module 5

What is the first sign of Bell's palsy? a. Inability to wrinkle forehead and pucker lips on affected side b. Sudden pain in nostril on affected side c. Excessive salivation on the affected side d. Excessive mucus running from nostril on affected side

A

_________________ is/are responsible for the transmission of impulses between synapses. a. Neurotransmitters b. Dopamine c. Neurons d. Brain

A

Which foods should the person who suffers from migraine headaches avoid? (Select all that apply.) a. Yogurt b. Caffeine c. Beef d. Pears e. Marinated foods f. Milk

A B E

Which system controls blood pressure and body temperature?

Autonomic nervous system

The newly admitted patient to the emergency room after a motorcycle accident has serosanguineous drainage coming from the nose. What is the most appropriate nursing response to this assessment? a. Cleanse nose with a soft cotton-tipped swab b. Gently suction the nasal cavity c. Gently wipe nose with absorbent gauze d. Ask patient to blow his nose

C

The nurse is aware that when assessing a patient by the FOUR score coma scale, the patient is assessed in four categories: eye response, brainstem reflexes, motor response, and respiration. How are these results reported? a. As a sum of the scores of the four categories b. As part of the Glasgow coma scale c. As individual scores in each category d. As progressive scores during a 24-hour period

C

An older adult patient is to receive atenolol, a beta adrenergic blocking agent. Prior to administration of the drug, the nurse assesses an apical pulse rate of 58 and notes ankle edema. Which action will the nurse take first?

Withhold the medication.

Medications that cause effects similar to those produced by the adrenergic neurotransmitter norepinephrine are called?

adrenergic agents or sympathomimetic agents

The medications that slow down heart rated and cause pupillary constriction are ?

cholinergic agents

When patients start on monoamine oxidase type B inhibitor therapy in conjunction with carbidopa-levodopa(Sinemet), the dosages of Sinemet can be titrated downward starting at?

day 2 or 3 of therapy

This classification of drugs used to treat parkinsonism by reducing the metabolism of dopamine in the brain is?

monamine oxidase type B inhibitors

A long term care resident is taking an anticholinergic agent. The nurse observes the resident to be disoriented and hallucinating. The priority nursing action is to:

provide for resident's safety.

The major action of the drug carbidopa-levodopa (simenet) is to?

reduce metabolism of levodopa

The major action of the drug entacapone (comtan) which is a COMT inhibitor, is to?

reduce the destruction of dopamine in the peripheral tissues

The PNS is further subdivided into ?

the somatic nervous system and the autonomic nervous system

What is the rationale for administering levodopa instead of dopamine for treatment of Parkinsons disease?

Dopamine does not cross the bloodbrain barrier when administered orally.

The drug carbidopa-levodopa (simenet) must be given in combination because?

carbidopa has no effect when used alone

The major action of the drug, rasagiline is considered neuroprotective, which?

slows the rate of deterioration of the dopamine neurons

Which statement does the nurse include when teaching a Pt with Parkinson's disease about the drug apomorphine (apokyn)?

It is chemically related to morphine, but does not have any opioid activity

Anticholinergic agents are usually clinically in the treatment of which disorders?

1. bradycardia 2. ophthalmic disorders 3. GI motility disorders

What are serious adverse effects of beta-adrenergic blocking agent therapy?

1. bradycardia 2. wheezing 3. orthopnea 4. hypoglycemia

The nurse understands that the 2 major neurotransmitters of the autonomic nervous system are?

1. norepinephrine 2. acetylcholine (auto-nor-ace) little phrase to remember

The body's catecholamines that are produced primarily from nerve terminals; the adrenal medulla; and selected sites in the brain, kidneys, and GI tract include?

1. norepinephrine 2. epinephrine 3. dopamine

The therapeutic outcomes desired when an anticholinergic agent is prescribed for a Parkinson's pt include ?

1. reduced drooling 2. reduced tremors

Since beta-adrenergic blocking agents have the potential to cause hypotension, bradycardia, and heart failure, it is important to monitor for symptoms of heart failure including an increase in?

1. edema 2. crackles 3. dyspnea

After being treated for Parkinson's disease, pt's will demonstrate improvement in their symptoms by?

