Exam 5
Which age-related changes does the nurse anticipate in the auditory system when assessing older patients? Slect all that apply. A. Tinnitus B. Collapsed ear canal C. Increase in cerumen moisture D. Increased sensitivity to loud sounds E. Diminished sensitivity to low-pitched sounds.
Answers: A. Tinnitus B. Collapsed ear canal D. Increased sensitivity to loud sounds Rationale: Age-related changes in the auditory system include tinnitus, collapsed ear canal, increased sensitivity to loud sounds, diminished sensitivity to high-pitched sounds, and drier cerumen. p. 378
The nurse is educating a patient with Meniere's disease about cae management after discharge. Which statement by the patient indicates effective teaching? A. "I should eat a low-sodium diet." B. "I should exercise in the evening." C. "I should choose solid foods over liquids." D. "I should limit alcohol intake to 2 ounces a day."
Answer: A. "I should eat a low-sodium diet." Rationale: Meniere's disease is a middle-ear infection associated with an increase of fluid in the ear. A low-sodium diet reduces the risk of water retention, which lowers the risk of Meniere's disease. Performing exercise in the evening will be tedious for patients with Meniere's disease. The patient will have difficulty with solid foods because chewing may cause ear pain. The patient with Meniere's disease should completely avoid alcohol, which causes dizziness and vertigo. pp. 386-387
While caring for a patient with hearing loss, the nurse notes a deficit of 75 decibels on the audiogram. The nurse understands this is consistent with which type of hearing loss? A. Profound deafness B. Severe impairment C. Moderate impairment D. Moderately severe impairment
Answer: B. Severe impairment Rationale: Severe impairment is represented by a loss of 71-90 decibels on the audiogram.
The nurse is aware that otic drops are administered at room temperature in the ear canal due to which effect of the administration of cold otic drops? A. Vertigo B. Infection C. Barotrauma D. Tympanum burn
Answer: A. Vertigo Rationale: Administration of cold eardrops can cause vertigo due to the stimulation of the semicircular canals of the ear. Hot drops, not cold drops, can burn the tympanic membrane of the ear. For this reason, eardrops are instilled at room temperature. Barotrauma of the ear is ear discomfort caused by pressure changes. Increased air or water pressure can cause this. Microorganisms such as bacteria or fungi cause infection to the ear. Eardrops are not responsible for this. p. 384
Which neurologic condition is associated with constipation? A. Dementia B. Spina bifida C. Parkinson's disease D. Myelomeningocele
Answer: C. Parkinson's Disease Rationale: Conditions or diseases that hamper neurologic funciton, such as Parkinson's disease, cause constipation. Dementia, spina bifida, and myelomeningocele are neurologic conditions that cause fecal incontinence. p. 930
A student nurse is teaching a patient about normal changes of aging of the auditory system. Which statement requires correction from the nursing instructior? A. "There is reduced production of cerumen." B. "There is a decreased ability to filter sound to hear." C. "The tympanic membranes atrophy, or reduce in size." D. "There is an increased growth of hair in the auditory canal."
Answer: A. "There is a reduced production of cerumen." Rationale: The production of cerumen increases, not decreases, with age and dries out, which causes difficulty hearing. A patient's ability to filter sound is reduced as he or she ages. In addition, the tympanic membrane atrophies with aging, and there is an increase in hair growth in the auditory canal as a patient ages. p. 378
While the patient with Parkinson's disease, who is unresponsive to drug therapy, considers the surgical options presented by the health care provider, which procedures would the nurse anticipate providing as additional resources? Select all that apply. A. Ablation B. Thymectomy C. Transplantation D. Deep-brain stimulation E. Dorsal-column electrical stimulation
Answer: A. Ablation C. Transplantation D. Deep-brain stimulation Rationale: The surgical therapies for Parkinson's disease include ablation, deep-brain stimulation, and transplantation. Ablation surgery involves stereotactic ablation of areas in the thalamus, globus pallidus, and subthalamic nucleus. Deep-brain stimulation involves placing an electrode in the thalamus, globus pallidus, or subthalamic nucleus and connecting it to a generator placed in the upper chest. The provider programs the device to deliver a specific current to the targeted brain location. The design of transplantation of fetal neural tissue into the basal ganglia is to provide dopamine-producing cells in the brain. Use of a thymectomy occurs in the treatment of myasthenia gravis. Dorsal-column electrical stimulation helps to minimize symptoms of multiple sclerosis. p. 1375
A patient calls the office and reports that his 78-year-old spouse has suddenly lost hearing in one ear. Which recommendation by the nurse is correct? A. Bring his spouse in to be evaluated immediately B. Suggest gently cleaning out the ears to remove impacted cerumen C. Monitor the patient's hearing and call back the next day with an update D. Advise that this is normal with aging, and suggest facing his spouse when speaking
Answer: A. Bring his spouse in to be evaluated immediately Rationale: Sudden hearing loss is a medical emergency, and the patient should see the heath care provider immediately.
