Med Surg - Exam 3 - Ch 59 (Chronic Neurologic Problems)

Question 1

A 50-year-old man complains of recurring headaches. He describes these as sharp, stabbing, and located around his left eye. He also resports that his left eye seems to swell and get teary when these headaches occur. Based on this history, you suspect that he has

a. cluster headaches.
b. tension headaches.
c. migraine headaches.
d. medication overuse headaches.

Answer 1

a. cluster headaches.

Cluster headaches involve repeated headaches that can occur for weeks to months, followed by periods of remission. The pain of cluster headache is sharp and stabbing; the intense pain lasts a few minutes to 3 hours. Cluster headaches can occur every other day and as often as eight times a day. The clusters occur with regularity, usually occurring at the same time each day and during the same seasons of the year. Typically, a cluster lasts 2 weeks to 3 months, and the patient then goes into remission for months to years. The pain usually is located around the eye and radiates to the temple, forehead, cheek, nose, or gums. Other manifestations may include swelling around the eye, lacrimation (tearing), facial flushing or pallor, nasal congestion, and constriction of the pupil. During the headache, the patient is often agitated and restless, unable to sit still or relax.

Question 2

A 65-year-old woman was just diagnosed with Parkinson’s disease. The priority nursing intervention is

a. searching the Internet for educational videos.
b. evaluating the home for environmental safety.
c. promoting physical exercise and a well-balanced diet.
d. designing an exercise program to strengthen and stretch specific muscles.

Answer 2

c. promoting physical exercise and a well-balanced diet.

Promotion of physical exercise and a well-balanced diet are major concerns of nursing care for patients with Parkinson’s disease.

Question 3

The nurse finds that an 87-year-old woman with Alzheimer’s disease is continually rubbing, flexing, and kicking out her legs throughout the day. The night shift reports that this same behavior escalates at night, preventing her from obtaining her required sleep. The next step the nurse should take is to

a. ask the physician for a daytime sedative for the patient.
b. request soft restraints to prevent her from falling out of bed.
c. ask the physician for a nighttime sleep medication for the patient.
d. assess the patient more closely, suspecting a disorder such as restless legs syndrome.

Answer 3

d. assess the patient more closely, suspecting a disorder such as restless legs syndrome.

The severity of sensory symptoms of restless legs syndrome (RLS) ranges from infrequent, minor discomfort (paresthesias, including numbness, tingling, and “pins and needles” sensation) to severe pain. The discomfort occurs when the patient is sedentary and is most common in the evening or at night. The pain at night can disrupt sleep and is often relieved by physical activity, such as walking, stretching, rocking, or kicking. In the most severe cases, patients sleep only a few hours at night, which results in daytime fatigue and disruption of the daily routine. The motor abnormalities associated with RLS consist of voluntary restlessness and stereotyped, periodic, involuntary movements. The involuntary movements usually occur during sleep. Symptoms are aggravated by fatigue.

Question 4

Social effects of a chronic neurologic disease include (select all that apply)

a. divorce.
b. job loss.
c. depression.
d. role changes.
e. loss of self-esteem.

Answer 4

All of the above.

Social problems related to chronic neurologic disease may include changes in roles and relationships (e.g., divorce, job loss, role changes); other psychologic problems (e.g., depression, loss of self-esteem) also may have social effects.

Question 5

The nurse is reinforcing teaching with a newly diagnosed patient with amyotrophic lateral sclerosis. Which statement would be appropriate to include in the teaching?

a. “ALS results from an excess chemical in the brain, and the symptoms can be controlled with medication.”
b. “Even though the symptoms you are experiencing are severe, most people recover with treatment.”
c. “You need to consider advance directives now, since you will lose cognitive function as the disease progresses.”
d. “This is a progressing disease that eventually results in a permanent paralysis, though you will not lose any cognitive function.”

Answer 5

d. “This is a progressing disease that eventually results in a permanent paralysis, though you will not lose any cognitive function.”

The disease results in destruction of the motor neurons in the brainstem and spinal cord, causing gradual paralysis. Cognitive function is maintained. Because there is no cure for amyotrophic lateral sclerosis (ALS), collaborative care is palliative and based on symptom relief. Death usually occurs within 3-6 years after diagnosis.

Question 6

A patient has been receiving scheduled doses of phenytoin (Dilantin) and begins to experience diplopia. The nurse immediately assesses the patient for

a. an aura or focal seizure.
b. nystagmus or confusion.
c. abdominal pain or cramping.
d. irregular pulse or palpitations.

Answer 6

b. nystagmus or confusion.

Diplopia is a sign of phenytoin toxicity. The nurse should assess for other signs of toxicity, which include neurologic changes, such as nystagmus, ataxia, confusion, dizziness, or slurred speech. An aura, focal seizure, abdominal pain or cramping, irregular pulse, or palpitations are not associated with phenytoin toxicity.

Question 7

Which characteristic of a patient’s recent seizure is consistent with a focal seizure?

a. The patient lost consciousness during the seizure.
b. The seizure involved lip smacking and repetitive movements.
c. The patient fell to the ground and became stiff for 20 seconds.
d. The etiology of the seizure involved both sides of the patient’s brain.

Answer 7

b. The seizure involved lip smacking and repetitive movements.

The most common complex focal seizure involves lip smacking and automatisms (repetitive movements that may not be appropriate). Loss of consciousness, bilateral brain involvement, and a tonic phase are associated with generalized seizure activity.

Question 8

Which measure should the nurse prioritize when providing care for a patient with a diagnosis of multiple sclerosis (MS)?

a. Vigilant infection control and adherence to standard precautions
b. Careful monitoring of neurologic assessment and frequent reorientation
c. Maintenance of a calorie count and hourly assessment of intake and output
d. Assessment of blood pressure and monitoring for signs of orthostatic hypotension

Answer 8

a. Vigilant infection control and adherence to standard precautions

Infection control is a priority in the care of patients with MS, since infection is the most common cause of an exacerbation of the disease. Decreases in cognitive function are less likely, and MS does not typically result in malnutrition, hypotension, or fluid volume excess or deficit.

Question 9

A male patient with a diagnosis of Parkinson’s disease (PD) has been admitted recently to a long-term care facility. Which action should the health care team take in order to promote adequate nutrition for this patient?

a. Provide multivitamins with each meal.
b. Provide a diet that is 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 a minced or pureed diet that is high in potassium and low in sodium.

Answer 9

c. Provide small, frequent meals throughout the day that are easy to chew and swallow.

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 vitamin intake, along with protein intake, must be monitored to prevent contraindications with medications. It is likely premature to introduce a minced or pureed diet, and a low carbohydrate diet is not indicated.

Question 10

Which nursing diagnosis is likely to be a priority in the care of a patient with myasthenia gravis (MG)?

a. Acute confusion
b. Bowel incontinence
c. Activity intolerance
d. Disturbed sleep pattern

Answer 10

c. Activity intolerance

The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG, and although sleep disturbance is likely, activity intolerance is usually of primary concern.

Question 11

A female patient complains of a throbbing headache. When her history is obtained, the nurse discovers that the patient has had this type of headache before and experienced photophobia before the headache occurred. The nurse should know that what is probably the cause of this patient’s headache?

a. Polycythemia vera
b. A cluster headache
c. A migraine headache
d. A hemorrhagic stroke

Answer 11

c. A migraine headache

Although a headache may occur with any of these options, a migraine headache is the only one that has a throbbing headache with an aura (the photophobia). Headache from polycythemia vera is from erythrocytosis. The cluster headache pain is sharp and stabbing, and the headache with a hemorrhagic stroke has a sudden onset and is not recurrent.

Question 12

The patient with type 1 diabetes mellitus with hypoglycemia is having a seizure. Which medication should the nurse anticipate administering to stop the seizure?

a. IV dextrose solution
b. IV diazepam (Valium)
c. IV phenytoin (Dilantin)
d. Oral carbamazepine (Tegretol)

Answer 12

a. IV dextrose solution

This patient’s seizure is caused by low blood glucose, so IV dextrose solution should be given first to stop the seizure. IV diazepam, IV phenytoin, and oral carbamazepine would be used to treat seizures from other causes such as head trauma, drugs, and infections.

