Neuro 3 Flashcards
Patient reports increased fatigue and stiffness of the extremities. These symptoms had occurred in the past, but resolved and no medical attention was sought. Which questions of the nurse asked to assess whether the symptoms may be associated with multiple sclerosis?
- Do you have a persistent sensitivity to cold
- Do you ever have slurred speech or trouble swallowing
- Has anyone in your family been diagnosed with multiple sclerosis
Patient with multiple sclerosis is prescribed oral prednisone 60 mg daily for seven days following a course of IV methylprednisone. Which laboratory abnormality is a side effect of the medication?
Decrease in serum potassium
The patient is a woman in her early 30s was recently been diagnosed with multiple sclerosis. The nurses has taught the patient’s husband about the course of the illness and what problems might occur in the future. Which statement by the husband indicates the need for additional teaching?
Later on she could have intermittent short-term memory loss
The patient and family are referred to the nurse for education about amyotrophic lateral sclerosis. What information does the nurse include an educational session?
- It is a progressive disease involving the motor system
- The cause of ALS is unknown
- There is no cure for ALS
What early symptoms does the nurse expect to observe in a 50-year-old patient recently diagnosed with ALS?
Tongue atrophy and dysphagia
The nurses assessing a patient with a diagnosis of Gillion bar syndrome. Which signs and symptoms are consistent with GPS?
- Sudden onset of weakness in the legs
- Decrease deep tendon reflexes
- Ataxia
During shift report, the nurse here’s the patient with GBS has a decrease in vital capacity that it’s less than two thirds of normal, and there’s a progressing inability to clear a cop up secretions. The physician been notified and is coming to evaluate the patient. What interventions the nurse prepared to implement for this patient?
Elective intubation
The patient with GBS is identified as having poor dietary intake secondary to dysphasia. A feeding tube is prescribed. How does the nurse monitor this patient’s nutritional status?
- Weighing the patient three times a week
2. Monitoring weekly sorry I’m pre-albumin level
The patient my GPS is in intubated for respiratory failure. The nurse must suction the patient. In assessing the risk for vagal nerve stimulation, what does the nurse closely monitor the patient for?
Bradycardia
The patient is admitted for a probable diagnosis of GPS, but needs additional diagnostic testing for confirmation. Which test does the nurse anticipate will be ordered for this patient?
- Electrophysiologic study
2. Electromyography
The nurses reviewing the cerebrospinal fluid results for patient with probable GBS. Which abnormal finding is common in GPS?
Increase in CSF protein level
An ambulatory patient has sought treatment for symptoms of GBS within two weeks of symptom onset. Which drug therapy is likely preferred for this patient?
Immunoglobulin
The patient is scheduled to receive immunoglobin therapy. Before administering the medication nurse ensures that which laboratory tests of been completed?
Serum IgA
Which interventions are appropriate for pain management and an older adult with GBS?
- IV opiates
- Neurontin
- Massage
- Music therapy
The patient with CVS is receiving IV immuno globulin. The nurse monitors for which major potential complication of this drug therapy?
Anaphylaxis
The nurse is monitoring a patient with GBS undergoing plasmapheresis. The patient reports dizziness and has a heart rate is dropped 48 bpm. The nurse notifies the primary care provider. Which ordered as the nurse anticipate?
Atropine IV push
The patient is the newly diagnosed with GBS the nurses teaching the patient and family about the condition. Which statement by the family indicates a need for additional teaching?
He’ll never be able to walk again
Which strategies should be incorporated in the plan of care to provide emotional support for patient with GBS who has the ascending Paralysis?
- Encouraged patient to verbalize feeling
- Teach the patient and family about the condition
- Explain all procedures and test
- Assess previous coping skills
What is the priority expected outcome in a patient with GBS?
Maintain airway patency and gas exchange
The nurses reviewing the admission and history notes for patient admitted for GPS. Which medical condition is most likely to be present for the onset of GBS?
Recent G.I. illness
The patient with GBS describes the chronological progression of motor weakness that started in the legs and spread to his arms and upper body. Which type of GPS to these symptoms indicate?
Ascending
The patient my GPS is in the plateau period. Which intervention is best for the nurse to delegate to the nursing assistant?
Performed passive range of motion every 2 to 4 hours
The nurses assessing patient with myasthenia gravis. Wish manifestations commoners expect to observe?
- Ptosis
- Diplopia
- InComplete Eye closure
Which statements about MG are accurate?
- It is an acquired autoimmune disease
- It occurs equally and men and women
- There is a small Familal incidence
- It is characterized by remissions and exacerbations
What is the most common electrodiagnostic test performed to detect MG?
Repetitive nerve stimulation
What is the cause of a cholinergic crisis?
Too many anticholinesterase drugs
What test is used to differentiate a cholinergic crisis from a myasthenia crisis?
Tensilon testing
What factors are associated with the development of GBS?