The nurse provides education to a patient with Meniere's disease. Which long-term effect of the disease would the nurse include in the teaching? A. Hearing loss B. Double vision C. Chronic vertigo D. Chronic headaches
Answer: A. Hearing loss Rationale: Meniere's disease, which involves the inner ear, is characterized by episodes of acute vertigo and tinnitus. It can result in progressive and irreversible sensorineural hearing loss. Double vision is not an associated symptom of Meniere's disease. Chronic vertigo and chronic headaches may or may bot be associated with Meniere's disease. pp. 386-387
Which medication overdose may lead to paradoxical intoxication in a patient with parkinsonism? A. Levodopa (L-dopa) B. Biperiden (Akineton) C. Trihexyphenidyl (Artane) D. Diphenhydramine (Benadryl)
Answer: A. Levodopa (L-dopa) Rationale: Paradoxical intoxication is the aggravation, rather than relief, of symptoms. This condition is mainly due to the excessive use of dopaminergic drugs such as levodopa. Biperiden is an anticholinergic drug that blocks the cholinergic receptors and maintains the balance between dopaminergic and cholinergic activity. Trihexyphenidyl is an example of an anticholinergic drug that does not aggravate the symptoms of the disease with overuse. Diphenhydramine is an antihistamine that has anticholinergic effects and does not lead to paradoxical intoxication in a patient with parkinsonism when overdosed with this medication. p. 1375
An older patient reports not being able to hear very well. Which would the nurse do first to determine the cause of the hearing loss? A. Look for cerumen in the ear. B. Assess for increased hair growth in the ear. C. Tell the patient it is probably related to aging. D. Ask the patient whether he or she has fallen because of dizziness.
Answer: A. Look for cerumen in the ear. Rationale: Gerontologic differences in the assessment of the auditory system include increased production of drier cerumen, which can become impacted in the ear canal and contribute to hearing loss. Conductive hearing loss with impacted cerumen may lead to speaking softly because the patient's voice conducted through bone seems lout to the patient. Although increased hair growth occurs, it will not impact the hearing. Age-related hearing loss may be occurring, but it should not be assumed. There is no reason to ask the patient if he or she has fallen because of dizziness; vertigo is not a normal change of aging of the ear. p. 379
Which is the nurse's highest priority when caring for a patient experiencing an acute attack of vertigo? A. Manage the patient symptomatically B. Educate the patient about diet restriction to prevent future episodes. C. Consult with an audiologist to arrange for an audiogram to be completed. D. Explain that a labyrinthectomy is a successful treatment for vertigo.
Answer: A. Manage the patient symptomatically. Rationale: Managing the patient's symptoms in acute attack of vertigo is the nursing intervention that will bring the patient the most immediate relief, which makes it a top priority. Patients are treated symptomatically with bedrest, sedation, and antiemetics or anti-vertigo drugs for motion sickness. Educating a patient about how to further prevent episodes of vertigo is not a priority in the acute management of vertigo; this can take place once the symptoms are under control. While an audiogram may help to confirm a diagnosis of Meniere's disease, it is not necessary to provide an audiogram for the patient during an attack of vertigo. A labyrinthectomy is not the only recognized treatment for vertigo, nor is it a priority during the initial phase of the patient's illness. p. 386
Which factor is most likely to cause a low arterial oxygen saturation by pulse oximetry (SpO2) reading in a patient with Parkinson's disease in the absence of any other signs of decreased oxygenation? A. Motion B. Anemia C. Dark skin color D. Thick acrylic nails
Answer: A. Motion Rationale: Motion is the most likely cause of the low SpO2 for this patient with Parkinson's disease. Anemia, dark skin color, and thick acrylic nails, as well as low perfusion, bright fluorescent lights, and intravascular dyes, also may cause an inaccurate pulse oximetry result. There is no mention of these or any reason to suspect these in this question. p. 469
Upon review of four patients' medical records, which patient would the nurse suspect as being susceptible to developing Parkinson's disease? Patient A: Deficiency of dopamine Patient B: Cauda equine Patient C: Intracranial injury Patient D: Acute hemorrhage A. Patient A B. Patient B C. Patient C D. Patient D
Answer: A. Patient A Rationale: Parkinson's disease is a progressive disease of the nervous system. Dopamine plays an important role in controlling neuron function. Destruction of dopamine-secreting neurons causes dopamine deficiency, which may result in Parkinson's disease in Patient A. Compression of the nerve root causes cauda equine, as seen in Patient B. Intracranial injury puts Patient C at risk for increased intracranial pressure (ICP). Acute hemorrhage causes the expainsion of brain tissue in Patient D. p. 1372
The nurse assesses a patient with an inner ear problem. Which is the most significant symptom for which the nurse would be alert in this patient? A. Vertigo B. Tinnitus C. Headaches D. Hearing loss
Answer: A. Vertigo Rationale: The patient with an inner-ear problem will most often complain of vertigo because the inner ear Is directly related to maintenance of equilibrium and balance. The patient should be assessed by the nurse because of the safety implications. A patient with an inner ear issue may manifest tinnitus (ringing or buzzing in the ear), headaches, or hearing loss. Vertigo presents the greatest safety risk. pp. 378, 386-387
The nurse observes a patient ambulating with a stumbling gait. Which condition would the nurse note to be a possible cause of this patient's condition? A. Vertigo B. Tinnitus C. Nystagmus D. Presbycusis
Answer: A. Vertigo Rationale: Vertigo is stimulated by movement; this condition can cause an unsteady gait. Presbycusis is hearing loss due to aging. Nystagmus is an abnormal eye movement or twitching of the eye. Tinnitus is ringing in the ears. p. 378
A nurse is teaching a group of new nurses about working with patients with profound hearing loss. Which statement made by a new nurse requires correction? A. "I should speak at a normal volume." B. "I should avoid using hand movements." C. "I should make sure that there is good lighting in the room." D. "I should avoid chewing gum when speaking with a patient with hearing loss."