Question 13

A 50-year-old male patient has been diagnosed with amyotrophic lateral sclerosis (ALS). What nursing intervention is most important to help prevent a common cause of death for patients with ALS?

a. Reduce fat intake.
b. Reduce the risk of aspiration.
c. Decrease injury related to falls.
d. Decrease pain secondary to muscle weakness.

Answer 13

b. Reduce the risk of aspiration.

Reducing the risk of aspiration can help prevent respiratory infections that are a common cause of death from deteriorating muscle function. Reducing fat intake may reduce cardiovascular disease, but this is not a common cause of death for patients with ALS. Decreasing injury related to falls and decreasing pain secondary to muscle weakness are important nursing interventions for patients with ALS but are unrelated to causes of death for these patients.

Question 14

When establishing a diagnosis of MS, the nurse should teach the patient about what diagnostic studies (select all that apply)?

a. EEG
b. CT scan
c. Carotid duplex scan
d. Evoked response testing
e. Cerebrospinal fluid analysis

Answer 14

b. CT scan
d. Evoked response testing
e. Cerebrospinal fluid analysis

There is no definitive diagnostic test for MS. CT scan, evoked response testing, cerebrospinal fluid analysis, and MRI along with history and physical examination are used to establish a diagnosis for MS. EEG and carotid duplex scan are not used for diagnosing MS.

Question 15

A 48-year-old man was just diagnosed with Huntington’s disease. His 20-year-old son is upset about his father’s diagnosis. How can the nurse best help this young man?

a. Provide emotional and psychologic support.
b. Encourage him to get diagnostic genetic testing done.
c. Tell him the cognitive deterioration will be treated with counseling.
d. Tell him the chorea and psychiatric disorders can be treated with haloperidol (Haldol).

Answer 15

a. Provide emotional and psychologic support.

The patient’s son will first need emotional and psychologic support. He should be taught about diagnostic genetic testing for himself but should decide for himself with a genetic counselor if and when he wants this done. The treatment plan for his father will be determined depending on his father’s needs.

Question 16

Which type of headache is suspected when the headaches are unilateral and throbbing, preceded by a prodrome of photophobia, and associated with a family history of this type of headache?

a. Cluster
b. Migraine
c. Frontal-type
d. Tension-type

Answer 16

b. Migraine

Migraine headaches are frequently unilateral and usually throbbing. They may be preceded by a prodrome and frequently there is a family history. Cluster headaches are also unilateral with severe bone-crushing pain but there is no prodrome or family history. Frontal-type headache is not a functional type of headache. Tension-type headache are bilateral with constant, squeezing tightness without prodrome or family history.

Question 17

A patient is diagnosed with cluster headaches. The nurse knows that which characteristics are associated with this type of headache (select all that apply)?

a. Family history
b. Alcohol is the only dietary trigger
c. Abrupt onset lasting 5 to 180 minutes
d. Severe, sharp, penetrating head pain
e. Bilateral pressure or tightness sensation
f. May be accompanied by unilateral ptosis or lacrimation

Answer 17

b. Alcohol is the only dietary trigger
c. Abrupt onset lasting 5 to 180 minutes
d. Severe, sharp, penetrating head pain
f. May be accompanied by unilateral ptosis or lacrimation

Cluster headaches have only alcohol as a dietary trigger and have an abrupt onset lasting 5 minutes to 3 hours with severe, sharp, penetrating pain. Cluster headaches may be accompanied by unilateral ptosis, lacrimation, rhinitis, facial flushing or pallor and commonly recur several times each day for several weeks, with months or years between clustered attacks. Family history and nausea, vomiting, or irritability may be seen with migraine headaches. Bilateral pressure occurring between migraine headaches and intermittent occurrence over long periods of time are characteristics of tension-type headaches.

Question 18

What is the most important method of diagnosing functional headaches?

a. CT scan
b. Electromyography (EMG)
c. Cerebral blood flow studies
d. Thorough history of the headache

Answer 18

d. Thorough history of the headache

The primary way to diagnose and differentiate between headaches is with a careful history of the headaches, requiring assessment of specific details related to the headache. Electromyelography (EMG) may reveal contraction of the neck, scalp, or facial muscles in tension-type headaches but this is not seen in all patients. CT scans and cerebral angiography are used to rule out organic causes of the headaches.

Question 19

What drug therapy is included for acute migraine and cluster headaches that appears to alter the pathophysiologic process for these headaches?

a. B-Adrenergic blockers such as propanolol (Inderal)
b. Serotonin antagonists such as methysergide (Sansert)
c. Tricyclic antidepressants such as amitriptyline (Elavil)
d. Specific serotonin receptor agonists such as sumatriptan (Imitrex)

Answer 19

d. Specific serotonin receptor agonists such as sumatriptan (Imitrex)

Triptans (sumatriptan [Imitrex]) affect selected serotonin receptors that decrease neurogenic inflammation of the cerebral blood vessels and produce vasoconstriction. Both migraine headaches and cluster headaches appear to be related to vasodilation are useful in treatment of migraine and cluster headaches. Methysergide blocks serotonin receptors in the central and peripheral nervous systems and is used for prevention of migraine and cluster headaches. B-adrenergic blockers and tricyclic antidepressants are used prophylactically for migraine headaches but are not effective for cluster headaches.

Question 20

What is a nursing intervention that is appropriate for the patient with a nursing diagnosis of anxiety related to lack of knowledge of the etiology and treatment of headache?

a. Help the patient to examine lifestyle patterns and precipitating factors.
b. Administer medications as ordered to relieve pain and promote relaxation.
c. Provide a quiet, dimly lit environment to reduce stimuli that increase muscle tension and anxiety.
d. Support the patient’s use of counseling or psychotherapy to enhance conflict resolution and stress reduction.

Answer 20

a. Help the patient to examine lifestyle patterns and precipitating factors.

When the anxiety is related to a lack of knowledge about the etiology and treatment of a headache, helping the patient to identify stressful lifestyle patterns and other precipitating factors and ways of avoiding them are appropriate nursing interventions for the anxiety. Interventions that teach alternative therapies to supplements drug therapy also give the patient some control over pain and are appropriate teaching regarding treatment of the headache. The other interventions may help to reduce anxiety generally but they do not address the etiologic factor of the anxiety.

Question 21

The nurse is preparing to admit a newly diagnosed patient experiencing tonic-clonic seizures. What could the nurse delegate to unlicensed assistive personnel (UAP)?

a. Complete the admission assessment.
b. Explain the call system to the patient.
c. Obtain the suction equipment from the supply cabinet.
d. Place a padded tongue blade on the wall above the patient’s bed.

Answer 21

c. Obtain the suction equipment from the supply cabinet.

The unlicensed assistive personnel (UAP) is able to obtain equipment from the supply cabinet or department. The RN may need to provide a list of necessary equipment and should set up the equipment and ensure proper functioning. The RN is responsible for the initial history and assessment as well as teaching the patient about the room’s call system. Padded tongue blades are no longer used and no effort should be made to place anything in the patient’s mouth during a seizure.

Question 22

How do generalized seizures differ from focal seizures?

a. Focal seizures are confined to one side of the brain and remain focal in nature.
b. Generalized seizures result in loss of consciousness whereas focal seizures do not.
c. Generalized seizures result in temporary residual deficits during the postictal phase.
d. Generalized seizures have bilateral synchronous epileptic discharges affecting the whole brain at onset of the seizure.

Answer 22

d. Generalized seizures have bilateral synchronous epileptic discharges affecting the whole brain at onset of the seizure.

Generalized seizures have bilateral synchronous epileptic discharge affecting the entire brain at onset of the seizure. Loss of consciousness is also characteristic but many focal seizures also include an altered consciousness. Focal seizures begin in one side of the brain but may spread to involve the entire brain. Focal seizures that start with a local focus and spread to the entire brain, causing a secondary generalized seizure, are associated with a transient residual neurologic deficit postictally known as Todd’s paralysis.

