Peripheral Nervous System Flashcards
Which drugs can exacerbate the condition of a client with myasthenia gravis (MG)? Select all that apply.
- Timolol
- Prednisone
- Cyclosporine
- Procainamide
- Carbamazepine
Option 1:
Timolol is an antiarrhythmic drug known to exaggerate the condition of MG.
Option 2:
Prednisone is used in the treatment of MG.
Option 3:
Cyclosporine is used in the treatment of MG.
Option 4:
Procainamide, an antiarrhythmic, is known to exaggerate the condition of MG.
Option 5:
Carbamazepine exaggerates the condition of MG.
1, 4, 5
Which cranial nerve controls sensory functions from the tongue, such as taste, touch, and temperature?
- IX (glossopharyngeal)
- X (vagus)
- XI (spinal accessory)
- XII (hypoglossal)
1
Option 1:
The glossopharyngeal cranial nerve controls sensory functions in the tongue such as taste, touch, and temperature.
Option 2:
The vagus cranial nerve innervates (supplies organs with nerves) organs in the head, neck, and thoracic and abdominal cavities.
Option 3:
The cranial nerve XI, also known as the spinal accessory, controls movement of the head, neck, and shoulders.
Option 4:
The hypoglossal cranial nerve controls tongue movement.
Which cranial nerve, when affected because of Guillain-Barré syndrome (GBS), affects expressions such as smiling or frowning?
- Cranial nerve VII (facial nerve)
- Cranial nerve X (vagus)
- Cranial nerve XI (spinal accessory)
- Cranial nerve XII (hypoglossal)
1
Option 1:
The facial nerve (cranial nerve VII) is the most commonly nerve affected by GBS, and a client may have problems with facial expressions such as smiling or frowning.
Option 2:
The vagus nerve innervates (i.e., supplies with nerves) organs in the head, neck, and thoracic and abdominal cavities.
Option 3:
The cranial nerve XI or the spinal accessory controls movement of the head, neck, and shoulders.
Option 4:
The hypoglossal or cranial nerve XII controls tongue movement.
Which nursing intervention is essential while caring for a client with myasthenia gravis (MG)?
- Keeping the head of the bed in a lowered position
- Providing meals when medications are at trough levels
- Offering soft foods and thickened liquids per the order of the speech therapist
- Encouraging the client to refrain from taking breaks by keeping him/her involved in activities of daily living (ADLs)
3
Option 1:
Because weakness of the oropharyngeal muscles may increase the risk of aspiration, it is essential to raise the head of the bed when the client is eating or drinking.
Option 2:
Since MG causes difficulty and discomfort while chewing or swallowing, the nurse should provide meals to the client when medications are at peak levels.
Option 3:
Since MG may result in impaired swallowing, the nurse should offer soft foods and thickened liquids according to orders of the speech language pathologist.
Option 4:
Because MG causes fatigue and muscle weakness, the nurse should use energy conservation techniques such as encouraging the client to rest when ADLs are completed.
An RN is teaching nursing students about Guillain-Barré syndrome (GBS). Which statement of a nursing student indicates a need for further teaching?
- “It leads to flaccid paralysis.”
- “It is not an autoimmune disease.”
- “It leads to the destruction of the myelin between the nodes of Ranvier.”
- “It is acute inflammatory demyelinating polyneuropathy.”
2
GBS leads to a rapidly progressing flaccid paralysis.
Option 2:
In GBS, a client’s own immune system begins to destroy the myelin that surrounds the peripheral nerves, and destruction occurs between the nodes of Ranvier. So it is an autoimmune disease and is mediated by an immune response.
Option 3:
Destruction of the myelin occurs between the nodes of Ranvier in GBS.
Option 4:
GBS is an acute inflammatory demyelinating polyneuropathy (simultaneous dysfunction of peripheral nerves).
Which type of surgery is usually performed for a client with myasthenia gravis (MG)?
- Microvascular decompression
- Thymectomy
- Percutaneous rhizotomy
- Sterotactic radiosurgery
Thymectomy
Option 1:
This surgical procedure is used to treat trigeminal neuralgia. It involves placing a shredded fluorocarbon resin pad between the vessels and the nerve.
Option 2:
Thymectomy is a surgical procedure that is used for treating clients with MG. It is performed within the first 3 years of diagnosis in clients under age 65.
Option 3:
Percutaneous rhizotomy is a procedure in which a needle is inserted through the cheek into the foramen ovale for treating trigeminal neuralgia.
Option 4:
Sterotactic radiosurgery is not a surgical procedure but is a treatment that uses radiation therapy for treating trigeminal neuralgia.
A client is exhibiting autonomic dysfunction with cardiac dysrhythmia. Which cranial nerve damage is responsible for the client’s condition?