1. improved gait 2. improved speech 3. decreased tremors

What Glasgow Coma Scale rating would a patient receive who opens the eyes spontaneously, but has incomprehensible speech and obeys commands for movement?

12

Generally, Pt's with Parkinson's disease will be treated with carbidopa-levodopa, but the drugs effect gradually wears off in?

3-5 years

A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned with respect to this diagnostic test? a. Obtain an allergy history before the test. b. Ambulate the patient when returned to the room after the test. c. Use a heated blanket to keep the patient warm after the procedure. d. Keep NPO for 6 to 8 hours after the test.

A

The newly admitted patient to the emergency room 30 minutes ago after a fall off a ladder has gradually decreased in consciousness and has slowly reacting pupils, a widening pulse pressure, and verbal responses that are slow and unintelligible. What is the most appropriate position for the patient? a. Neck placed in a neutral position b. Head raised slightly with hips flexed c. Supine in gravity neutral position d. Turn on right side with head elevated

A

Beta-adrenergic blocking agents such as carvedilol (coreg) must be used with caution in diabetic pt's because these agents may induce, as well as mask, the signs of?

hypoglycemia

Peripheral Nervous system (PNS) is comprised of?

peripheral nerves subdivided into afferent and efferent nerves

Autonomic Nervous system?

works automatically and is not under voluntary control

What should the nurse do when the child arrives on the floor with the diagnosis of bacterial meningitis? a. Arrange for humidified oxygen per mask b. Place the child in respiratory isolation c. Inquire about drug allergy d. Hold NPO until orders arrive

B

The nurse explains that the two divisions of the autonomic nervous system work to maintain homeostasis. Place in order the autonomic events. (Separate letters by a comma and space as follows: A, B, C, D) a. Parasympathetic nervous system dominates b. Extremely stressful or frightening event c. Blood pressure, heart rate, and adrenaline output decrease d. Sympathetic nervous system dominates e. Heart rate and blood pressure rise, secretion of adrenaline

B D E A C

What are the effects of normal aging on the nervous system? (Select all that apply.) a. Small vessel occlusion b. Loss of neurons c. Calcification of cerebrum d. Reduction of cerebral blood flow e. Lipofuscin f. Decrease in oxygen use B D E F

B D E F

Medications used to inhibit the effects of the natural neurotransmitter acetylcholine secreted by cholinergic fibers are called?

anticholinergic agents

The nurse understands a possible effect of administering beta blockers to the pt in the scenario with a known respiratory disease such as asthma is ?

bronchoconstriction

Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition?

Closed angle glaucoma

A patient with chronic obstructive pulmonary disease (COPD) reports having insomnia and a racing heart after starting terbutaline therapy. Which explanation by the nurse is most accurate?

"The symptoms will tend to resolve with continued therapy."

A patient with Parkinson's disease asks the nurse why anticholinergics are used in the treatment. Which response by the nurse is most accurate?

"These drugs inhibit the action of acetylcholine."

The major types of receptors found in the autonomic nervous system include?

1. alpha 2. beta 3. dopaminergic

Which are nursing considerations for patients on apomorphine (apokyn) therapy?

1. assess pt's on apomorphine therapy for orthostatic hypotension 2. do not administer apomorphine intravenously 3. asses pt's receiving apomorphine therapy for sudden sleep attacks

Which category of medications is used for peripheral vascular diseases characterized by excessive vasoconstriction, such as Raynaud's disease?

Alpha adrenergic blocking agents

Which disorder(s) would indicate the use of anticholinergic agents?

Bradycardia Parkinson's disease Preparation for surgery

The symptom of parkinson's disease manifested as extremely slow body movements that may eventually progress to a total lack of movement is known as ?