Question 23

Which type of seizure occurs in children, is also known as a petit mal seizure, and consists of a staring spell that lasts for a few seconds?

a. Atonic
b. Simple focal
c. Typical absence
d. Atypical absence

Answer 23

c. Typical absence

The typical absence seizure is also known as petit mal and the child has staring spells that last for a few seconds. Atonic seizures occur when the patient falls from loss of muscle tone accompanied by brief unconsciousness. Simple focal seizures have focal motor, sensory, or autonomic symptoms related to the area of the brain involved without loss of consciousness. Staring spells in atypical absence seizures last longer than those in typical absence seizures and are accompanied by peculiar behavior during the seizure or confusion after the seizure.

Question 24

The patient is diagnosed with complex focal seizures. Which characteristics are related to complex focal seizures (select all that apply)?

a. Formerly known as grand mal seizure
b. Often accompanied by incontinence or tongue or cheek biting
c. Psychomotor seizures with repetitive behaviors and lip smacking
d. Altered memory, sexual sensations, and distortions of visual or auditory sensations
e. Loss of consciousness and stiffening of the body with subsequent jerking of extremities
f. Often involves behavioral, emotional, and cognitive functions with altered consciousness

Answer 24

c. Psychomotor seizures with repetitive behaviors and lip smacking
d. Altered memory, sexual sensations, and distortions of visual or auditory sensations
f. Often involves behavioral, emotional, and cognitive functions with altered consciousness

Complex focal seizures are psychomotor seizures with automatisms such as lip smacking. They cause altered consciousness or loss of consciousness producing a dreamlike state and may involve behavioral, emotional, or cognitive experiences without memory of what was done during the seizure. In generalized tonic-clonic seizures (previously known as grand mal seizures) there is a loss of consciousness and stiffening of the body with subsequent jerking of extremities. Incontinence or tongue or cheek biting may also occur.

Question 25

Which type of seizure is most likely to cause death for the patient? a. Subclinical seizures b. Myoclonic seizures c. Psychogenic seizures d. Tonic-clonic status epilepticus

Answer 25

d. Tonic-clonic status epilepticus Tonic-clonic status epilepticus is most dangerous because the continuous seizing can cause respiratory insufficiency, hypoxemia, cardiac dysrhythmia, hyperthermia, and systemic acidosis, which can all be fatal. Subclinical seizures may occur in a patient who is sedated, so there is no physical movement. Myoclonic seizures may occur in clusters and have a sudden, excessive jerk of the body that may hurl the person to the ground. Psychogenic seizures are psychiatric in origin and diagnosed with video-electroencephalography (EEG) monitoring. They occur in patients with a history of emotional abuse or a specific traumatic episode.

Question 26

A patient admitted to the hospital following a generalized tonic-clonic seizure asks the nurse what caused the seizure. What is the best response by the nurse? a. "So many factors can cause epilepsy that it is impossible to say what caused your seizure." b. "Epilepsy is an inherited disorder. Does anyone else in your family have a seizure disorder?" c. "In seizures, some type of trigger causes sudden, abnormal bursts of electrical brain activity." d. "Scar tissue in the brain alters the chemical balance, creating uncontrolled electrical discharges."

Answer 26

c. "In seizures, some type of trigger causes sudden, abnormal bursts of electrical brain activity." A seizure is a paroxysmal, uncontrolled discharge of neurons in the brain, which interrupts normal function, but the factor that causes the abnormal firing is not clear. Seizures may be precipitated by many factors and although scar tissue may make the brain neurons more likely to fire, it is not the usual cause of seizures. Epilepsy is established only by a pattern of spontaneous, recurring seizures.

Question 27

A patient with a seizure disorder is being evaluated for surgical treatment of seizures. The nurse recognizes that what is one of the requirements for surgical treatment? a. Identification of scar tissue that is able to be removed b. An adequate trial of drug therapy that had unsatisfactory results c. Development of toxic syndromes from long-term use of antiseizure drugs d. The presence of symptoms of cerebral degeneration from repeated seizures

Answer 27

b. An adequate trial of drug therapy that had unsatisfactory results Most patients with seizures disorders maintain seizure control with medications but if surgery is considered, three requirements must be met: the diagnosis of epilepsy must be confirmed, there must have been an adequate trial with drug therapy without satisfactory results, and the electroclinical syndrome must be defined. The focal point must be localized but the presence of scar tissue is not required.

Question 28

The nurse teaches the patient taking antiseizure drugs that this method is most commonly used to measure compliance and measure for toxicity. a. A daily seizure log b. Urine testing for drug levels c. Blood testing for drug levels d. Monthly electroencephalography (EEG)

Answer 28

c. Blood testing for drug levels Serum levels of antiseizure drugs are monitored regularly to maintain therapeutic levels of the drug, above which patients are likely to experience toxic effects and below which seizures are likely to occur. Many newer drugs do not require drug level monitoring because of large therapeutic ranges. A daily seizure log and urine testing for drug levels will not measure compliance or monitor for toxicity. EEGs have limited value in diagnosis of seizures and even less value in monitoring seizure control.

Question 29

When teaching a patient with a seizure disorder about the medication regimen, what is it most important for the nurse to emphasize? a. The patient should increase the dosage of the medication if stress is increased. b. Most over-the-counter and prescription drugs are safe to take with antiseizure drugs. c. Stopping the medication abruptly may increase the intensity and frequency of seizures. d. If gingival hypertrophy occurs, the drug should be stopped and the health care provider notified.

Answer 29

c. Stopping the medication abruptly may increase the intensity and frequency of seizures. If antiseizure drugs are discontinued abruptly, seizures can be precipitated. Missed doses should be made up if the omission is remembered within 24 hours and patients should not adjust medications without professional guidance because this can also increase seizure frequency and may cause status epilepticus. Antiseizure drugs have numerous interactions with other drugs and the use of other medications should be evaluated by health professionals. If side effects occur, the physician should be notified and drug regimens evaluated.

Question 30

The nurse finds a patient in bed having a tonic-clonic seizure. During the seizure activity, what actions should the nurse take (select all that apply)? a. Loosen restrictive clothing. b. Turn the patient to the side. c. Protect the patient's head from injury. d. Place a padded tongue blade between the patient's teeth. e. Restrain the patient's extremities to prevent soft tissue and bone injury.

Answer 30

a. Loosen restrictive clothing. b. Turn the patient to the side. c. Protect the patient's head from injury. The focus is on maintaining a patent airway and preventing patient injury. The nurse should not place objects in the patient's mouth or restrain the patient.

Question 31

Following a generalized tonic-clonic seizure, the patient is tired and sleepy. What care should the nurse provide? a. Suction the patient before allowing him to rest. b. Allow the patient to sleep as long as he feels sleepy. c. Stimulate the patient to increase his level of consciousness. d. Check the patient's level of consciousness every 15 minutes for an hour.

Answer 31

b. Allow the patient to sleep as long as he feels sleepy. In the postictal phase of generalized tonic-clonic seizures, patients are usually very tired and may sleep for several hours and the nurse should allow the patient to sleep for as long as necessary. Suctioning is performed only if needed and decreased level of consciousness is not a problem postictally unless a head injury has occurred during the seizure.

Question 32

During the diagnosis and long-term management of a seizure disorder, what should the nurse recognize as one of the major needs of the patient? a. Managing the complicated drug regimen of seizure control b. Coping with the effects of negative social attitudes toward epilepsy c. Adjusting to the very restricted lifestyle required by a diagnosis of epilepsy d. Learning to minimize the effect of the condition in order to obtain employment

Answer 32

b. Coping with the effects of negative social attitudes toward epilepsy One of the most common complications of a seizure disorder is the effect it has on the patient's lifestyle. This is because of the social stigma attached to seizures, which causes patients to hide their diagnosis and to prefer not to be identified as having epilepsy. Medication regimens usually require only once-or twice-daily dosing and the major restrictions of the lifestyle usually involve driving and high-risk environments. Job discrimination against the handicapped is prevented by federal and state laws and patients only need to identify their disease in case of medical emergencies.