- VII
- IX
- X
- XII
x
Option 1:
VII is the facial nerve. When this nerve is affected, the client may have problems with facial expressions.
Option 2:
Damage of the IX nerve may cause dysphagia.
Option 3:
The X cranial nerve is the vagus nerve. Damage of the vagus nerve may lead to autonomic dysfunction with cardiac dysrhythmia.
Option 4:
Damage of the XII nerve may cause dysphagia.
A client diagnosed with myasthenia gravis is prescribed neostigmine. Which side effects are likely to be observed? Select all that apply.
- Anemia
- Leucopenia
- Bradycardia
- Muscle twitches
- Stomach cramps
all but 1
Option 1:
Anemia is associated with mycophenolate mofetil.
Option 2:
Leucopenia is associated with mycophenolate mofetil.
Option 3:
Neostigmine is a shorter-acting reversible inhibitor of acetylcholinesterase. A common side effect associated with neostigmine is bradycardia.
Option 4:
Muscle twitches are a side effect of neostigmine.
Option 5:
Stomach cramps are a side effect of neostigmine.
The pain in a client with trigeminal neuralgia is not relieved by the use of antiepileptics. Which nondrug treatment is most appropriate for the client?
- Microvascular decompression
- IV immunoglobulin
- Plasmapheresis
- Thymectomy
1
Option 1:
When a client’s pain is not relieved by the use of antiepileptics, microvascular decompression is used as the treatment.
Option 2:
IV immunoglobulin is a nondrug procedure used in the treatment of myasthenia gravis.
Option 3:
Plasmapheresis is a nondrug procedure used in the treatment of myasthenia gravis.
Option 4:
Thymectomy is a surgical procedure used in the management of myasthenia gravis.
Which device is considered to be the gold standard for monitoring intracranial pressure?
- Subarachnoid bolt
- Epidural sensor
- Intraventricular catheter
- Intraparenchymal sensor
3
Option 1:
A subarachnoid bolt is used to monitor intracranial pressure but is not considered to be the gold standard for the measurement of intracranial pressure. It can be inserted at the bedside or in the operating room.
Option 2:
An epidural sensor is used to monitor intracranial pressure but is not considered to be the gold standard for the measurement of intracranial pressure.
Option 3:
An intraventricular catheter is used for monitoring intracranial pressure and is considered to be the gold standard for the measurement of intracranial pressure because of the location of the tip of the catheter in the lateral ventricle.
Option 4:
An intraparenchymal sensor is fiber optic technology used in the monitoring of intracranial pressure but is not considered to be the gold standard.
The RN suspects lower cranial nerve dysfunction in a client with hemorrhagic stroke. Which diagnostic characteristic supports the nurse’s suspicion?
- Impaired swallowing
- Impaired family coping
- Impaired physical mobility
- Impaired verbal communication
1.
Option 1:
Impaired swallowing is related to lower cranial nerve dysfunction or decreased level of consciousness.
Option 2:
Impaired family coping is related to catastrophic illness.
Option 3:
Impaired physical mobility is related to hemiparesis.
Option 4:
Impaired verbal communication is related to decreased perfusion to the speech centers in the brain.
An RN is teaching a group of nursing students about trigeminal neuralgia. Which statement by a nursing student indicates a need for further teaching?
- “Trigeminal neuralgia results in facial pain.”
- “The fifth cranial nerve or the trigeminal nerve is affected in trigeminal neuralgia.”
- “Microvascular decompression is the least invasive and least effective treatment for trigeminal neuralgia.”
- “Carbamazepine may be used for treating trigeminal neuralgia.”
3
Option 1:
Trigeminal neuralgia affects facial sensation and strength of the jaw and results in facial pain.
Option 2:
The fifth cranial nerve is called the trigeminal nerve and is affected in trigeminal neuralgia.
Option 3:
Microvascular decompression is the most effective surgical treatment for trigeminal neuralgia and is the most invasive procedure.
Option 4:
Trigeminal neuralgia may be treated by antiepileptic drugs such as carbamazepine, which help in relieving neuropathic pain.
The primary health-care provider is performing the mini-mental status examination (MMSE) to assess cognitive function in different clients. Which client score indicates cognitive impairment?
- 16
- 21
- 25
- 29
1
The MMSE is a tool that is used to assess the cognitive function of a client. This tool assesses the client’s orientation, attention and calculation ability, memory, and language abilities. The client is asked to answer questions. For each correct answer, the client scores one point, with a total of 30 points available. A score below 20 is an indication of a cognitive impairment.
Option 2:
A score of 21 does not indicate cognitive impairment.
Option 3:
A score of 25 does not indicate cognitive impairment.