Bradykinesia

How would the nurse instruct a patient with Parkinson disease to improve activity level? a. To use a soft mattress to relax the spine b. To walk with a shuffling gait to avoid tripping c. To walk with hands clasped behind back to help balance d. To sit in hard chair with arms for posture control

C

What is the nurse aware of when assessing a person with a craniocerebral injury? a. Most injuries of this type are irreversible b. Open injuries are always more serious than closed injuries c. Signs and symptoms may not occur until several days after the trauma d. Trauma to the frontal lobe is more significant than to any other area

C

What is the purpose of a "drug holiday" in the treatment of Parkinson's disease? a. Change all drugs b. Allow the natural dopamine levels to rise c. Restart drugs at a lower dosage with favorable results d. Reduce the extrapyramidal symptoms

C

A family member of a patient who has just suffered a tonic-clonic seizure is concerned about the patient's deep sleep. What is this behavior called? a. Convalescent period b. Neural recovery period c. Sombulant period d. Postictal period

D

What does the nurse know about the stroke patient who has expressive aphasia? a. Has difficulty comprehending spoken and written communication b. Cannot make any vocal sounds c. Has total loss and comprehension of language d. Can understand the spoken word, but cannot speak

D

What is the cardinal sign of increased intracranial pressure in a brain injured patient? a. Pupil changes b. Ipsilateral paralysis c. Vomiting d. Decrease in the level of consciousness

D

What is the cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and also carries motor fibers to glands that produce digestive juices and other secretions? a. Somatic motor nerve b. Visceral sensory nerve c. Abducens nerve d. Vagus nerve

D

What is the nurse assessing when asking the patient, "Who is the president of the United States?" during a level of consciousness assessment? a. Orientation b. Memory c. Calculation d. Fund of knowledge

D

Which symptom is specific to migraine headaches? a. Tachycardia b. They become worse in the evening c. They involve the entire head d. They are preceded by an aura

D

Which medication used in treating pt's with Parkinson's disease reduces the destruction of dopamine in the peripheral tissues, allowing significantly more dopamine to reach the brain to eliminate the symptoms of parkinsonism?

Entacapone (Comtan)

Adrenergic fibers are those nerve endings that secrete neurotransmitter?

Norepinephrine

A patient is using rasagiline for early-onset Parkinson disease. The patient should be counseled to avoid certain foods while using this medicine. These foods include: (Select ALL that apply.) Answer A Aged cheeses B Dairy products like milk and yogurt C Air-dried or cured meats D Some red wines and some beers E Grass-fed beef and pork

A, C and D Rasagaline is a MAO-B inhibitor. Hypertensive crisis (a dangerous rise in blood pressure) could occur if rasagiline is combined with foods that are high in tyramine. Foods can become high in tyramine when they have been aged, fermented, pickled or smoked. Next

Which question is likely to elicit the most valid response from the patient who is being interviewed about a neurologic problem? a. "Do you have any sensations of pins and needles in your feet?" b. "Does the pain radiate from your back into your legs?" c. "Can you describe the sensations you are having?" d. "Do you ever have any nausea or dizziness?"

C

Why is the patient with suspected Guillain-Barre Syndrome (GBS) hospitalized immediately? a. The infection needs to be treated with IV antibiotics to prevent paralysis b. The brain may swell quickly causing seizures c. The disease can rapidly progress into respiratory failure d. IV hydration is needed to prevent possible fatal hypotension

C

Which of the following techniques are necessary for safely feeding a hemiplegic patient? (Select all that apply.) a. Mixing liquids and solid foods together b. Taking the patient's dentures out to prevent choking c. Checking the affected side of mouth for food accumulation d. Offering small bites of food e. Elevating the patient to no more than 30 degrees f. Adding a thickening agent to liquids

C D F

The nurse is aware that the drug t-PA (Activase), a tissue plasminogen activator, must be given in____hours of the onset of symptoms to have maximum benefit. a. 3 hours b. 4 hours c. 6 hours d. 8 hours

A

The nurse is caring for a home health patient who had a spinal cord injury at C5 three years ago. The nurse bases the plan of care on the knowledge that the patient will be able to: a. feed self with setup and adaptive equipment. b. transfer self to wheelchair. c. stand erect with full leg braces. d. sit with good balance.

A

A patient has recently suffered a stroke with left-sided weakness and has problems with choking, especially when drinking thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely? a. Use a straw b. Tuck chin when swallowing c. Take a sip of liquid with each bite d. Turn head to the left

B

A patient is in which stage of Alzheimer's disease when she demonstrates "sundowning"? a. Early stage b. Second stage c. Third stage d. Final stage

B

The nurse is caring for a patient taking a cholinergic agent. When auscultating lung sounds, the nurse notes inspiratory and expiratory wheezing bilaterally. The best action for the nurse to take would be to:

withhold the next dose and notify the physician.