Question 33

A patient at the clinic for a routine health examination mentions that she is exhausted because her legs bother her so much at night that she cannot sleep. The nurse questions the patient further about her leg symptoms with what knowledge about restless legs syndrome? a. The condition can be readily diagnosed with EMG. b. Other more serious nervous system dysfunctions may be present. c. Dopaminergic agents are often effective in managing the symptoms. d. Symptoms can be controlled by vigorous exercise of the legs during the day.

Answer 33

c. Dopaminergic agents are often effective in managing the symptoms. Restless legs syndrome that is not related to other pathologic processes, such as diabetes mellitus or rheumatic disorders, may be caused by a dysfunction in the basal ganglia circuits that use the neurotransmitter dopamine, which controls movements. Dopamine precursors and dopamine agonists, such as those used for parkinsonism, are effective in managing sensory and motor symptoms. Polysomnography studies during sleep are the only tests that have diagnostic value and although exercise should be encouraged, excessive leg exercise does not have an effect on the symptoms.

Question 34

Which chronic neurologic disorder involves a deficiency of the neurotransmitters acetylcholine and y-aminobutyric acid (GABA) in the basal ganglia and extrapyramidal system? a. Myasthenia gravis b. Parkinson's disease c. Huntington's disease d. Amyotrophic lateral sclerosis (ALS)

Answer 34

c. Huntington's disease Huntington's disease (HD) involves deficiency of acetylcholine and y-aminobutyric acid (GABA) in the basal ganglia and extrapyramidal system that causes the opposite symptoms of parkinsonism. Myasthenia gravis involves autoimmune antibody destruction of cholinergic receptors at the neuromuscular junction. Amyotrophic lateral sclerosis (ALS) involves degeneration of motor neurons in the brainstem and spinal cord.

Question 35

A 38-year-old woman has newly diagnosed multiple sclerosis (MS) and asks the nurse what is going to happen to her. Which is the best response by the nurse? a. "You will have either periods of attacks and remissions or progression of nurse damage over time." b. "You need to plan for a continuous loss of movement, sensory functions, and mental capabilities." c. "You will most likely have a steady course of chronic progressive nerve damage that will change your personality." d. "It is common for people with MS to have an acute attack of weakness and then not to have any other symptoms for years."

Answer 35

a. "You will have either periods of attacks and remissions or progression of nurse damage over time." Most patients with multiple sclerosis (MS) have remissions and exacerbations of neurologic dysfunction or a relapsing-remitting initial course followed by progression with or without occasional relapses, minor remissions, and plateaus that progressively cause loss of motor, sensory, and cerebellar functions. Intellectual function generally remains intact but patients may experience anger, depression, or euphoria. A few people have chronic progressive deterioration and some may experience only occasional and mild symptoms for several years after onset.

Question 36

During assessment of a patient admitted to the hospital with an acute exacerbation of MS, what should the nurse expect to find? a. Tremors, dysphasia, and ptosis b. Bowel and bladder incontinence and loss of memory c. Motor impairment, visual disturbances, and parathesias d. Excessive involuntary movements, hearing loss, and ataxia

Answer 36

c. Motor impairment, visual disturbances, and parathesias Specific neurologic dysfunction of MS is caused by destruction of myelin and replacement with glial scar tissue at specific areas in the nervous system. Motor, sensory, cerebellar, and emotional dysfunctions, including parasthesias as well as patchy blindness, blurred vision, pain radiating along the dermatome of the nerve, ataxia, and severe fatigue, are the most common manifestations of MS. Constipation and bladder dysfunctions, short-term memory loss, sexual dysfunction, anger, and depression or euphoria may also occur. Excessive involuntary movements and tremors are not seen in MS.

Question 37

The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by a. spinal x-ray findings. b. T-cell analysis of the blood. c. analysis of cerebrospinal fluid. d. history and clinical manifestations.

Answer 37

d. history and clinical manifestations. There is no specific diagnostic test for MS. A diagnosis is made primarily by history and clinical manifestations. Certain dianostic tests may be used to help establish a diagnosis of MS. Positive findings on MRI include evidence of at least two inflammatory demyelinating lesions in at least two different locations within the central nervous system (CNS). Cerebrospinal fluid (CSF) may have increased immunoglobin G and the presence of oligoclonal banding. Evoked potential responses are often delayed in persons with MS.

Question 38

Mitoxantrone (Novatrone) is being considered as treatment for a patient with progressive-relapsing MS. The nurse explains that the disadvantage of this drug compared with other drugs used for MS is what? a. It must be given subcutaneously every day. b. It has a lifetime dose limit because of cardiac toxicity. c. It is an anticholinergic agent that causes urinary incontinence. d. It is an immunosuppressant agent that increases the risk for infection.

Answer 38

b. It has a lifetime dose limit because of cardiac toxicity. Mitoxantrone (Novantrone) cannot be used for more than 2 to 3 years because it is an antineoplastic drug that causes cardiac toxicity, leukemia, and infertility. It is a monoclonal antibody given IV monthly when patients have inadequate responses to other drugs. It increases the risk of progressive multifocal leukoencephalopathy.

Question 39

A patient with MS has a nursing diagnosis of self-care deficit related to muscle spasticity and neuromuscular deficits. In providing care for the patient, what is most important for the nurse to do? a. Teach the family members how to care adequately for the patient's needs. b. Encourage the patient to maintain social interactions to prevent social isolation. c. Promote the use of assistive devices so the patient can participate in self-care activities. d. Perform all activities of daily living (ADLs) for the patent to conserve the patient's energy.

Answer 39

c. Promote the use of assistive devices so the patient can participate in self-care activities. The main goal in care of the patient with MS is to keep the patient active and maximally functional and promote self-care as much as possible to maintain independence. Assistive devices encourage independence while preserving the patient's energy. No care activity that the patient can do for himself or herself should be performed by others. Involvement of the family in the patient's care and maintenance of social interactions are also important but are not the priority in care.

Question 40

A patient with newly diagnosed MS has been hospitalized for evaluation and initial treatment of the disease. Following discharge teaching, the nurse realizes that additional instruction is needed when the patient says what? a. "It is important for me to avoid exposure to people with upper respiratory infections." b. "When I begin to feel better, I should stop taking the prednisone to prevent side effects." c. "I plan to use vitamin supplements and a high-protein diet to help manage my condition." d. "I must plan with my family how we are going to manage my care if I become more incapacitated."

Answer 40

b. "When I begin to feel better, I should stop taking the prednisone to prevent side effects." Corticosteroids used in treating acute exacerbations of MS should not be abruptly stopped by the patient because adrenal insufficiency may result and prescribed tapering doses should be followed. Infections may exacerbate symptoms and should be avoided and high-protein diets with vitamin supplements are advocated. Long-term planning for increasing disability is also important.

Question 41

The classic triad of manifestations associated with Parkinson's disease is tremor, rigidity, and bradykinesia. What is a consequence related to rigidity? a. Shuffling gait b. Impaired handwriting c. Lack of postural stability d. Muscle soreness and pain

Answer 41

d. Muscle soreness and pain The degeneration of dopamine-producing neurons in the substantia nigra of midbrain and basal ganglia lead to this triad of signs. Muscle soreness, pain, and slowness of movement are patient function consequences related to rigidity. Shuffling gait, lack of postural stability, absent arm swing while walking, absent blinking, masked facial expression, and difficulty initiating movement are all related bradykinesia. Impaired handwriting and hand activities are related to the tremor of Parkinson's disease (PD).

Question 42

A patient with a tremor is being evaluated for Parkinson's disease. The nurse explains to the patient that Parkinson's disease can be confirmed by a. CT and MRI scans. b. relief of symptoms with administration of dopaminergic agents. c. the presence of tremors that increase during voluntary movement. d. cerebral angiogram that reveals the presence of cerebral atherosclerosis.

Answer 42

b. relief of symptoms with administration of dopaminergic agents. Although clinical manifestations are characteristic in PD, no laboratory or diagnostic tests are specific for the condition. A diagnosis is made when at least two of the three signs of the classic triad are present and it is confirmed with a positive response to antiparkinsonian medication. Research regarding the role of genetic testing and MRI to diagnose PD is ongoing. Essential tremors increase during voluntary movement whereas the tremors of PD are more prominent at rest.