Option 4:
A score of 29 does not indicate cognitive impairment.
Which cranial nerve is associated with movement of the tongue with speech?
- IX
- X
- XI
- XII
4
Option 1:
The IX cranial nerve is the glossopharyngeal nerve that is associated with the regulation of blood pressure and respiration.
Option 2:
The X cranial nerve is the vagus nerve that is associated with taste and sensations of hunger and fullness.
Option 3:
The accessory nerve is the XI cranial nerve. It is associated with swallowing and head, neck, and shoulder movements.
Option 4:
The XII cranial nerve is the hypoglossal nerve, which is associated with movement of the tongue with speech, food manipulation, and swallowing.
Which is true regarding atropine?
- It works only at the neuromuscular junction.
- It results in severe bradycardia.
- It is a muscarinic stimulator.
- It is a muscarinic blocker.
4
Option 1:
Atropine works only in the autonomic nervous system, so it does not interfere with the activity at the neuromuscular junction.
Option 2:
Atropine is administered to reverse any severe bradycardia that may occur during the Tensilon or edrophonium test. It can be given to treat side effects during the Tensilon test.
Option 3:
Atropine is a muscarinic blocker that is administered to decrease the stimulation of the muscarinic receptors that leads to bradycardia in the heart and bronchospasm in the lungs during the Tensilon test.
Option 4:
Atropine is a muscarinic blocker, and the side effects of edrophonium and other acetylcholinesterase inhibitors can be reversed with this medication.
Which is true regarding single fiber electromyography (SFEMG? Select all that apply.
- It requires needles to be placed in the muscle to measure electrical activity.
- It involves IV administration of edrophonium.
- The recording from normal muscles shows two evoked responses from two muscle fibers firing with minimal fluctuation of the interval between the two.
- This test is an assay for detecting acetylcholine receptor antibodies in the serum.
- It is the most sensitive diagnostic tool for detecting an abnormality in neuromuscular transmission.
1, 3, 5
Option 1:
The SFEMG test requires needles to be placed in the muscle to measure electrical activity. It is a diagnostic test for myasthenia gravis.
Option 2:
The Tensilon test involves IV administration of edrophonium, an anticholinesterase drug. It is used to diagnose myasthenia gravis.
Option 3:
SFEMG involves placing needles in the muscles to measure and record electrical activity. The recording from normal muscles shows two evoked responses from two muscle fibers firing with minimal fluctuation between the two.
Option 4:
Serological testing detects acetylcholine receptor antibodies in the serum.
Option 5:
SFEMG is the most sensitive diagnostic tool for detecting an abnormality in neuromuscular transmission.
Which is true regarding percutaneous rhizotomy to treat trigeminal neuralgia? Select all that apply.
- In this process, a needle is inserted through the cheek into the foramen ovale.
- In this process, a lesion forms, which interrupts pain transmission to the brain.
- In this process, nerve fibers are damaged or destroyed.
- In this process, a shredded fluorocarbon resin pad is placed between the vessels and the nerve.
- In this process, clients may experience permanent facial numbness.
1, 3, 5
Option 1:
In percutaneous rhizotomy, a needle is inserted through the cheek into the foramen ovale.
Option 2:
Because of the dose of radiation in stereotactic radiosurgery, a lesion forms that interrupts pain transmission to the brain.
Option 3:
Percutaneous rhizotomy, radio frequency, glycerol injection, and balloon compression may result in damaged or destroyed nerve fibers.
Option 4:
In microvascular decompression, the neurosurgeon places a shredded fluorocarbon resin pad between the vessels and the nerve.
Option 5:
In a percutaneous rhizotomy, permanent facial numbness in the region supplied by the branch may occur.
Which is true regarding sterotactic radiosurgery?
- It refers to a procedure in which a needle is inserted.
- It is performed by inserting a shredded fluorocarbon resin pad.
- It is delivered through the cheek into the foramen ovale.
- It causes a lesion to form that interrupts pain transmission to the brain.
4
Option 1:
Percutaneous rhizotomy is a procedure in which a needle is inserted. Sterotactic radiosurgery is a procedure done by a single, high concentrated dose of ionizing radiation.
Option 2:
Neurovascular decompression is usually performed by keeping a shredded fluorocarbon resin pad between the vessels and the nerve.
Option 3:
In sterotactic radiosurgery, the ionizing radiation is delivered to a precise target at the trigeminal nerve root. In percutaneous rhizotomy, the needle is inserted through the cheek into the foramen ovale.
((Option 4:
The dose of radiation in sterotactic radiosurgery causes a lesion to form interrupting pain transmission to the brain.))
Which immunosuppressant medication is used to treat myasthenia gravis (MG)? Select all that apply.