Answer: B. "I should avoid using hand movements." Rationale: A nonverbal aid such as hand movements would help the patient understand what the nurse is trying to communicate and should not be avoided. This statement requires correction.
A patient in the emergency department is diagnosed with Meniere's disease after an acute episode and asks the nurse how long the attack will last. What is the nurse's correct response? A. "You should start to feel better soon." B. "These attacks can last for hours to days." C. "You may feel like this for the rest of your life." D. "It can be several months before you feel better."
Answer: B. "These attacks can last for hours to days." Rationale: Attacks of Meniere's disease can last for hours or days and may occur several times a year.
A nurse receives orders for a patient with an acute attack of Meniere's disease. Which drug order should the nurse question? A. Antiemetics B. ACE inhibitors C. Anticholinergivs D. Benzodiazepines
Answer: B. ACE inhibitors Rationale: This is an angiotensin-converting enzyme inhibitor and normally used for cardiac disease, not Meniere's disease. Calcium channel blockers may be used for the treatment of acute attacks.
Which intervention is important for the nurse to include in the plan of care for a patient experiencing an acute episode of Meniere's disease? A. Increased fluid intake B. Decreased environmental stimuli C. Provision of the patient's regular diet D. Assessment for orthostatic hypotension
Answer: B. Decreased environmental stimuli Rationale: The etiology of Meniere's disease is not well understood, but stress and excessive sensory stimulation are possible causes. Decreasing environmental stimuli is one approach to treatment and controlling the severity of the symptoms. Fluid intake should be decreased; this may ease the symptoms because in Meniere's disease there is an increase in the endolymphatic fluid of the inner ear. It is believed this causes disease symptoms. If there is no nausea and vomiting, the patient may eat a regular diet as tolerated, but this is not as high a priority as decreasing environmental stimuli. Patients may experience tinnitus and vertigo, but the BP is not affected, so orthostatic hypotension does not occur. p. 386
The nurse is preparing a teaching plan for a patient with mild hearing loss who was fitted with an in-canal hearing aid. Which information should the nurse include in the teaching? A. Normal hearing should be restored within 2 weeks. B. Ensure the hearing aid fits properly inside the ear canal. C. Use the highest amplification setting when in crowded places. D. If the hearing aid becomes uncomfortable, it can be moved to the ear.
Answer: B. Ensure the hearing aid fits properly inside the ear canal. Rationale: For mild hearing loss, the type of hearing aid needed is one that fits completely inside the ear canal. The nurse should teach the patient how to insert the hearing aid to ensure optimal function.
A patient with Parkinson's disease taking a dopamine agonist medication reported nausea and vomiting. The patient lost consciousness from a sudden drop in BP after receiving an IV antiemetic. Which antiemetic medication interaction would nurse associate with the patient's response? A. Ondansetron (Zofran) and amantadine (Symmetrel) B. Ondansetron (Zofran) and apomorphine (Apokyn) C. Trimethobenzamide (Tifan) and amantadine (Symmetrel) D. Trimethobenzamide (Tigan) and apomorphine (Apokyn)
Answer: B. Ondansetron (Zofran) and apomorphine (Apokyn) Rationale: When administering the dopamine agonist apomorphine alone, the medication causes severe nausea and vomiting. Apomorphine, when administered along with antiemetics such as ondansetron, leads to very low BP and loss of consciousness. Amantadine does not have any drug-drug interactions with antiemetics such as ondansetron. Amantadine would not cause any side effects such as nausea and vomiting; thereforre there is no a need for coadministration with an antiemetic such as trimethobenzamide. Trimethobenzamide is the preferred antiemetic coadministered with apomorphine because apomorphine causes nausea and vomiting when taken alone. p. 1375
A degeneration of dopamine-producing neurons and decreased levels of dopamine are characteristics of which disease? A. Multiple sclerosis B. Parkinson's disease C. Lou Gehrig's disease D. Huntington's disease (HD)
Answer: B. Parkinson's disease Rationale: Characteristics of Parkinson's disease include a lack of dopamine because of the degeneration of dopamine-producing neurons; this disrupts the normal balance between acetylcholine and dopamine in the brain. Multiple sclerosis is due to the demyelination of the nerve fibers of the brain and spinal cord. Characteristics of this disease are not associated with a deficiency of neurotransmitters. Lou Gehrig's disease is a rare, progressive neurologic disorder that involves the degeneration of motor neurons in the brain and spinal cord, not the degeneration of neurons producing dopamine. HD involves a deficiency of the acetylcholine and y-aminobutyric acid neurotransmitters. HD has increased levels of dopamine. p. 1372
A patient has central and functional hearing loss. The nurse understands that which finding may have contributed to this disorder? A. Impacted cerumen B. History of ototoxic medication use C. History of multiple ear infections as a child D. No physical reason for hearing loss can be Identified
Answer: D. No physical reason for hearing loss can be identified Rationale: Central and functional hearing loss is caused by an emotional or psychological factor, where no physical reason for hearing loss can be identified.