Question 43

Which observation of the patient made by the nurse is most indicative of Parkinson's disease? a. Large, embellished handwriting b. Weakness of one leg resulting in a limping walk c. Difficulty rising from a chair and beginning to walk d. Onset of muscle spasms occurring with voluntary movement

Answer 43

c. Difficulty rising from a chair and beginning to walk The bradykinesia of PD prevents automatic movements and activities such as beginning to walk, rising from a chair, or even swallowing of saliva cannot be executed unless they are consciously willed. Handwriting is affected by the tremor and results in the writing trailing off at the end of words. Specific limb weakness and muscle spasms are not characteristic of PD.

Question 44

A patient with Parkinson's disease is started on levodopa. What should the nurse explain about this drug? a. It stimulates dopamine receptors in the basal ganglia. b. It promotes the release of dopamine from brain neurons. c. It is a precursor of dopamine that is converted to dopamine in the brain. d. It prevents the excessive breakdown of dopamine in the peripheral tissues.

Answer 44

c. It is a precursor of dopamine that is converted to dopamine in the brain. Peripheral dopamine does not cross the blood-brain barrier but its precursor, levodopa, is able to enter the brain, where it is converted to dopamine, increasing the supply that is deficient in PD. Other drugs used to treat PD include bromocriptine, which stimulates dopamine receptors in the basal ganglia, and amantadine, which blocks the reuptake of dopamine in presynaptic neurons. Carbidopa is an agent that is usually administered with levodopa to prevent the levodopa from being metabolized in peripheral tissues before it can reach the brain.

Question 45

To reduce the risk for falls in the patient with Parkinson's disease, what should the nurse teach the patient to do? a. Use an elevated toilet seat. b. Use a walker or cane for support. c. Consciously lift the toes when stepping. d. Rock side to side to initiate leg movements.

Answer 45

c. Consciously lift the toes when stepping. The shuffling gait of PD causes the patient to be off balance and at risk for falling. Teaching the patient to use a wide stance with the feet apart, to lift the toes when walking, and to look ahead helps promote a more balanced gait. Use of an elevated toilet seat and rocking from side to side will enable a patient to initiate movement. Canes and walkers are difficult for patients with PD to maneuver and may make the patient more prone to injury.

Question 46

A patient with myasthenia gravis is admitted to the hospital with respiratory insufficiency and severe weakness. When is a diagnosis of cholinergic crisis made? a. The patient's respiration is impaired because of muscle weakness. b. Administration of edrophonium (Tensilon) increases muscle weakness. c. Administration of edrophonium (Tensilon) results in improved muscle contractility. d. EMG reveals decreased response to repeated stimulation of muscles.

Answer 46

b. Administration of edrophonium (Tensilon) increases muscle weakness. The reduction of acetylcholine (ACh) effect in myasthenia gravis (MG) is treated with anticholinesterase drugs, which prolong the action of ACh at the neuromuscular synapse, but too much of these drugs will cause a cholingergic crisis with symptoms very similar to those of MG. To determine whether the patient's manifestations are due to a deficiency of ACh or too much anticholinesterase drug, the anticholinesterase drug edrophonium chloride (Tensilon) is administered. If the patient is in cholinergic crisis, the patient's symptoms will worsen; if the patient is in a myasthenic crisis, the patient will improve.

Question 47

During care of a patient in myasthenic crisis, maintenance of what is the nurse's first priority for the patient? a. Mobility b. Nutrition c. Respiratory function d. Verbal communication

Answer 47

c. Respiratory function The patient in myasthenic crisis has severe weakness and fatigability of all skeletal muscles, affecting the patient's ability to breathe, swallow, talk and move. However, the priority of nursing care is monitoring and maintaining adequate ventilation.

Question 48

When providing care for a patient with ALS, the nurse recognizes what as one of the most distressing problems experienced by the patient? a. Painful spasticity of the face and extremities b. Retention of cognitive function with total degeneration of motor function c. Uncontrollable writhing and twisting movements of the face, limbs, and body d. Knowledge that there is a 50% chance the disease has been passed to any offspring

Answer 48

b. Retention of cognitive function with total degeneration of motor function In ALS there is gradual degeneration of motor neurons with extreme muscle wasting from lack of stimulation and use. However, cognitive function is not impaired and patients feel trapped in a dying body. Chorea manifested by writhing, involuntary movements is characteristic of HD. As an autosomal dominant genetic disease, HD also has a 50% chance of being passed off to each offspring.

Question 49

In providing care for patients with chronic, progressive neurologic disease, what is the major goal of treatment that the nurse works toward? a. Meet the patient's personal care needs. b. Return the patient to normal neurologic function. c. Maximize neurologic functioning for as long as possible. d. Prevent the development of additional chronic diseases.

Answer 49

c. Maximize neurologic functioning for as long as possible. Many chronic neurologic diseases involve progressive deterioration in physical or mental capabilities and have no cure, with devastating results for patients and families. Health care providers can only attempt to alleviate physical symptoms, prevent complications, and assist patients in maximizing function and self-care abilities for as long as possible.

Question 50

The male client is sitting in the chair and his entire body is rigid with his arms and legs contracting and relaxing. The client is not aware of what is going on and is making guttural sounds. Which action should the nurse implement first? a. Push aside any furniture. b. Place the client on his side. c. Assess the client's vital signs. d. Ease the client to the floor.

Answer 50

d. Ease the client to the floor. The client should not remain in the chair during a seizure. He should be brought safely to the floor so that he will have room to move the extremities. a - The nurse needs to protect the client from injury. Moving the furniture would help ensure that the client would not hit something accidentally, but this is not done first. b - This is done to help keep the airway patent, but it is not the first intervention in this specific situation. c - Assessment is important but, when the client is having a seizure, the nurse should not touch him or her.

Question 51

The client is scheduled for an electroencephalogram (EEG) to help diagnose a seizure disorder. Which preprocedure teaching should the nurse implement? a. Tell the client not to take any routine antiseizure medication prior to the EEG. b. Tell the client not to eat anything for eight (8) hours prior to the procedure. c. Instruct the client to stay awake for 24 hours prior to the EEG. d. Explain to the client that there will be some discomfort during the procedure.

Answer 51

c. Instruct the client to stay awake for 24 hours prior to the EEG. The goal is for the client to have a seizure during the EEG. Sleep deprivation, hyperventilating, or flashing lights may induce a seizure. a - Antiseizure drugs, tranquilizers, stimulants, and depressants are withheld before an EEG because they may alter the brain wave patterns. b - Meals are not withheld because altered blood glucose level can cause changes in brain wave patterns. d - Electrodes are placed on the client's scalp, but there are no electroshocks or any type of discomfort.

Question 52

The client who just had a three (3)-minute seizure has no apparent injuries and is oriented to name, place, and time but is very lethargic and just wants to sleep. Which intervention should the nurse implement? a. Perform a complete neurological assessment. b. Awaken the client every 30 minutes. c. Turn the client to the side and allow the client to sleep. d. Interview the client to find out what caused the seizure.

Answer 52

c. Turn the client to the side and allow the client to sleep. During the postictal (after-seizure) phase, the client is very tired and should be allowed to rest quietly; placing the client on the side will help prevent aspiration and maintain a patent airway. a - The client is exhausted from the seizure and should be allowed to sleep. b - Awakening the client every 30 minutes possibly could induce another seizure as a result of sleep-deprivation. d - The client must rest, and asking questions about the seizure will keep the client awake and may induce another seizure as a result of sleep deprivation.

Question 53

The client is prescribed phenytoin (Dilantin), an anticonvulsant, for a seizure disorder. Which statement indicates the client understands the discharge teaching concerning this medication? a. "I will brush my teeth after every meal." b. "I will check my Dilantin level daily." c. "My urine will turn orange while on Dilantin." d. "I won't have any seizures while on this medication."

Answer 53

a. "I will brush my teeth after every meal." Thorough oral hygiene after each meal, gum massage, daily flossing, and regular dental care are essential to prevent hyperplasia, which is a common occurrence in clients taking Dilantin. b - A serum (venipuncture) Dilantin level is checked monthly at first and then, after a therapeutic level is attained, every six (6) months. c - Dilantin does not turn the urine orange. d - The use of Dilantin does not ensure that the client will not have any seizures, and in some instances, the dosage may need to be adjusted or another medication may need to be used.