- Recent immunization
- Systemically lupus erythematosus
- Acute illness
- Trauma
The nurses receiving the biographic data and history for patient with MG. What does a nurse expect to see included in the patient’s residence?
Muscle weakness that increases with exertion or as the day wears on
Because the most common symptoms of MG are related to involvement of the levator palpebra it or extraocular muscles, which assessment technique does the nurse use?
Face the patient and direct him or her to open and close the eyelids
The patient with MG has bulbar involvement. What is the nurses priority assessment for this patient?
Ability to chew and swallow
The patient with MG the nurse are having a long discussion about plans for the future. After an extended conversation what does the nurse anticipate will occur in this patient?
Voice may become weaker or exhibit a nasal twang
Patient with MG reports having difficulty climbing stairs lifting heavy objects and raising arms overhead. What is the pathophysiology of this patient’s symptoms due to?
Limb weakness is more often proximal
The nurses planning activities for patient with MG. Which factor does the nurse considered to promote self-care, yet prevent excessive fatigue
Medication times
The patient is suspected of having MG and it tensile and Tessa’s been ordered. What does the nurse do in order to prepare the patient for the test?
Ensure that the patient has a patent IV access
The nurses caring for patient recently diagnosed admitted with MG. During the morning assessment, the nurse notes some abnormal findings. Which symptoms as a nurse reports the physician immediately?
Inability to swallow
What is considered a positive diagnostic findings of a tensile and test?
Within 30 to 60 seconds after receiving the cholinesterase inhibitors there is increased muscle tone the last 4 to 5 minutes
Although an adverse reaction to tensile and is considered rare, which medication should be readily available to give us an antidote in case of patients experience complications?
Atropine sulfate
The nurses caring for a patient newly diagnosed with MG. The nurses vigilant for complications related to both myasthenic crisis and cholinergic crisis. What is the priority nursing assessment for this patient?
Assess respiratory status and function
The nurses performing patient and family teaching about MG medication therapy. What important information does a nurse give during the teaching session?
- Administer with a small amount of food to decrease G.I. upset
- If there is bulbar involvement eat meals 45 minutes to an hour after taking the medication
- Drugs containing morphine are sedatives can increase muscle weakness
The patient with MG develops difficulty coughing. Auscultation of the lungs reveal course crackles throughout the lung fields. The nurse identifies the patient is unable to cost-effectively enough to clear the airway secretions. Which interventions that’s for this patient?
Perform chest physiotherapy
The patient is experiencing acute respiratory failure secondary to MG crisis. Which alternative to mechanical ventilation me this patient benefit from?
Bi level positive airway pressure
The patient with MG has generalized weakness and fatigue and is limited in their ability to perform ADLs. Which nursing action best to help this patient avoid excessive fatigue?
Assess the patient’s motor strength before and after periods of activity
The nurses reviewing medication orders for a patient with MG. Which order does the nurse question?
PRN order for milk of magnesia
The nurses caring for a patient receiving anti-cholinesterase drugs for MG. With symptoms does the nurse immediately report to the physician?
Dyspnea and difficulty swallowing
During shift report the nurse learns a patient with MG deteriorated through the end of the shift in the physician was called. A Tensilon test indicated that the patient was having my synthetic crisis. What is the priority problem for this patient?
Potential for in adequate oxygenation
The patient with MG is been referred to surgeon for a procedure that may improve the patient’s symptoms. Which procedure is the nurse anticipate will be recommended for this patient?
Thymectomy
The patient with MG experience the cholinergic crisis and is currently being maintained on a ventilator. The patient receives several 1 mg doses of atropine. What does the nurse closely Montrose patient for?
Development of mucous plug
The nurses performing patient teaching about plasmapheresis. Which statement by the patient indicates understanding of this material?
The goal of the treatment is to decrease symptoms, but is not the cure
The nurses performing teaching for the family about fatigue and activities of daily living. Statement by family member indicates a need for additional teaching?
We should do hygienic care for her to avoid undue frustration and fatigue
The patient with MG is experiencing impaired communication related to weakness of the facial muscles. Which interventions are best in assisting patient communicate with staff and family?
- Instructed patient to speak slowly
- Ask yes or no question
- Have the patient is a picture or word board
The patient with MGs having difficulty maintaining an adequate intake of food and fluid because of difficulty chewing and swallowing. Which task for this patient is best to delegate to an unlicensed assistive personnel?
Weigh the patient daily
Which interventions are appropriate to protect the patient of MG from corneal abrasions?
- Administer artificial tears
2. Apply lubricant gel and shield to the eyes at bedtime
A patient is receiving a cholinesterase inhibitor drug for the treatment of MG. What is a nursing implication for safe administration ?
Feed meals 45-60 minutes after admin
Following a thymectomy what postoperative care does the nurse provide for a patient with MG?