Which neurodegenerative disorder has the characteristics of rigidity and bradykinesia? A. Multiple sclerosis B. Parkinson's disease C. Lou Gehrig's disease D. Huntington's disease
Answer: B. Parkinson's disease Rationale: Parkinson's disease is a chronic, progressive neurodegenerative disorder characterized by an increased muscle tone (known as rigidity), slowness in the initiation and execution of movement (known as bradykinesia), tremors, and gait disturbances. Multiple sclerosis is a chronic progressive degenerative disorder of the central nervous system characterized by progressive, chronic demyelination of nerve fibers of the spinal cord and brain. Lou Gehrig's disease is a rare progressive neurologic disorder involving degeneration of motor neurons in the spinal cord and brain; characteristics include limb weakness, dysarthria, and dysphagia. Huntington's disease is a genetically transmitted, autosomal dominant disorder characterized by chorea movements and cognitive and psychiatric disorders. p. 1371
Which nursing strategy should be implemented when caring for a patient who has Parkinson's disease and is at risk of falling? A. Obtain an order for physical restraints to be used. B. Perform hourly rounds to assess the patient's needs. C. Encourage the patient to stay in bed to nap frequently. D. Ask family members to stay with the patient at all times.
Answer: B. Perform hourly rounds to assess the patient's needs. Rationale: Safety is a primary concern when caring for an older adult who has a high risk for falls. The nurse should perform hourly rounds to ensure that the patient's basic physiologic needs are being met. Physical restraints should be used as a last resort. Families can sit with the patient; however, there may not be family available, or family they may not be available at all times. Encouraging the patient to stay in bed decreases the patient's mobility and is not necessary. pp. 69-70
For the patient with Parkinson's disease who has difficulty swallowing, which intervention would the nurse initially include in the patient's plan of care? A. Arrange for someone to feed the patient. B. Provide the patient with semisolid or soft foods. C. Encourage the patient to drink fluids with meals. D. Place food into the unaffected side of the patient's mouth.
Answer: B. Provide the patient with semisolid or soft foods. Rationale: In Parkinson's disease, the patient may have poor control of the tongue, increasing the risk for aspiration. Semisolid food without lumps and thickened liquids stick together, allowing the tongue to direct the food bolus to the back of the mouth. Encourage the patient to self-feed to maintain independence and function. Clear fluids with meals at any time may present a risk of aspiration if there is difficulty swallowing. Parkinson's disease likely affects the tongue and entire mouth, so placing food into the unaffected side of the patient's mouth is not an appropriate choice. p. 1375
Which instructions would the nurse include when teaching a patient how to administer eardrops? Select all that apply. A. Administer cold, not warm, drops. B. The tip of the dropper should not touch the ear. C. The ear should be positioned so that the drops can run into the canal. D. The drops should not be put in using a cotton wick placed in the ear canal. E. The position of the ear should be maintained for two minutes to let the drops spread.
Answer: B. The tip of the dropper should not touch the ear. C. The ear should be positioned so that the drops can run into the canal. E. The position of the ear should be maintained for two minutes to let the drops spread. Rationale: When administering eardrops, the patient should position the ear so that the drops run into the canal, and this position should be maintained for two minutes to let the drops spread. The dropper should not touch the ear; avoiding contact reduces the spread of infection. The eardrops should be at room temperature when administered. Cold drops can cause vertigo; very warm drops can burn the tympanic membrane. Sometimes the drops are placed onto a wick of cotton that is placed in a canal. p. 384
The patient with Parkinson's disease lost 35 lbs over the last two months, and a swallow study indicates ability to swallow without aspiration. Which intervention would the nurse discuss with the patient and spouse to improve nutritional intake? A. Include chewy foods so that the patient builds up the jaw muscles. B. Administer prescribed carbidopa/levodopa with a protein drink. C. Allow adequate time for the patient to eat each of six small meals. D. Encourage the patient to eat at least every two hours while awake.
