ATI Neuro/Musculoskeletal

Question 1

Gullian Barre

Answer 1

Greatest risk is adventitious breath sounds- sign of respiratory failure

Expected findings, not priority: altered sensory perception, loss of bowel and bladder control, weak or incomplete eye closure.

Question 2

Increased ICP

Answer 2

restlessness, irritability, hypertension, widening pulse pressure

Question 3

Stimulate micturation in spastic bladder

Answer 3

stroking the inner thigh

Question 4

Acute angle closure glaucoma med

Answer 4

IV osmotic diuretics, emergency treatment to rapidly reduce intraocular pressure

Question 5

Myasthenic crisis- increasing muscle weakness

Answer 5

administer tensilon test- this will determine if its a myasthenic or cholinergic crisis.

not priority- instill artificial tears for dry eye, administer immunosupressants and prep for plasmapeheresis to reduce symptoms

Question 6

MS characterized by

Answer 6

remissions and exacerbations, unpredictable

Question 7

Gullian Barre

Answer 7

respiratory failure, ascending paralysis

Question 8

Amytrophic lateral sclerosis

Answer 8

respiratory failure, gradual loss of cognitive function
make sure to monitor pulse ox- greatest risk is resp compromise because progressive paralysis

not priority- bowel training, pain meds, adequate oral intake

Question 9

Seizures

Answer 9

est IV access
dont need bed rest, dont put anything in mouth, dont need to assess for spike in BP, doesnt correlate with incidence of seizure

Question 10

Carbidopa/Levidopa (SINEMET)

Answer 10

dont take with high protein food- delays absorption or reduce amount absorbed

• may feel lightheaded- orthostatic hypot
• urine, saliva, sweat will be darker
• weeks or months for symptom relief

Question 11

Alzheimers drugs

Answer 11

may help delay cognitive changes. they enhance the availability of acetylcholine allowing for greater response from cholinergic neurons in the brain

Question 12

phenytoin (Dilantin) for epilepsy

Answer 12

take med at same time each day to maintain therapeutic blood levels.
tell dr if you get rash.
still take med even in absence of seizures.
maintain good oral hygiene.

Question 13

Right sided homonymous hemianoposia

Answer 13

loss of vision in right visual field of both eyes, may not be able to see half of meal tray- tell them to consciously look at both sides of meal tray.

Question 14

total hip

Answer 14

use abductor pillow between clients legs if client becomes restless. pt should not adduct hips due to risk of dislocation. pillow will help hips remain in abduction.
dont flex hip more than 90 degrees.
wear thromboembolic hose.

Question 15

Right hemispheric stroke

Answer 15

impulsive behavior, poor judgement, lack of awareness of neurological deficits. left sided deficits.

Question 16

left hemispheric stroke

Answer 16

aphasia, right sided neglect, inability to read

Question 17

alendronate (Fosamax)

Answer 17

take before breakfast in upright position for 30 minutes.this prevents esophagitis or esophageal ulcers. Biphosphonates are structural analogs of normal bone constituents, they are incorporated into the bone tissue to prevent bone resorption- may decrease serum calcium level.

Question 18

Embolic cerebrovascular accident

Answer 18

tissue plasminogen activator (Alteplase)

Question 19

closed head injury on vent

Answer 19

maintain paco2 of approximately 35 mmhg to prevent hypercarbia. vasodilation effects of carbon dioxide can lead to increase in ICP

Question 20

pt in skeletal traction complains of muscle spasms

Answer 20

check position of weights and ropes- ensure weights are hanging freely- first action.

not first actions- reposition, notify pcp, muscle relaxant

Question 21

after LP

Answer 21

ensure pt lays flat for 4-8 hours to prevent csf leakage from the puncture.
increase fluid intake to 3000 mL to facilitate csf production.
dont need pressure dressing.
shouldnt need pain med.

Question 22

Detached retina

Answer 22

floating dark spots, flashes of bright light, usually painless

Question 23

Cataract surgery- after

Answer 23

call dr if experience decreased vision.
dont take aspirin following surgery.
avoid activities that require bending over- can increase intraocular pressure.
dont need to sleep upright for 24 hours.

Question 24

Rheumatoid arthritis

Answer 24

bilateral and symmetrical, ulnar deviation & deviation of fingers- inflammation in small joints makes them susceptible to deformity from daily use (opening jars etc).
Increased sedimentation rate r.t bodys response to inflammatory connective tissue disorder.
warm red joints.

Question 25

Osteoarthritis

Answer 25

unilateral joint involvement, deformity of the spine

Crepitus with joint movement, decreased ROM of affected joint, joint pain that resolves with rest, larger joints- hips and knees.

Question 26

Phantom limb pain

Answer 26

treat as real pain- gabapentin (Neurontin)

Question 27

postop craniotomy

Answer 27

elevate HOB 30 degrees- keeps head in neutral position and promotes venous drainage. greatest risk is increased ICP.

not highest priority- administer corticosteroids, obtain ABGs, assess head drsg

Question 28

Menieres disease, how to decrease symptoms

Answer 28

move head slowly to decrease vertigo

Question 29

Quadriplegic, cervical fracture c5, reports throbbing, headache, nausea, facial flushing, increased BP

Answer 29

Elevate HOB- takes advantage of postural hypotension experienced by quadriplegic.

These findings are usually due to noxious stimul from lower parts of the body such as fecal impaction or distended bladder.