PrepU 69
trigeminal neuralgia
A 45-year-old client is admitted to the facility with excruciating paroxysmal facial pain. He reports that the episodes occur most often after feeling cold drafts and drinking cold beverages. Based on these findings, the nurse determines that the client is most likely suffering from which neurologic disorder?
Initiate isolation precautions.
A client has been brought to the ED with altered LOC, high fever, and a purpura rash on the lower extremities. The family states the client was reporting neck stiffness earlier in the day. What action should the nurse do first?
Initiate seizure precautions.
A client has been diagnosed with a frontal lobe brain abscess. Which nursing intervention is appropriate?
Facial (VII)
Bell palsy is a disorder of which cranial nerve?
myoclonus.
Creutzfeldt-Jakob disease causes severe dementia and
Administer atropine to control the side effects of edrophonium.
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?
antimicrobial chemoprophylaxis, ideally within 24 hours after exposure.
People in close contact with clients who have meningococcal meningitis should be treated with
80% of cases of meningitis in adults.
The bacteria Streptococcus pneumoniae and Neisseria meningitides are responsible for
Magnetic resonance imaging
The diagnosis of multiple sclerosis is based on which test?
mosquito
The primary arthropod vector in North America that transmits encephalitis is the
20/20 vision
Vagus nerve demyelinization, which may occur in Guillain-Barré syndrome, would not be manifested by which of the following?
Pain Fatigue Spasticity Depression Numbness
Which are the most commonly reported clinical manifestations of multiple sclerosis? Select all that apply.
Controlling seizures and increased intracranial pressure
Which is the primary medical management of arthropod-borne virus (arboviral) encephalitis?
Mosquitoes
Which is the primary vector of arthropod-borne viral encephalitis in North America?
Trigeminal neuralgia (tic douloureux)
a disorder of the trigeminal nerve, causes facial pain.
Guillain-Barré Syndrome (GBS) (Numbness/Weakness DDX)
a disorder of the vagus nerve.
Parkinson disease
associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain.
Bell's Palsy
characterized by facial dysfunction, weakness, and paralysis.
A client in myasthenic crisis
has severe muscle weakness, including the muscles needed to support respiratory effort. Myasthenic crisis can lead to respiratory failure and death if not recognized early. Administering IVIG, preparing for plasmapheresis, and ensuring adequate nutritional support are important and appropriate interventions, but maintaining adequate respiratory status or support is the priority during the crisis.
occipital headache, ataxia, and nystagmus.
Indicators of a cerebellar abscess include
"There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive."
The parents of a client intubated due to the progression of Guillain-Barré syndrome ask whether their child will die. What is the best response by the nurse?
Providing supportive care
Which is a component of the nursing management of the client with new variant Creutzfeldt-Jakob disease (vCJD)?
Reduced muscle spasticity
A client has an exacerbation of multiple sclerosis. The physician orders dantrolene (Dantrium), 25 mg P.O. daily. Which assessment finding indicates the medication is effective?
Treatment with antimicrobial prophylaxis as soon as possible
A client is diagnosed with meningococcal meningitis. The 22-year-old client shares an apartment with one other person. What would the nurse expect as appropriate care for the client's roommate?
Administer prescribed antibiotics.
A client is suspected to have bacterial meningitis. What is the priority nursing intervention?
multiple sclerosis
Which of the following is considered a central nervous system (CNS) disorder?
"Have you experienced any viral infections in the last month?"
The nurse is taking health history from a client admitted to rule out Guillain-Barre syndrome. An important question to ask related to the diagnosis is which of the following?
"The client may be experiencing a change in affect due to the brain injury."
The nurse is talking with the mother of a client who is diagnosed with a traumatic brain injury. The mother states that she has never seen the client lash out when frustrated or throw things across the room. Which instruction, made by the nurse, is most correct?
Alternatively patch one eye every 2 hours.
A client who recently experienced a stroke tells the nurse that he has double vision. Which nursing intervention is most appropriate?
Creutzfeldt-Jakob disease
Which condition is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain?
A positive Kerning sign
occurs when the client is lying with the thigh flexed on the abdomen and the leg cannot be completely extended.
"The paralysis caused by this disease is temporary."
A client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond?
bacteria
The nurse is caring for a client admitted with a diagnosis of septic meningitis. The nurse is aware that this infection is caused by which of the following?