Answer: C. Allow adequate time for the patient to eat each of six small meals. Rationale: Allowing adequate time for the patient to eat each of six small meals will limit frustration and improve overall intake. Six small feedings may improve intake, but eating every two hours would exhaust the patient. Protein impairs the absorption of levodopa, so the best practice is to avoid large amounts of protein when administering carbidopa/levodopa. Foods should be easily chewable and dissected into small bites to increase the overall intake. p. 1375
Which medication would the nurse anticipate administering to a patient with parkinsonism as treatment for their hypomobility? A. Ropinirole (Requip) B. Pramipexole (Mirapex) C. Apomorphine (Apokyn) D. Bromocriptine (Parlodel)
Answer: C. Apomorphine (Apokyn) Rationale: Hypomobility is a condition occuring towards the end of the dosing interval of standard medications in patients with parkinsonism. Drugs such as apomorphine, a dopamine agonist, block the reuptake of dopamine into the presynaptic neurons and stimulate the postsynaptic dopamine receptors. Carbidopa and entacapone block the COMT enzyme. Ropinirole, pramipexole, and bromocriptine are dopamine receptor agonists that act by stimulating the dopamine receptors. Do not use these dopamine receptor agonists when the patient experiences hypomobility. p. 1375
Based on the documentation below, which part of the auditory system was assessed? Auricle: Free of lesions Tragus: Non-tender Canal: Yellow sticky cerumen present A. Inner ear B. Middle ear C. External ear D. Central auditory system
Answer: C. External ear Rationale: Assessment of the auricle, tragus, and canal indicates assessment of the structures of the external ear. The inner ear is assessed with hearing and balance testing. The middle ear is assessed with hearing tests. The central auditory system is assessed with hearing and balance testing.
If a patient has Parkinson's disease, which patient reaction would the nurse expect when performing a pull test by standing behind the patient and giving a tug backward on the patient's shoulders? A. Loses balance and sits down B. Loses balance and falls forward C. Loses balance and falls backward D. Loses balance and becomes unconscious
Answer: C. Loses balance and falls backward Rationale: In a pull test, when the examiner stands behind the patient and gives a tug backward on the shoulder, the patient loses balance and falls backward. This reaction indicates postural instability, a common feature in Parkinson's disease. Sitting down, falling forward, or becoming unconscious after losing balance is not indicative of postural instability related to Parkinson's disease. p. 1373
Which neurologic disorder has paradoxical intoxication as a potential adverse effect of medication therapy? A. Multiple sclerosis B. Myasthenia gravis C. Parkinson's disease D. Huntington's disease
Answer: C. Parkinson's disease Rationale: Paradoxical intoxication involves the aggravation, rather than relief, of symptoms, after using a drug. Dopaminergic drugs, prescribed for parkinsonism, may cause paradoxical intoxication after prolonged use. Drug therapy therapy for multiple sclerosis includes immunomodulators or corticosteroids and other drugs that help to reduce the symptoms. These drugs help to reduce the symptoms but do not cause paradoxical intoxication. Drug therapy for Huntington's disease includes managing the symptoms of chorea and cognitive and psychiatric disorders. These drugs help to reduce the symptoms but do not cause paradoxical intoxication. Drug therapy for myasthenia gravis includes using anticholinergics, corticosteroids, and immunosuppressive agents. These drugs help to reduce the symptoms but do not cause paradoxical intoxication. p. 1375
Regarding the patient with Parkinson's disease (PD) who recently entered a long-term care facility, which action would the health care team implement to promote adequate nutrition for this patient? A. Provide multivitamins with each meal. B. Provide a diet low in complex carbohydrates and high in protein. C. Provide small, frequent meals throughout the day that are easy to chew and swallow. D. Provide the patient with minced or pureed diet, high in potassium and low in sodium.
Answer: C. Provide small, frequent meals throughout the day that are easy to chew and swallow. Rationale: Nutritional support is a priority in the care of individuals with PD. Such patients may benefit from meals that are smaller and more frequent than normal and that are easy to chew and swallow. Multivitamins are not necessary at each meal; and the patient's vitamin intake, along with protein intake, will be monitored to prevent contraindications with medications. It is premature to introduce a minced or pureed diet at this time, and a low-carbohydrate diet is not indicated. p. 1375
The nurse is assessing a patient with Meniere's disease. The patient presents with complaints of vertigo. What additional sign or symptom would the nurse suspect? A. Ear pain B. Sudden hearing loss C. Significant inability to function D. Difficulty understanding speech
Answer: C. Significant inability to function Rationale: Patients with Meniere's disease may experience significant instability because of sudden, severe attacks of vertigo.
The wife of an older adult patient states, "If I don't speak loudly to my husband, he can't hear me. It's been getting worse these past few months." When planning care for this patient, which recommendation should the nurse include? A. Recommend the patient be fitted for a hearing aid B. Encourage the patient to schedule an appointment with an audiologist C. Suggest the patient have his hearing evaluated by his primary care provider immediately D. Remind the wife that hearing changes are common in older adult men and likely no action is necessary.