- Assist the patient to turn , cough, and deep breathe
- Assess for chest pain, dyspnea, hypotension
- Assess for Diminshed or absent breath sounds
A patient with a thump a had surgery to relieve symptoms of mg. A single chest tube has been inserted into the patients anterior mediastinum. The nurse notes that the patient is restless with Diminshed breath sounds and decreased chest wall expansion. What is the nurses priority action.
Provide oxygen and elevate the head of the bed
The nurses teaching the patient and family about factors that predispose the patient episode of exacerbation of MG. Which factors does the nurse mention?
- Infection
- Stress
- Enemas
- Strong cathartics
- Which client should be assigned to the traveling nurse, new to neurologic nursing care, who has been on the neurologic unit for one week?
A 68 year old with chronic amyotrophic lateral sclerosis
- A client with MS tells the nursing assistant after physical therapy that she is too tired to take a bath. What is the priority nursing diagnosis at this time?
Self care deficit related to fatigue and neuromuscular weakness
- An LPN, under your supervision, is providing nursing care for a client with GBS. What observation should you instruct the LPN to report immediately.
Shallow respirations and decreased breath sounds
- The nursing assistant reports to you, the RN, that a cleint with myasthenia gravis has an elevated temperature, an increased HR, rise in BP and was incontinent of urine and stool. What is your best first action at this time?
Notify the physician immediately
- The LPN whom you are supervising comes to you and says “ I gave the client with myasthenia gravis 90 mg of neostigmine instead of the ordered 45 mg”. In which order should you perform the following actions?
- Assess the clients HR
- Notify the physician of the incorrect medication dose
- Ask the LPN to explain how the error occurred
- Complete a medication error report
Which clinical findings does the nurse anticipate a client with an exacerbation of multiple sclerosis to experience?
- Double vision
2. Scanning speech
Which statement by client with multiple sclerosis indicate to the nurse of the client needs further teaching?
I will take a hot bath to help relax my muscles
A recently hospitalized client with multiple sclerosis is concerned about generalized weakness and fluctuating physical status. What is the priority nursing intervention for this client?
Space activities throughout the day
The client with Gillion bar syndrome has been hospitalized for three days. Which assessment finding indicates a need for more frequent monitoring?
Ascending weakness
What does the nurse understand the clients with mysthenia Gravis, Gillion bar syndrome, amyotrophic lateral sclerosis share in common?
Increased risk for respiratory complications
A nurses caring for a client with the diagnosis of Gillion bar syndrome. The nurse identifies that the client is having difficulty expectorating respiratory secretions. What should be the nurses first intervention?
Suction the clients oropharynx
What nursing intervention is anticipated for a client with Gillion bar syndrome?
Maintaining ventilator settings to support respiration
The nurses caring for a client in the home has a diagnosis of amyatrophic lateral sclerosis. Which position should the nurse recommended the client assume after eating?
Semi Fowler
Homecare nurses counseling to client with ALS. What information should the nurse including the discussion?
- Space activities throughout the day
2. Anticipate some alternate ways to communicate
A client with mysthenia gravis expanses dysphasia. What is the priority risk associated with dysphasia that must be considered when planning nursing care?
Aspiration
A client with myasthenia gravis ask the nurse why the diseases occurred. What pathology underlies the nurses reply?
A decreased number of functioning acetylcholine receptor sites
The client with mycigna gray this as a nurse what is going to happen to me and my family. What information about what the client can anticipate should be incorporated into the nurses response?
Chronic illness with exacerbations and remissions
Nurse enters the room of a client with my Sennea gravest and identified with the client is experiencing increased dysphagia. What should the nurse to first?
Raise the head of the bed
What does the nurse attribute the increased risk of respiratory complications and clients with myasthenia gravis?
InEffective coughing
The client with Myasthenia gravis has been receiving neostigmine an asks about its action. What information about it’s action should the nurse consider one formulating a response?
It blocks the action of cholinesterase
A client with myasthenia gravis continues to become weaker despite treatment with neostigmine. What reason should the nurse identify for the healthcare providers prescription for edrophonium?
Rule out cholinergic crisis
The nurse explains to the family of a client suspected of having myasthenia gravis that edrophonium establish the diagnosis. An increase in which factor will confirm the diagnosis?
Muscle strength
Ambulatory female client with relapsing remitting multiple sclerosis is to receive every other day injections of interferon beta one. What adverse effects should the nurse explained me occur when taking this medication?
- Depression
- Constipation
- Flulike symptoms
- Increased heart rate
The client is admitted to the hospital with a diagnosis of myasthenia gravis. For which common early clinical finding should the nurse assessed the client?
Diplopia
A hospitalize client is receiving pyridostigmine for control of myasthenia gratis. In the middle of the night the nurse finds the client weak and barely able to move. Which additional clinical findings support the conclusion that these responses are related to pyridostigmine ?
- Respiratory depression
- Decreased blood pressure
- High pitch gurgling bowel sounds
The client with multiple sclerosis is in remission. Which diversional activity should the nurse encourage the best meets the clients needs while in remission?
Swimming