- Cyclophosphamide
- Azathioprine
- Pyridostigmine
- Mycophenolate mofetil
- Neostigmine
1, 2, 4
((Option 1:
Cyclophosphamide is an immunosuppressant medication that may be used to let the client’s endogenous stem cells repopulate the immune system with the assistance of new lymphocytes.
Option 2:
Azathioprine is an immunosuppressant medication that may be used to inhibit T cell and B cell proliferation through interaction with purine metabolism and nucleic acid synthesis.))
Option 3:
Pyridostigmine may be considered as the accepted initial treatment of choice for an MG client, but it is not an immunosuppressant medication.
((Option 4:
Mycophenolate mofetil is an immunosuppressant medication that may be used to suppress both T cell and B cell proliferation.))
Option 5:
Neostigmine may be used while treating myasthenia gravis, but it is not an immunosuppressant medication.
Which is a clinical features of a myasthenic crisis? Select all that apply.
- Tachycardia
- Sweating and excessive secretions
- Pale, cool skin
- Bradycardia
- Flaccid muscles
1, 3, 5
((Option 1:
Tachycardia (an abnormally rapid heart rate) is a clinical feature of a myasthenic crisis.))
Option 2:
Sweating and excessive secretions are the clinical features of a cholinergic crisis.
Option 3:
A client affected by a myasthenic crisis may have pale, cool skin.
((Option 4:
Bradycardia (abnormally slow heart action) is seen in a client affected by a cholinergic crisis.
Option 5:
Myasthenic crisis is an issue that a client suffering from myasthenic gravis may encounter, and it is characterized by flaccid muscles.))
Which is a clinical features of a myasthenic crisis? Select all that apply.
- Tachycardia
- Sweating and excessive secretions
- Pale, cool skin
- Bradycardia
- Flaccid muscles
1, 3, 5
((Option 1:
Tachycardia (an abnormally rapid heart rate) is a clinical feature of a myasthenic crisis.))
Option 2:
Sweating and excessive secretions are the clinical features of a cholinergic crisis.
Option 3:
A client affected by a myasthenic crisis may have pale, cool skin.
((Option 4:
Bradycardia (abnormally slow heart action) is seen in a client affected by a cholinergic crisis.
Option 5:
Myasthenic crisis is an issue that a client suffering from myasthenic gravis may encounter, and it is characterized by flaccid muscles.))
Which statement by a nursing student regarding neostigmine for treating myasthenia gravis (MG) indicates a need for further teaching?
- “The ratio of IV neostigmine to oral pyridostigmine is 1:60.”
- “Oral pyridostigmine is administered 1 hour before stopping IV neostigmine.”
- “It is administered IV when the oral route is not available.”
- “It is a longer-acting acetylcholinesterase inhibitor.”
4
Option 1:
The ratio of IV neostigmine is 1 mg per 60 mg of oral pyridostigmine.
Option 2:
The nurse should administer oral pyridostigmine 1 hour before stopping the IV neostigmine.
Option 3:
Neostigmine is administered IV when a client’s oral route is not available because of surgery or other conditions such as Crohn’s disease, gastrointestinal bleeding, or paralytic ileus.
((Option 4:
Neostigmine is a shorter-acting acetylcholinesterase inhibitor.))
A client on drug therapy for myasthenia gravis (MG) has developed hyperglycemia and sleep disturbances. Which drug is most likely responsible for the client’s side effects?
- Prednisone
- Neostigmine
- Pyridostigmine
- Mycophenolate mofetil
1
Option 1:
Prednisone is a corticosteroid used in the treatment of MG. The side effects associated with this drug are hyperglycemia, weight gain, and sleep disturbances.
Option 2:
A client taking neostigmine may develop muscle cramps and diarrhea.
Option 3:
A client taking pyridostigmine may develop nausea and muscle twitches.
Option 4:
A client taking mycophenolate mofetil may have diarrhea, leucopenia, and anemia.
Which type of cerebral herniation syndrome is most likely to lead to stroke in the tissue surrounding the anterior cerebral artery?
- Uncal herniation
- Central herniation
- Tonsillar herniation
- Subfalcine herniation
4
In uncal herniation, an expanding lesion causes the tip of the temporal lobe to shift downward and inward toward the midbrain.
Option 2:
Central herniation occurs when the structures of the diencephalon and the tips of both temporal lobes are displaced.
Option 3:
Tonsillar herniation occurs when the bottom portion of the cerebellar hemispheres (tonsils) descend through the foramen magnum, damaging the medulla.
Option 4:
In a subfalcine herniation, brain tissue is shifted over and underneath the falx cerebri. There is risk of compression to the anterior cerebral artery, which may cause a stroke in the surrounding region of brain tissue.