Answer: C. Suggest the patient have his hearing evaluated by his primary care provider immediately. Rationale: The primary care provider should do an initial assessment and collect health data to determine the problem, if the patient needs to see the audiologist. The nurse should not recommend a hearing aid. There is not enough information available to support the need for a hearing aid at this time.
During an auditory assessment, the nurse finds that the patient is able to hear a low whisper at a distance of 30 cm. Which statement reflects the correct interpretation of this finding by the nurse? A. The patient has impaired reception. B. The patient has mastoid tenderness. C. The patient has normal auditory function. D. The patient has sensorineural hearing loss.
Answer: C. The patient has normal auditory function. Rationale: Ability to hear a low whisper of 20 dB at a short distance of 30 cm indicates that the patient has normal auditory function. Impairment of the cochlea will result in impairment of reception. The nurse palpates the mastoid area to detect tenderness and nodules. The tuning fork test, not the whisper test, helps detect sensorineural hearing loss. p. 381
The student nurse is caring for a patient with an acute attack of Meniere's disease. Which finding indicates a need for further teaching of the student nurse? A. The patient's urine output is measured. B. An emesis basin is kept on the bedside table. C. The patient is placed in the dayroom to watch a favorite action movie. D. Three side rails on the patient's bed are placed in the upright position.
Answer: C. The patient is placed in the dayroom to watch a favorite action movie. Rationale: When caring for a patient with an acute attack of Meniere's disease, the nurse should plan interventions that minimize vertigo and provide for patient safety. Avoiding fluorescent or flickering lights or a television will minimize the attack and/or symptoms.
A patient presents with symptoms of Parkinson's disease. Which medical history finding would be most concerning for the nurse? A. The patient takes ibuprofen daily for headaches. B. The patient was prescribed an antibiotic last week. C. The patient takes medication daily for schizophrenia. D. The patient has a history of malignant hyperthermia with anesthesia.
Answer: C. The patient takes medication daily for schizophrenia. Rationale: Some antipsychotic medications can cause Parkinson-like symptoms.
A nurse is caring for a patient with hearing loss. The patient asks the nurse what it means to have sensorineural hearing loss. Which response from the nurse is correct? A. "It is just a normal part of aging." B. "It is a type of mixed hearing loss." C. "It may be caused by a psychological issue, so you may need to see a psychiatrist." D. "It is an impairment of one of your cranial nerves that affects the function of your ear."
Answer: D. "It is an impairment of one of your cranial nerves that affects the function of your ear." Rationale: Sensorineural hearing loss is caused by impairment of function of the inner ear or the vestibulocochlear nerve (Cranial Nerve 7).
A patient is diagnosed with otitis media with effusion. The nurse expects the patient will likely exhibit which symptom? A. Fever B. Malaise C. Episodic vertigo D. Feeling of fullness of the ear
Answer: D. Feeling of fullness of the ear Rationale: Otitis media with effusion is an inflammation of the middle ear with an accumulation of fluid in the middle-ear space. The patient may complain of a feeling of fullness of the ear. Fever and malaise are symptoms of acute otitis media. Episodic vertigo is a sign of Meniere's disease. p. 384-385
Which condition is consistent with excessive daytime sleepiness and a decreased dopamine level? A. Narcolepsy B. Jet lag disorder C. Alzheimer's disease D. Parkinson's disease
Answer: D. Parkinson's disease Rationale: Degeneration of dopamine neurons in the substantia nigra occurs in patients with Parkinson's disease; this leads to excessive daytime sleepiness. pp. 89-91
When evaluating the presence of an initial symptom of Parkinson's disease, which clinical manifestation would the nurse evaluate? A. Akinesia B. Aspiration C. Forgetfulness' D. Pill-rolling tremors
Answer: D. Pill-rolling tremors Rationale: Early symptoms of Parkinson's disease include coarse resting tremors of the fingers and thumb, also known as pill-rolling movements. Akinesia (complete or partial loss of muscle movement), aspiration, and mental deterioration occur later in the disease process. p. 1373
A patient presents with mixed hearing loss. What should the nurse keep in mind when assessing the patient? A. Speak directly with the sign language interpreter B. Interview the patient's caregiver in another room C. Have a family member present during the assessment to provide additional information D. Take a careful medical and family history, especially assessing for deafness in the family
Answer: D. Take a careful medical and family history, especially assessing for deafness in the family Rationale: The nurse would want to assess the patient's medical and family history. Having a history of deafness in the family may give insight into the patient's medical condition.
For the patient with Parkinson's disease, which dietary adjustments would the nurse include in the plan of care to prevent malnutrition and constipation? Select all that apply. A. Cut food into bite-size pieces. B. Serve hot foods on a warmed plate. C. Include whole grains and fruits in the diet. D. Include plenty of food items high in protein. E. Provide three large meals rather than six small meals.