Question 54

The client is admitted to the intensive care unit (ICU) experiencing status epilepticus. Which collaborative intervention should the nurse anticipate? a. Assess the client's neurological status every hour. b. Monitor the client's heart rhythm via telemetry. c. Administer an anticonvulsant medication by intravenous push. d. Prepare to administer a glucocorticosteroid orally.

Answer 54

c. Administer an anticonvulsant medication by intravenous push. Administering an anticonvulsant medication by intravenous push requires the nurse to have an order or confer with another member of the health-care team. a - Assessment is an independent nursing action, not a collaborative one. b - All clients in the ICD will be placed on telemetry, which does not require an order by another health-care provider or collaboration with one. d - A glucocorticoid is a steroid and is not used to treat seizures.

Question 55

The client has been newly diagnosed with epilepsy. Which discharge instructions should be taught to the client? Select all that apply. a. Keep a record of seizure activity. b. Take tub baths only; do not take showers. c. Avoid over-the-counter medications. d. Have anticonvulsant medication serum levels checked regularly. e. Do not drive alone; have someone in the car.

Answer 55

a. Keep a record of seizure activity. c. Avoid over-the-counter medications. d. Have anticonvulsant medication serum levels checked regularly. Keeping a seizure and medication chart will be helpful when keeping follow-up appointments with the health-care provider and in identifying activities that may trigger a seizure. Over-the-counter medications may contain ingredients that will interact with seizure medications or, in some cases, as with the use of stimulants, possibly cause a seizure. Most of the anticonvulsant medications have therapeutic serum levels that should be maintained, and regular checks of serum levels help to ensure the correct level. b - The client should take showers, rather than tub baths, to avoid drowning if a seizure occurs. The nurse should also instruct the client to never swim alone. e - A newly diagnosed client would have just been put on medication, which may cause drowsiness. Therefore, the client should avoid activities that require alertness and coordination and should not be driving at all until after the effects of the medication have been evaluated.

Question 56

Which statement by the female client indicates that the client understands factors that may precipitate seizure activity? a. "It is all right for me to drink coffee for breakfast." b. "My menstrual cycle will not affect my seizure disorder." c. "I am going to take a class in stress management." d. "I should wear dark glasses when I am out in the sun."

Answer 56

c. "I am going to take a class in stress management." Tension states, such as anxiety and frustration, induce seizures in some clients, so stress management may be helpful in preventing seizures. a - The client with a seizure disorder should avoid stimulants, such as caffeine. b - The onset of menstruation can cause seizure activity in the female client. d - Bright flickering lights, television viewing, and some other photic (light) stimulation may cause seizures, but sunlight does not. Wearing dark glasses or covering one eye during potential seizure-stimulating activities may help prevent seizure.

Question 57

The nurse asks the male client with epilepsy if he has auras with his seizures. The client says, "I don't know what you mean. What are auras?" Which statement by the nurse would be the best response? a. "Some people have a warning that the seizure is about to start." b. "Auras occur when you are physically and psychologically exhausted." c. "You're concerned that you do not have auras before your seizures?" d. "Auras usually cause you to be sleepy after you have a seizure."

Answer 57

a. "Some people have a warning that the seizure is about to start." An aura is a visual, auditory, or olfactory occurrence that takes place prior to a seizure and warns the client a seizure is about to occur. The aura often allows time for the client to lie down on the floor or find a safe place to have the seizure. b - An aura is not dependent on the client being physically or psychologically exhausted. c - This is a therapeutic response, reflecting feelings, which is not an appropriate response when answering a client's question. d - Sleepiness after a seizure is very common, but the aura does not itself cause the sleepiness.

Question 58

The nurse educator is presenting an in-service on seizures. Which disease process is the leading cause of seizures in the elderly? a. Alzheimer's disease. b. Parkinson's disease. c. Cerebral vascular accident (stroke). d. Brain atrophy due to aging.