Ensure atropine is readily available
The nurse is preparing the client for an acetylcholinesterase inhibitor test to rule out myasthenia gravis. Which is the priority nursing action?
Accept the patient's behavior and do not take it personally.
A client has a neurological defect and will be transferred to a nursing home because family members are unable to care for the client at home. While receiving a bed bath, the client yells at the nurse, "You don't know what you are doing!" What is the best reaction by the nurse?
Streptococcus pneumoniae
A client has meningitis and cultures are being done to determine the cause. Which of the following is most likely to be identified as the causative factor?
Placement of a feeding tube
A client in a long-term nursing facility has severe dysphagia. Which of the following would best assist this client in preventing further complications?
Prevention of joint contractures
During the acute phase of a debilitating cerebrovascular accident, which nursing intervention is most helpful in promoting the rehabilitation of the client?
Speeds nerve impulse transmission
Guillain-Barré syndrome is an autoimmune attack on the peripheral myelin sheath. Which of the following is an action of myelin?
peripheral nervous system disorders.
Guillain-Barré, myasthenia gravis, and Bell's palsy are peripheral nervous system disorders.
CNS
Multiple sclerosis is an immune-mediated, progressive demyelinating disease of the
myasthenia gravis (MG)
Ptosis and diplopia are associated with
Multiple sclerosis
Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of small patches of demyelination in the brain and spinal cord?
Ménière syndrome
a disorder of the vestibulocochlear nerve.
Neurovascular system
A client is brought to the emergency department in a confused state, with slurred speech, characteristics of a headache, and right facial droop. The vital signs reveal a blood pressure of 170/88 mm Hg, pulse of 92 beats/minute, and respirations at 24 breaths/minute. On which bodily system does the nurse focus the nursing assessment?
Help the client perform range-of-motion (ROM) exercises every 8 hours.
A client is experiencing muscle weakness and an ataxic gait. The client has a diagnosis of multiple sclerosis (MS). Based on these symptoms, the nurse formulates "Impaired physical mobility" as one of the nursing diagnoses applicable to the client. What nursing intervention should be most appropriate to address the nursing diagnosis?
Edrophonium (Tensilon)
A client is undergoing testing to confirm a diagnosis of myasthenia gravis. The nurse explains that a diagnosis is made if muscle function improves after the client receives an IV injection of a medication. What is the medication the nurse tells the client he'll receive during this test?
vegitables
A client with a neurologic impairment reports having problems with constipation. Which foods might the nurse recommend?
Neurontin
A patient diagnosed with multiple sclerosis (MS) has ataxia. Which of the following medications could be used to treat this clinical manifestation?
MS info
Fatigue affects 87% of people with MS, and 40% of that group indicate that fatigue is the most disabling symptom. Pain, spasticity, and ataxia are other clinical manifestations of MS, but are not the most disabling.
Multiple Sclerosis (MS)
Fatigue and depression are associated with
controlling seizures and increased intracranial pressure.
Medical management of arthropod-borne virus (arboviral) encephalitis is aimed at
Acetylcholine
Myasthenia gravis occurs when antibodies attack which receptor sites?
overmedication
The most common cause of cholinergic crisis includes which of the following?
"I will stretch daily as directed by the physical therapist."
The nurse has been educating a client newly diagnosed with MS. Which statement by the client indicates an understanding of the education?
Apply warm packs to the affected area.
The nurse is advising a client with multiple sclerosis on methods to minimize spasticity and contractures. Which of the following techniques would the nurse instruct the client to perform?
Diplopia and ptosis
The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe?
Approximately 60% to 75% of clients recover completely.
The nurse is caring for a client diagnosed with Guillain-Barre syndrome. His spouse asks about recovery rates. The nurse can correctly relate which of the following?
"Grief is a normal process. Let's discuss offering support throughout the process."
The nurse is caring for a client with tetraplegia following a motor vehicle accident. A family member of the client states, "I know there is grief associated with the loss of independence, but how do I help my loved one to move past that?" The nurse is most helpful to say which of the following?
The client will remain free of injury if a seizure does occur.
Which client goal, established by the nurse, is most important as the nurse plans care for a seizure client in the home setting?
Providing palliative care
Which is a component of the nursing management of the client with variant Creutzfeldt-Jakob disease (vCJD)?
fatigue
Which is often the most disabling clinical manifestation of multiple sclerosis?
Assessing respiratory effort
Which nursing intervention is the priority for a client in myasthenic crisis?