Answers: A. Cut food into bite-size pieces. B. Serve hot foods on a warmed plate. C. Include whole grains and fruits in the diet. Rationale: patients with Parkinson's disease are predisposed to malnutrition and constipation, owing to inadequate food intake caused by difficulty in chewing and swallowing. To promote adequate nutrition, the nurse should include whole grains and fruits in the diet, which will prevent constipation. Cut food into bite-size pieces so chewing and swallowing are easy. Serving hot foods on a warmed plate makes the food more appealing. Limit food items high in protein because they can interfere with absorption of carbidopa-levodopa, the most common drug use in the treatment of Parkinson's disease. Six small meals, rather than three large meals, would be less exhausting for the patients. p. 1375
A patient is diagnosed with sensorineural hearing loss. Which potential causes of this disorder would the nurse discuss with the patient? Select all that apply. A. Damage to the inner ear B. An increase in cerumen output C. Damage to the tympanic membrane D. Impairment for the auditory pathway E. Damage to the vestibulocochlear nerve
Answers: A. Damage to the inner ear E. Damage to the vestibulocochlear nerve Rationale: Damage to the inner ear or damage to the vestibulocochlear nerve that lines the inner ear results in sensorineural hearing loss. An increase in cerumen will result in central loss of hearing because the auditory canal is blocked. The tympanic membrane is found in the external ear; impairment of the tympanic membrane is associated with impaired transmission of sound waves. Impairment of the auditory pathway will result in central loss of hearing. p. 388
A nurse is caring for a patient with Parkinson's disease. Which points should the nurse teach the patient to aid muscle development and decrease the risk of injury. Select all that apply. A. Elevate the toilet seat. B. Avoid all caffeinated beverages. C. Place nonskid pads under all rugs. D. Use assistive devices when necessary. E. Include light weight training in an exercise regimen. F. Follow a diet with balanced carbohydrates and protein.
Answers: A. Elevate the toilet seat. C. Place nonskid pads under all rugs. D. Use assistive devices when necessary. E. Include light weight training in an exercise regimen. F. Follow a diet with balanced carbohydrates and protein. Rationale: An elevated toilet seat decreases the distance the patient has to move for sitting. Nonskid rugs help prevent falls. Assistive devices help to prevent falls. Weight training strengthens muscles and helps prevent injury. Protein and carbohydrates are necessary for a healthy diet and muscle development. Proper muscle development is critical for strength and stability to prevent falls and other injuries. Avoiding caffeine is a suggestion for patients with multiple sclerosis, not Parkinson's disease.
To promote self-care and independence in patients with Parkinson's disease, which interventions would the nurse provide family members? Select all that apply. A. Have the patient wear slip-on shoes. B. Provide the patient with an elevated toilet seat. C. Use rugs on the floor to keep the patient's feet warm. D. Examine the patients clothing and use items with buttons and hooks. E. Encourage the patient to elevate the legs on an ottoman when sitting.
Answers: A. Have the patient wear slip-on shoes. B. Provide the patient with an elevated toilet seat. E. Encourage the patient to elevate the legs on an ottoman when sitting. Rationale: To promote self-care and independence of the patient, identify potential changes in the home environment. The patient should use slip-on shoes because the patient can be easily put them on or take them off. Elevated toilet seats help with getting on and off the toilet easily. Elevate legs on an ottoman prevents ankle edema. Remove rugs because they can cause the patient to fall. Hooks and buttons as clothing fasteners may be difficult for the patient to use; instead, use clothing with hook-and-loop (Velcro) fasteners or zippers. p. 1376
What are the primary symptoms used to help diagnose patients with Parkinson's disease? Select all that apply. A. Tremor B. Rigidity C. Dysphagia D. Paraplegia E. Bradykinesia
Answers: A. Tremor B. Rigidity E. Bradykinesia
Which actions would the nurse take when performing a focused assessment on the auditory system? Select all that apply. A. Ask whether the patient wears earrings. B. Ask whether the patient is feeling any ear pain. C. Assess whether the patient can hear a clock ticking. D. Determine whether the patient can hear loud noises. E. Check the external auditory meatus for any discharge
Answers: B. Ask whether the patient is feeling any ear pain. C. Assess whether the patient can hear a clock ticking. E. Check the external auditory meatus for any discharge. Rationale: While assessing any patient with hearing problems, it is important to collect subjective data as well as objective data. Subjective data are what the patient says regarding complaints. These consist of modalities of pain or discharge. Objective information is the information that the nurse can see or perceive. The nurse can assess the patient's ability to hear by testing for the ability to hear a clock ticking in the room. Checking the external auditory meatus helps the nurse observe if any discharge is present. The patient's auditory ability is assessed based on the ability to hear low sounds. There is no test for checking hearing ability based on loud noises. Wearing ear jewelry may cause inflammation but does not affect hearing capacity. p. 381
A patient with Parkinson's disease presents for continued care. The patient was initially taking carbidopa-levodopa and was later prescribed bromocriptine after the effectiveness of carbidopa-levodopa appeared to wear off. The patient is not responding to these medication changes and has developed difficulty walking and holding objects. Which collaborative care treatments are options for this patient? Select all that apply. A. Surgical thymectomy B. Deep brain stimulation C. Dorsal column stimulation D. Ablation of the affected area E. Transplantation of fetal neural tissue
Answers: B. Deep brain stimulation D. Ablation of the affected area E. Transplantation of fetal neural tissue Rationale: Deep brain stimulation is used in patients with Parkinson's disease to control symptoms when medication therapy is ineffective. Ablation surgery targets problem areas in patients with Parkinson's disease when medication therapy is ineffective. Transplantation of fetal neural tissue into the basal ganglia is designed to provide dopamine receptor agonist- producing cells in the brains of patients with Parkinson's disease when medication therapy is ineffective. Thymectomy is indicated for almost all patients with thymoma, a condition associated with myasthenia gravis, not Parkinson's disease. Dorsal column stimulation is used to treat spasticity in multiple sclerosis.
