may survive for slightly longer periods, but for most cure is not possible. Palliative care is thus necessary. This is a priority over promotion of function and the family should not normally withhold information from the client. Adherence to medications such as analgesics is important, but palliative care is a high priority.

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. 1 hour after the antibiotic has infused and daily for 7 days b. 15 to 20 minutes before the first dose of antibiotic and every 6 hours for the next 4 days c. 2 hours prior to the administration of antibiotics for 7 days d. It can be administered every 6 hours for 10 days.

b 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 diagnosed with myasthenia gravis has been hospitalized to receive therapeutic plasma exchange (TPE) for a myasthenic exacerbation. The nurse should anticipate what therapeutic response? a. Permanent improvement after 4 to 6 months of treatment b. Symptom improvement that lasts a few weeks after TPE ceases c. Permanent improvement after 60 to 90 treatments d. Gradual improvement over several months

b Symptoms improve in 75% of patients undergoing TPE; however, improvement lasts only a few weeks after treatment is completed.

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 take hot tub baths to decrease spasms." b. "I should participate in non-weight-bearing exercises." c. "I will stretch daily as directed by the physical therapist." d. "The exercises should be completed quickly to reduce fatigue."

c 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 with a brain tumor has begun to exhibit signs of cachexia. What subsequent assessment should the nurse prioritize? a. Assessment of peripheral nervous function b. Assessment of cranial nerve function c. Assessment of nutritional status d. Assessment of respiratory status

c Cachexia is a wasting syndrome of weight loss, muscle atrophy, fatigue, weakness, and significant loss of appetite. Consequently, nutritional assessment is paramount.

The nurse teaches the client that corticosteroids will be used to treat his brain tumor to a. prevent extension of the tumor. b. facilitate regeneration of neurons. c. reduce cerebral edema. d. identify the precise location of the tumor.

c Corticosteroids may be used before and after treatment to reduce cerebral edema and to promote a smoother, more rapid recovery. Corticosteroids do not prevent extension of the tumor or facilitate regeneration of neurons. Stereotactic procedures identify the precise location of the tumor.

A client, brought to the clinic by his wife and son, is diagnosed with Huntington disease. When providing anticipatory guidance, the nurse should address the future possibility of what effect of Huntington disease? a. Metastasis b. Risk for stroke c. Emotional and personality changes d. Pathologic bone fractures

c Huntington disease causes profound changes to personality and behavior. It is a nonmalignant disease and stroke is not a central risk. The disease is not associated with pathologic bone fractures.

Myasthenia gravis occurs when antibodies attack which receptor sites? a. Serotonin b. Dopamine c. Acetylcholine d. Gamma-aminobutyric acid

c In myasthenia gravis, antibodies directed at the acetylcholine receptor sites impair transmission of impulses across the myoneural junction. Serotonin, dopamine, and gamma-aminobutyric acid are not receptor sites that are attacked in myasthenia gravis.

While assessing the client at the beginning of the shift, the nurse inspects a surgical dressing covering the operative site after the clients' cervical discectomy. The nurse notes that the drainage is 75% saturated with serosanguineous discharge. What is the nurse's most appropriate action? a. Page the health care provider and report this sign of infection. b. Reinforce the dressing and reassess in 1 to 2 hours. c. Reposition the client to prevent further hemorrhage. d. Inform the surgeon of the possibility of a dural leak.

d After a cervical discectomy, the nurse will monitor the operative site and dressing covering this site. Serosanguineous drainage may indicate a dural leak. This constitutes a risk for meningitis, but is not a direct sign of infection. This should be reported to the surgeon, not just reinforced and observed.

A client diagnosed with a pituitary adenoma has arrived on the neurologic unit. When planning the client's care, the nurse should be aware that the effects of the tumor will primarily depend on what variable? a. Whether the tumor utilizes aerobic or anaerobic respiration b. The specific hormones secreted by the tumor c. The client's pre-existing health status d. Whether the tumor is primary or the result of metastasis

b Functioning pituitary tumors can produce one or more hormones normally produced by the anterior pituitary and the effects of the tumor depend largely on the identity of these hormones. This variable is more significant than the client's health status or whether the tumor is primary versus secondary. Anaerobic and aerobic respiration are not relevant.

A client who has been experiencing numerous episodes of unexplained headaches and vomiting has subsequently been referred for testing to rule out a brain tumor. What characteristic of the client's vomiting is most consistent with a brain tumor? a. The client's vomiting is accompanied by epistaxis. b. The client's vomiting does not relieve his nausea. c. The client's vomiting is unrelated to food intake. d. The client's emesis is blood-tinged.

c Vomiting is often unrelated to food intake if caused by a brain tumor. The presence or absence of blood is not related to the possible etiology and vomiting may or may not relieve the client's nausea.

A client's spouse relates how the client reported a severe headache, and shortly after was unable to talk or move their right arm and leg. The spouse indicates the client has hypertension. What should be the focus of management during this phase? a. preventing further neurologic damage b. reporting changes to the physician c. destabilizing client's condition d. assessing vital signs frequently

a The focus of management during the acute phase is to stabilize the client and prevent further neurologic damage.

The clinic nurse is caring for a client with a recent diagnosis of myasthenia gravis. The client has begun treatment with pyridostigmine bromide. What change in status would most clearly suggest a therapeutic benefit of this medication? a. Increased muscle strength. b. Decreased pain c. Improved GI function d. Improved cognition

a The goal of treatment using pyridostigmine bromide is improvement of muscle strength and control of fatigue. The drug is not intended to treat pain, or cognitive or GI functions.

The nurse cares for a client with Huntington disease. What intervention is a priority for safe care? a. Protecting the client from falls b. Measuring electrolytes c. Assessing serum cholesterol d. Range-of-motion exercises

a The client with Huntington disease has a risk for injury from falls and skin breakdown. Protecting the client from falls is a priority for safe care. Electrolyte and cholesterol monitoring is not a priority for this condition. Range-of-motion exercises will not protect the client from injuries.

A gerontologic nurse is advocating for diagnostic testing of an 81-year-old client who is experiencing personality changes. The nurse is aware of what factor that is known to affect the diagnosis and treatment of brain tumors in older adults? a. The effects of brain tumors are often attributed to the cognitive effects of aging. b. Brain tumors in older adults do not normally produce focal effects. c. Older adults typically have numerous benign brain tumors by the eighth decade of life. d. Brain tumors cannot normally be treated in clients over age 75.

a In older adult clients, early signs and symptoms of intracranial tumors can be easily overlooked or incorrectly attributed to cognitive and neurologic changes associated with normal aging. Brain tumors are not normally benign and they produce focal effects in all clients. Treatment options are not dependent primarily on age.

The nurse caring for a client in ICU diagnosed with Guillain-Barré syndrome should prioritize monitoring for what potential complication? a. Impaired skin integrity b. Cognitive deficits c. Hemorrhage d. Autonomic dysfunction

d Based on the assessment data, potential complications that may develop include respiratory failure and autonomic dysfunction. Skin breakdown, decreased cognition, and hemorrhage are not complications of Guillain-Barré syndrome.

A patient is diagnosed with a spinal cord tumor and has had a course of radiation and chemotherapy. Two months after the completion of the radiation, the patient complains of severe pain in the back. What is pain an indicator of in a patient with a spinal cord tumor? a. Lumbar sacral strain b. The development of a skin ulcer from the radiation c. Hematoma formation d. Spinal metastasis

d Pain is the hallmark of spinal metastasis. Patients with sensory root involvement may suffer excruciating pain, which requires effective pain management.