Answer 58

``` c. Cerebral vascular accident (stroke). A CVA (stroke) is the leading cause of seizures in the elderly; increased intracranial pressure associated with the stroke can lead to seizures. ``` a - Alzheimer's disease does not lead to seizures. b - Parkinson's disease does not cause seizures. d - Brain atrophy is not associated with seizures.

Question 59

The client diagnosed with Parkinson's disease (PD) is being admitted with a fever and patchy infiltrates in the lung fields on the chest x-ray. Which clinical manifestations of PD would explain these assessment data? a. Masklike facies and shuffling gait. b. Difficulty swallowing and immobility. c. Pill rolling of fingers and flat affect. d. Lack of arm swing and bradykinesia.

Answer 59

b. Difficulty swallowing and immobility. Difficulty swallowing places the client at risk for aspiration. Immobility predisposes the client to pneumonia. Both clinical manifestations place the client at risk for pulmonary complications. a - Masklike facies is responsible for lack of expression and is part of the motor manifestations of Parkinson's disease but is not related to the symptoms listed. Shuffling is also a motor deficit and does not pose a risk for falling, but fever and patchy infiltrates on a chest x-ray do not result from a gait problem. They are manifestations of a pulmonary complication. c - Pill rolling of fingers and flat affect do not have an impact on the development of pulmonary complications. d - Arm swing and bradykinesia are motor deficits.

Question 60

The nurse caring for a client diagnosed with Parkinson's disease writes a problem of "impaired nutrition." Which nursing intervention would be included in the plan of care? a. Consult the occupational therapist for adaptive appliances for eating. b. Request a low-fat, low-sodium diet from the dietary department. c. Provide three (3) meals per day that include nuts and whole-grain breads. d. Offer six (6) meals per day with a soft consistency.

Answer 60

d. Offer six (6) meals per day with a soft consistency. The client's energy levels will not sustain eating for long periods. Offering frequent and easy-to-chew (soft) meals of small proportions is the preferred dietary plan. a - Adaptive appliances will not help the client's shaking movements and are not used for clients with Parkinson's disease. b - Clients with Parkinson's disease are placed on high-calorie, high-protein, soft or liquid diets. Supplemental feedings may also be ordered. If liquids are ordered because of difficulty chewing, then the liquids should be thickened to a honey or pudding consistency. c - Nuts and whole-grain food would require extensive chewing before swallowing and would not be good for the client. Three large meals would get cold before the client can consume the meal, and one half or more of the food would be wasted.

Question 61

The charge nurse is making assignments. Which client should be assigned to the new graduate nurse? a. The client diagnosed with aseptic meningitis who is complaining of a headache and the light bothering his eyes. b. The client diagnosed with Parkinson's disease who fell during the night and is complaining of difficulty walking. c. The client diagnosed with a cerebrovascular accident whose vital signs are P 60, R 14, and BP 198/68. d. The client diagnosed with a brain tumor who has a new complaint of seeing spots before the eyes.

Answer 61

a. The client diagnosed with aseptic meningitis who is complaining of a headache and the light bothering his eyes. Headache and photophobia are expected clinical manifestations of meningitis. The new graduate could care for this client. b - This client has had an unusual occurrence (fall) and now has a potential complication (a fracture). The experienced nurse should take care of this client. c - These vital signs indicate increased intracranial pressure. The more experienced nurse should care for this client. d - This could indicate a worsening of the tumor. This client is at risk for seizures and herniation of the brainstem. The more experienced nurse should care for this client.

Question 62

The nurse is planning the care for a client diagnosed with Parkinson's disease. Which would be a therapeutic goal of treatment for the disease process? a. The client will experience periods of akinesia throughout the day. b. The client will take the prescribed medications correctly. c. The client will be able to enjoy a family outing with the spouse. d. The client will be able to carry out activities of daily living.

Answer 62

d. The client will be able to carry out activities of daily living. The major goal of treating PD is to maintain the ability to function. Clients diagnosed with PD experience slow, jerky movements and have difficulty performing routine daily tasks. a - Akinesia is lack of movement. The goal in treating PD is to maintain mobility. b - This could be a goal for a problem of noncompliance with the treatment regimen, but not a goal for treating the disease process. c - This might be a goal for a psychosocial problem of social isolation.

Question 63

The client diagnosed with Parkinson's disease is being discharged. Which statement made by the significant other indicates an understanding of the discharge instructions? a. "All of my spouse's emotions will slow down now just like his body movements." b. "My spouse may experience hallucinations until the medication starts working." c. "I will schedule appointments late in the morning after his morning bath." d. "It is fine if we don't follow a strict medication schedule on weekends."

Answer 63

c. "I will schedule appointments late in the morning after his morning bath." Scheduling appointments late in the morning gives the client a chance to complete ADLs without pressure and allows the medications time to give the best benefits. a - The emotions of a person diagnosed with PD are labile. The client has rapid mood swings and is easily upset. b - Hallucinations are a sign that the client is experiencing drug toxicity. d - The client should take the prescribed medications at the same time each day to provide a continuous drug level.

Question 64

The nurse is admitting a client with the diagnosis of Parkinson's disease. Which assessment data support this diagnosis? a. Crackles in the upper lung fields and jugular vein distention. b. Muscle weakness in the upper extremities and ptosis. c. Exaggerated arm swinging and scanning speech. d. Masklike facies and a shuffling gait.

Answer 64

d. Masklike facies and a shuffling gait. Masklike facies and a shuffling gait are two clinical manifestations of PD. a - Crackles and jugular vein distention indicate upper heart failure, not PD. b - Upper extremity weakness and ptosis are clinical manifestations of myasthenia gravis. c - The client has very little arm swing, and scanning speech is a clinical manifestation of multiple sclerosis.

Question 65

What is a common cognitive problem associated with Parkinson's disease? a. Emotional lability. b. Depression. c. Memory deficits. d. Paranoia.

Answer 65

c. Memory deficits. Memory deficits are cognitive impairments. The client may also develop dementia. a - Emotional lability is a psychosocial problem, not a cognitive one. b - Depression is a psychosocial problem. d - Paranoia is a psychosocial problem.

Question 66

The nurse is conducting a support group for clients diagnosed with Parkinson's disease and their significant orders. Which information regarding psychosocial needs should be included in the discussion? a. The client should discuss feelings about being placed on a ventilator. b. The client may have rapid mood swings and become easily upset. c. Pill-rolling tremors will become worse when the medication is wearing off. d. The client may automatically start to repeat what another person says.

Answer 66

b. The client may have rapid mood swings and become easily upset. These are psychosocial manifestations of PD. These should be discussed in the support meeting. a - This information should be discussed when filling out an advance directive form. A ventilator is used to treat a physiological problem. c - The reduction in unintentional pill-rolling movement of the hands is controlled at times by the medication; this is a physiological problem. d - Echolalia is a speech deficit in which the client automatically repeats the words or sentences of another person; this is a physiological problem.

Question 67

Which diagnostic test is used to confirm the diagnosis of ALS? a. Electromyogram (EMG). b. Muscle biopsy. c. Serum creatine kinase (CK). d. Pulmonary function test.

Answer 67

b. Muscle biopsy. Biopsy confirms changes consistent with atrophy and loss of muscle fiber, both characteristic of ALS. a - EMG is done to differentiate a neuropathy from a myopathy, but it does not confirm ALS. c - CK may or may not be elevated in ALS so it cannot confirm the diagnosis of ALS. d - This is done as ALS progresses to determine respiratory involvement, but it does not confirm ALS.

Question 68

The client is diagnosed with ALS. Which client problem would be the most appropriate for this client? a. Disuse syndrome. b. Altered body image. c. Fluid and electrolyte imbalance. d. Alteration in pain.

Answer 68

a. Disuse syndrome. Disuse syndrome is associated with complications of bedrest. Clients with ALS cannot move and reposition themselves, and they frequently have altered nutritional and hydration status. b - The client does not usually have a change in body image. c - ALS is a disease affecting the muscles, not the kidneys or circulatory system. d - ALS is not painful.

Question 69

The client is being evaluated to rule out ALS. Which signs/symptoms would the nurse note to confirm the diagnosis? a. Muscle atrophy and flaccidity. b. Fatigue and malnutrition. c. Slurred speech and dysphagia. d. Weakness and paralysis.

Answer 69

d. Weakness and paralysis. ALS results from the degeneration and demyelination of motor neurons in the spinal cord, which results in paralysis and weakness of the muscles. a - These signs and symptoms occur during the course of ALS, but they are not early symptoms. b - These signs and symptoms will occur as the disease progresses. c - These are late signs/symptoms of ALS.

Question 70

The client with ALS is admitted to the medical unit with shortness of breath, dyspnea, and respiratory complications. Which intervention should the nurse implement first? a. Elevate the head of bed 30 degrees. b. Administer oxygen via nasal cannula. c. Assess the client's lung sounds. d. Obtain a pulse oximeter reading.

Answer 70

b. Administer oxygen via nasal cannula. Oxygen should be given immediately to help alleviate the difficulty breathing. Remember that oxygenation is priority. a - Elevating the head of the bed will enhance lung expansion, but it is not the first intervention. c - Assessment is the first part of the nursing process and is a priority, but assessment will not help the client breathe easier. d - This is an appropriate intervention, but obtaining the pulse oximeter reading will not alleviate the client's respiratory distress.

Question 71

The nurse is caring for the following clients on a medical unit. Which client should the nurse assess first? a. The client with ALS who is refusing to turn every two (2) hours. b. The client with abdominal pain who is complaining of nausea. c. The client with pneumonia who has a pulse oximeter reading of 90%. d. The client who is complaining about not receiving any pain medication.

Answer 71

c. The client with pneumonia who has a pulse oximeter reading of 90%. A pulse oximeter reading of less than 93% indicates that the client is experiencing hypoxemia, which is a life-threatening emergency. This client should be addressed first. a - Refusing to turn needs to be addressed by the nurse, but it is not priority over a life-threatening condition. b - Nausea needs to be assessed by the nurse, but it is not priority over an oxygenation problem. d - The nurse must address the client's complaints, but it is not priority over a physiological problem.