Pyridostigmine bromide (Mestinon)
Which of the following is the first-line therapy for myasthenia gravis (MG)?
Use ophthalmic lubricant and protect the eye.
Which of the following teaching points is a priority in the management of symptoms for a client with Bell's palsy?
Positive Brudzinski sign
Which well-recognized sign of meningitis is exhibited when the client's neck is flexed and flexion of the knees and hips is produced?
Multiple sclerosis.
chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of small patches of demyelination in the brain and spinal cord.
Huntington disease
chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia.
Tic douloureux (trigeminal neuralgia)
is manifested by pain in the areas of the fifth (trigeminal) cranial nerve.
Nuchal rigidity
is neck stiffness.
photophobia
is sensitivity to light.
Dantrolene
reduces muscle spasticity. It doesn't increase the ability to sleep or relieve constipation or pain.
myoclonus
the sudden, involuntary jerking of a muscle or group of muscles (TWITCHING)
Gag reflex and bowel sounds
A client with Guillain-Barre syndrome cannot swallow and has a paralytic ileus; the nurse is administering parenteral nutrition intravenously. The nurse is careful to assess which of the following related to intake of nutrients?
may be controlled by the administration of diphenhydramine and acetaminophen approximately 30 minutes before administration of the amphotericin.
A client with fungal encephalitis receiving amphotericin B reports fever, chills, and body aches. The nurse knows that these symptoms
Within 24 hours after exposure
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?
Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone.
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?
Take small meals of soft consistency
The nurse is caring for a client with trigeminal neuralgia (tic douloureux). The care plan for this client reflects the client's problem eating due to jaw pain. To assist the client in meeting the adequate nutritional needs, what should the nurse suggest?
"I was brushing my teeth."
The nurse is caring for a patient in the emergency department with an onset of pain related to trigeminal neuralgia. What subjective data stated by the patient does the nurse determine triggered the paroxysms of pain?
The client grasps the affected arm at the wrist and raises it.
The nurse is evaluating the progression of a client in the home setting. Which activity of the hemiplegic client best indicates that the client is assuming independence?
Headache that is worse in the morning
The nurse is performing an initial assessment on a client admitted with a possible brain abscess. Which of the following would the nurse most likely find?
Facial distortion and pain
The nurse is performing an initial assessment on a client with suspected Bell's palsy. Which of the following findings would the nurse be most focused on related to this medical diagnosis?
Guillain-Barre Syndrome (GBS)
Hyporeflexia and weakness of the lower extremities are associated with
Ptosis and diplopia
The nurse is performing an initial assessment on a client who is admitted to rule out myasthenia gravis. Which of the following findings would the nurse expect to observe?
Headache and nuchal rigidity
The nurse is assessing a client with meningitis. Which of the following signs would the nurse expect to observe?
complications
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:
Facial pain in the areas of the fifth cranial nerve
While performing an initial nursing assessment on a client admitted with suspected tic douloureux (trigeminal neuralgia), for which of the following would the nurse expect to observe?
Positive Kernig's sign
The nurse is assessing a newly admitted client with a diagnosis of meningitis. On assessment, the nurse expects to find which of the following?
Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes.
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?
Ensure atropine is readily available.
The nurse is preparing the client for an acetylcholinesterase inhibitor test to rule out myasthenia gravis. Which is the priority nursing action?
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.
Positive Brudzinski's sign
A nurse is assessing a newly admitted client with meningitis. Which of the following findings in this client is most likely?
Cerebellar abscess
A nurse is assisting with a neurological examination of a client who reports a headache in the occipital area and shows signs of ataxia and nystagmus. Which of the following conditions is the most likely reason for the client's problems?
Nuchal rigidity Positive Kernig's sign Positive Brudzinski's sign Photophobia
A patient diagnosed with meningitis would be expected to exhibit which of the following clinical manifestations? Select all that apply.
Elevated protein levels in the CSF
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?
Ataxia is a chronic problem
most resistant to treatment. Medications used to treat ataxia include beta-adrenergic blockers (Inderal), antiseizure agents (Neurontin), and benzodiazepines (Klonopin). Baclofen, Dantrium, and Valium are used in the treatment of spasticity.
Increased pulse rate, adventitious breath sounds
The nurse is caring for a client with Guillain-Barré syndrome. Which assessment finding would indicate the need for oral suctioning?