For the patient with Parkinson's disease who is taking levodopa with carbidopa (Sinemet), the nurse would monitor the potential development of which side effect(s)? Select all that apply. A. Dizziness B. Dyskinesia C. Severe headache D. Involuntary eyelid movements E. Severe nausea and vomiting
Answers: B. Dyskinesia D. Involuntary eyelid movements E. Severe nausea and vomiting Rationale: Sinemet is a combination of levodopa and carbidopa and is prescribed to patients suffering from parkinsonism. The drug has few side effects. These side effects include dyskinesia due to increased dopamine availability. Severe nausea and vomiting are other important side effects because the dopaminergic pathway is the major pathway involved in emesis. Increased dopamine levels in the body may trigger the sensation of nausea and vomiting. Involuntary eyelid movements are due to increased levels of the neurotransmitter dopamine in the body. Dizziness or fainting, due to orthostatic hypotension, is a side effect of the drug bromocriptine. A severe headache is also a side effect of bromocriptine. p. 1374
Which factors lead to a higher risk of accidents or injuries in older adults? Select all that apply. A. Decreased weight B. Neurologic impairment C. Decreased visual acuity D. Increased muscle strength E. Changes in gait and balance
Answers: B. Neurologic impairment C. Decreased visual acuity E. Changes in gait and balance Rationale: Many factors increase the risk for falls, including neurologic impairment (e.g., stroke, Parkinson's disease), decreased visual acuity, and changes in gait and balance. Decreased weight does not put a patient at risk for accidents. Decreased muscle strength, not increased muscle strength, puts a patient at risk for accidents. p. 69
A nurse is caring for a patient with Parkinson's disease in long-term care who coughs when drinking and eating. How should the nurse modify the patient's diet? Select all that apply. A. Start the patient on a pureed diet. B. Perform a dysphagia screening test. C. Increase roughage in the patient's diet. D. Only allow the patient to consume thickened liquids. E. Remove shredded and ground meats from the diet.
Answers: B. Perform a dysphagia screening test. D. Only allow the patient to consume thickened liquids. E. Remove shredded and ground meats from the diet. Rationale: It is important to conduct a swallow study before administering any oral food or fluids. This will determine the severity of the patient's dysphagia and the types of foods the patient can eat. Thickened liquids are prescribed for patients at risk for aspiration. Patients with dysphagia should be encouraged to eat ground or shredded meat that is no larger than 1/4 inch.
When performing a physical examination of a patient with Parkinson's disease, which associated clinical manifestations would the nurse likely identify? Select all that apply. A. Nystagmus B. Patchy blindness C. Drooling of saliva D. Decreased arm swing E. Shuffling, propulsive gait
Answers: C. Drooling of saliva D. Decreased arm swing E. Shuffling, propulsive gait Rationale: The patient may manifest drooling of saliva, shuffling, propulsive gait, and decreased arm swing. These symptoms are due to the combination of tremors, rigidity of muscles, and bradykinesia. Parkinson's disease does not have clinical manifestations of patchy blindness (migraine headaches) or nystagmus. p. 1373
Which criterion would the nurse associate with the health care provider's diagnosis of Parkinson's disease (PD)? Select all that apply. A. Decreased serum dopamine levels B. Tumor present in the thymus gland C. Positive response to antiparkinsonian medications D. MRI shows areas of plaque on cranial nerves E. Presence of two of the tree classic features: rigidity, bradykinesia, and tremor.
Answers: C. Positive response to antiparkinsonian medications E. Presence of two of the three classic features: rigidity, bradykinesia, and tremor Rationale: Presently, there is no specific test to diagnose PD. When the patient demonstrates two of the tree classic signs: rigidity (increased resistance to passive motion as a cogwheel), bradykinesia (slowed and loss of automatic coordinated movement), and tremor (a tremor that is more severe at rest and pin-rolling hand tremor), the diagnosis occurs. Confirmation of the PD diagnosis is a positive response to medications used to treat the disease, sucg as cabidopa/levodopa. The cause of PD is decreased dopamine levels in the brain and inability to measure dopamine in the serum. Tumors of the thymus gland are associated with myasthenia gravis. MRI of patients with multiple sclerosis indicate areas of plaque development. p. 1373