Question 72

The client is diagnosed with ALS. As the disease progresses, which intervention should the nurse implement? a. Discuss the need to be placed in a long-term care facility. b. Explain how to care for a sigmoid colostomy. c. Assist the client to prepare an advance directive. d. Teach the client how to use a motorized wheelchair.

Answer 72

c. Assist the client to prepare an advance directive. A client with ALS usually dies within five (5) years. Therefore, the nurse should offer the client the opportunity to determine how he/she wants to die. a - With assistance, the client may be able to stay at home. Therefore, placement in a long-term care facility should not be discussed until the family can no longer care for the client in the home. b - There is no indication that a client with ALS will need a sigmoid colostomy. d - ALS affects both upper and lower extremities and leads to a debilitating state, so the client will not be able to transfer into and operate a wheelchair.

Question 73

The client is in the terminal stage of ALS. Which intervention should the nurse implement? a. Perform passive ROM every two (2) hours. b. Maintain a negative nitrogen balance. c. Encourage a low-protein, soft-mechanical diet. d. Turn the client and have him cough and deep breathe every shift.

Answer 73

a. Perform passive ROM every two (2) hours. Contractures can develop within a week because extensor muscles are weaker than flexor muscles. If the client cannot perform ROM exercises, then the nurse must do it for them -- passive ROM. b - The client should maintain a positive nitrogen balance to promote optimal body functioning. c - Adequate protein is required to maintain osmotic pressure and prevent edema. d - The client is usually on bedrest in the last stages and should be turned and told to cough and deep breathe more often than every shift.

Question 74

The son of a client diagnosed with ALS asks the nurse, "Is there any chance that I could get this disease?" Which statement by the nurse would be most appropriate? a. "It must be scary to think you might get this disease." b. "No, this disease is not genetic or contagious." c. "ALS does have a genetic factor and runs in families." d. "If you are exposed to the same virus, you may get the disease."

Answer 74

c. "ALS does have a genetic factor and runs in families." There is a genetic factor with ALs that is linked to a chromosome 21 defect. a - The son is not sure if he may get ALS, so this is not an appropriate response. b - This is incorrect information. d - ALS is not caused by a virus. The exact etiology is unknown, but studies indicate that some environmental factors may lead to ALS.

Question 75

The client with end-stage ALS requires a gastronomy tube feeding. Which finding would require the nurse to hold a bolus tube feeding? a. A residual of 125 mL. b. The abdomen is soft. c. Three episodes of diarrhea. d. The potassium level is 3.4 mEq/L.

Answer 75

a. A residual of 125 mL. ``` A residual (aspirated gastric contents) of greater than 50 to 100 mL indicates that the tube feeding is not being digested and that the feeding should be held. b - A soft abdomen is normal; a distended abdomen would be cause to hold the feeding. c - Diarrhea is a common complication of tube feedings, but it is not a reason to hold the feeding. d - The potassium level is low and needs intervention, but this would not indicate a need to hold the bolus tube feeding. ```

Question 76

An abnormal electroencephalogram (EEG) indicates that a 2-year-old client has epilepsy, but the staff report never observing a seizure in the daycare setting. The nurse interprets that the child may be experiencing which type of seizure? a. Tonic b. Atonic c. Absence d. Tonic-Clonic

Answer 76

c. Absence

Question 77

When preparing to admit a client who has been treated for status epilepticus in the emergency department, the nurse should have the following equipment available in the room except a. Suction tubing b. Oxygen mask c. Tongue blade d. Siderail pads

Answer 77

c. Tongue blade

Question 78

Which of the following nursing diagnoses can be applied to the most clients with multiple sclerosis, regardless of type or severity? a. Acute pain b. Risk for aspiration c. Activity intolerance d. Impaired gas exchange

Answer 78

c. Activity intolerance

Question 79

A client with Parkinson’s disease is admitted to the hospital. Which nursing interventions will be included in the plan of care (select all that apply)? 1. Use an elevated toilet seat. 2. Cut food into small pieces. 3. Provide high protein foods at each meal. 4. Provide an arm chair. 5. Observe for sudden exacerbation of symptoms.

Answer 79

1. Use an elevated toilet seat. 2. Cut food into small pieces. 4. Provide an arm chair.

Question 80

The nurse is teaching the client with myathenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by a. Eating large, well-balanced meals b. Doing muscle-strengthening exercises c. Doing all activities early in the day d. Taking medications on time to maintain therapeutic blood levels

Answer 80

d. Taking medications on time to maintain therapeutic blood levels

Question 81

Which of the following seizure activities is considered as the most dangerous condition a. Tonic-clonic seizure b. Status epilepticus c. Absence seizure d. Atonic seizure

Answer 81

b. Status epilepticus

Question 82

The classic manifestations of Parkinson’s disease do not include a. Tremor b. Rigidity c. Bradykinesia d. Loss of sensation

Answer 82

d. Loss of sensation

Question 83

Cholinergic crisis occurs when patient with Myasthenia Gravis took excessive amount of anticholinesterase drug. a. True b. False

Answer 83

a. True

Question 84

The client diagnosed with PD is being discharged on carbidopa/levodopa (Sinemet), an antiparkinsonian drug. Which statement is the scientific rationale for combining these medications? a. There will be fewer side effects with this combination than with carbidopa alone. b. Dopamine D requires the presence of both of these medications to work. c. Carbidopa makes more levodopa available to the brain. d. Carbidopa crosses the blood-brain barrier to treat Parkinson's disease.

Answer 84

c. Carbidopa makes more levodopa available to the brain. Carbidopa enhances the effects of levodopa by inhibiting decarboxylase in the periphery, thereby making more levodopa available to the central nervous system. Sinemet is the most effective treatment for PD.

Question 85

The nurse is caring for clients on a med-surg floor. Which client should be assessed first? a. The 65-year-old client diagnosed with seizures who is complaining of a headache that is a "2" on a 1-to-10 scale. b. The 24-year-old client diagnosed with a T10 spinal cord injury who cannot move his toes. c. The 58-year-old client diagnosed with Parkinson's disease who is crying and worried about her facial appearance. d. The 62-year-old client diagnosed with a cerebrovascular accident who has a resolving left hemiparesis.

Answer 85

c. The 58-year-old client diagnosed with Parkinson's disease who is crying and worried about her facial appearance. Body image is a concern for clients diagnosed with PD. This client is the one client who is not experiencing expected sequelae of the disease. 1. This is a mild headache. 2. Inability to move toes would be expected. 4. This client is getting better.

Question 86

Which assessment data would make the nurse suspect that the client has amyotrophic lateral sclerosis? a. History of a cold or GI upset in the last month. b. Complaints of double vision and drooping eyelids. c. Fatigue, progressive muscle weakness, and twitching. d. Loss of sensation below the level of the umbilicus.

Answer 86

c. Fatigue, progressive muscle weakness, and twitching. Fatigue, progressive muscle weakness, and twitching are signs of ALS, a progressive neurological disease in which there is a loss of motor neurons. There is no cure, but recently a medication to slow the deterioration of motor neurons has been found.

Question 87

Which assessment data should the nurse expect to observe for the client diagnosed with Parkinson's disease? a. Ascending paralysis and pain. b. Masklike facies and pill rolling. c. Diplopia and ptosis. d. Dysphagia and dysarthria.

Answer 87

b. Masklike facies and pill rolling. Masklike faces and pill rolling are signs/symptoms of Parkinson's disease, along with cogwheeling, postural instability, and stooped and shuffling gait. a. Spread of pain and paralysis are symptoms of Guillain-Barre syndrome. c. Diplopia and ptosis are signs/symptoms of myasthenia gravis. d. Dysphagia and dysarthria of signs/symptoms of myasthenia gravis.

Question 88

The client with Parkinson's disease is prescribed carbidopa/levodopa (Sinemet). Which intervention should the nurse implement prior to administering the medication? a. Discuss how to prevent orthostatic hypotension. b. Take the client's apical pulse for 1 full minute. c. Inform the client that this medication is for short-term use. d. Tell the client to take the medication on an empty stomach.

Answer 88

a. Discuss how to prevent orthostatic hypotension. Because carbidopa/levodopa has been linked to hypotension, teaching a client given the medication ways to help prevent a drop in blood pressure when standing - orthostatic hypotension - decreases the risks associated with hypotension and falling.

Question 89

Which intervention should the nurse take with the client recently diagnosed with amyotrophic lateral sclerosis (ALS)? a. Discuss a percutaneous gastronomy tube. b. Explain how a fistula is accessed. c. Provide an advance directive. d. Refer to a physical therapist for leg braces.

Answer 89

c. Provide an advance directive. It is never too early to discuss advance directives with a client diagnosed with a terminal illness.

Question 90

The client with a history of migraine headaches comes to the clinic and reports that a migraine is coming because the client is experiencing bright spots before the eyes. Which phase of migraine headaches is the client experiencing? a. Prodrome phase. b. Aura phase. c. Headache phase. d. Recovery phase.

Answer 90

b. Aura phase. This is the aura phase, which is characterized by focal neurological symptoms.

Question 91

The client with a history of migraine headaches comes to the emergency department complaining of a migraine headache. Which collaborative treatment should the nurse anticipate? a. Administer an injection of sumatriptan (Imitrex), a triptan. b. Prepare for a computed tomography (CT) of the head. c. Place the client in a quiet room with the lights off. d. Administer propanolol (Inderal), a beta blocker.

Answer 91

a. Administer an injection of sumatriptan (Imitrex), a triptan. Sumatriptan is a medication of choice for migraine headaches. It constricts blood vessels and reduces inflammation. The nurse administering the medication is part of a collaborative effort because the nurse must act on the order or prescription of a physician or other health-care provider who has prescriptive authority.

Question 92

Which statement would make the nurse suspect that the client has ALS? a. "I had a gastrointestinal upset a couple of weeks ago." b. "I notice my eyelids are drooping and I see double." c. "I am tired all the time and my muscles are getting weaker." d. "I notice my legs are becoming progressively numb."

Answer 92

c. "I am tired all the time and my muscles are getting weaker." Fatigue, progressive muscle weakness, and twitching are signs of ALS, a progressive neurological disease in which there is a loss of motor neurons.