Deck 59: Nursing Management: Chronic Neurologic Problems

Question 1

A patient has a tonic-clonic seizure while the nurse is in the patient's room. During the seizure, it is important for the nurse to

A) insert an oral airway during the seizure to maintain a patent airway.
B) restrain the patient's arms and legs to prevent injury during the seizure.
C) avoid touching the patient to prevent further nervous system stimulation.
D) time and observe and record the details of the seizure and postictal state.

Answer 1

time and observe and record the details of the seizure and postictal state.

Question 2

After teaching a patient about management of migraine headaches, the nurse determines that the teaching has been effective when the patient says,

A) "I will take the topiramate (Topamax) as soon as any headaches start."
B) "The sumatriptan (Imitrex) will help to increase the blood flow to my brain."
C) "I will try to lie down someplace dark and quiet when the headaches begin."
D) "A glass of wine might help me relax and prevent headaches from developing."

Answer 2

"I will try to lie down someplace dark and quiet when the headaches begin."

Question 3

The nurse witnesses a patient with a seizure disorder as the patient suddenly jerks the arms and legs, falls to the floor, and regains consciousness immediately. It will be most important for the nurse to

A) document the timing and description of the seizure.
B) notify the patient's health care provider about the seizure.
C) give the scheduled dose of divalproex (Depakote).
D) assess the patient for a possible head injury.

Answer 3

assess the patient for a possible head injury.

Question 4

A hospitalized patient complains of a moderate bilateral headache that radiates from the base of the skull. Which of the following medications ordered on a PRN basis for the patient should the nurse administer initially?

A) Lorazepam (Ativan)
B) Acetaminophen (Tylenol)
C) Morphine sulfate (Roxanol)
D) Butalbital and aspirin (Fiorinal)

Question 5

The health care provider prescribes phenytoin (Dilantin) for control of complex partial seizures. After the nurse has taught the patient about phenytoin, which patient statement indicates understanding of the medication?

A) "I should use soft swabs rather than a toothbrush to clean my mouth."
B) "After I have a seizure, I should call an ambulance to take me to the hospital."
C) "I may need to have my blood taken frequently to check the level of the Dilantin."
D) "I will take the medication at the beginning of the seizure when I experience an aura."

Question 6

The health care provider is considering the use of sumatriptan (Imitrex) for a patient with migraine headaches. Which information obtained by the nurse is most important to report to the health care provider?

A) The patient has a history of a recent acute myocardial infarction.
B) The patient has had migraine headaches for 30 years.
C) The patient has been taking topiramate (Topamax) for 2 months.
D) The patient has at least 1 to 2 cups of coffee daily.

Question 7

A patient with multiple sclerosis (MS) has a nursing diagnosis of urinary retention related to sensorimotor deficits. An appropriate nursing intervention for this problem is to

A) decrease fluid intake in the evening.
B) teach the patient how to use the Credé method.
C) suggest the use of incontinence briefs for nighttime use only.
D) assist the patient to the commode every 2 hours during the day.

Question 8

A patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). In planning the patient teaching necessary with the use of the drug, the nurse recognizes that the patient will need to be taught

A) how to draw up and administer injections of the medication.
B) use of contraceptive methods other than oral contraceptives for birth control.
C) to plan laboratory monitoring of CBC, chemistries, and liver function every 3 months.
D) that the drug will control symptoms but has no effect on the progression of the disease.

Question 9

When obtaining a health history and physical assessment for a patient with possible multiple sclerosis (MS), the nurse should

A) confirm patient information with family members.
B) ask about a recent history of temperature spikes.
C) question the patient about any leg weakness or spasm.
D) determine whether hypersexuality has caused problems.

Question 10

The nurse identifies the nursing diagnosis of impaired physical mobility related to bradykinesia for a patient with Parkinson's disease. To assist the patient to ambulate safely, the nurse should

A) allow the patient to ambulate only with assistance.
B) instruct the patient to rock from side to side to initiate leg movement.
C) have the patient take small steps in a straight line directly in front of the feet.
D) teach the patient to keep the feet in contact with the floor and slide them forward.

Question 11

A 28-year-old woman has had multiple sclerosis (MS) for 3 years and wants to have children before her disease worsens. When she asks about the risks associated with pregnancy, the nurse explains that

A) MS is associated with a slightly increased risk for congenital defects.
B) symptoms of MS are likely to become worse during her pregnancy.
C) women with MS frequently have premature labor.
D) MS symptoms may be worse after the pregnancy.

Question 12

A patient seen at the health clinic with a severe migraine headache tells the nurse about having four similar headaches in the last 3 months. The patient says, "I am afraid to make social plans because I never know when I will have these headaches." The most appropriate nursing action at this time is to

A) refer the patient for counseling to assist with stress reduction.
B) ask the patient to keep a diary with details about headaches.
C) encourage the patient to learn muscle-relaxation techniques to minimize headache frequency.
D) teach the patient about the effectiveness of the triptan drugs in treating migraine headaches.

Question 13

After experiencing a generalized tonic-clonic seizure in the classroom, an elementary school teacher is evaluated and diagnosed with idiopathic epilepsy. The patient cries and tells the nurse, "I can not teach anymore. It will be too difficult for the students if this happens again at work." The most appropriate nursing diagnosis for the patient is

A) anxiety related to loss of control during seizures.
B) hopelessness related to diagnosis of chronic illness.
C) disturbed body image related to new diagnosis of a seizure disorder.
D) ineffective role performance related to misinformation about epilepsy.

Question 14

A patient who has been taking bromocriptine (Parlodel) and benztropine (Cogentin) for Parkinson's disease is experiencing a worsening of symptoms. The nurse will anticipate that patient may benefit from

A) complete drug withdrawal for a few weeks.
B) use of levodopa (L-dopa)-carbidopa (Sinemet).
C) withdrawal of anticholinergic therapy.
D) increasing the dose of bromocriptine.

Question 15

A patient experiences cluster headaches that occur for 2 months every year. During assessment of the patient who is experiencing a headache episode, the nurse would expect to find

A) nuchal rigidity.
B) projectile vomiting.
C) unilateral eyelid swelling.
D) throbbing, bilateral facial pain.

Question 16

When planning care for a patient with MS who has a nursing diagnosis of risk for activity intolerance related to extremity weakness secondary to stress, the most appropriate patient goal is

A) "The patient will express minimal stress level."
B) "Strength in arms and legs will be maintained."
C) "The patient will complete ADLs without fatigue."
D) "Intake of high-nutrition foods will be adequate."

Question 17

When teaching the patient with newly diagnosed multiple sclerosis (MS) about the disease, the nurse explains that

A) MS is a congenitally acquired illness that causes progressive neurologic deterioration.
B) impulses travel too fast over nerves that have lost their myelin coat and cause overstimulation of muscle fibers.
C) autoimmune processes cause gradual destruction of the myelin sheath of nerves in the brain and spinal cord.
D) antibodies are produced against acetylcholine receptors at the synapse and result in blocked muscle contraction.

Question 18

When a patient is being evaluated for new onset cluster-type headaches, the nurse will anticipate

A) scheduling a magnetic resonance imaging (MRI) of the brain.
B) teaching the patient about electromyelography (EMG).
C) obtaining a detailed patient history.
D) arranging for a cerebral angiogram.

Question 19

A patient found in a tonic-clonic seizure reports afterward that the seizure was preceded by numbness and tingling of the arm. The nurse knows that this finding indicates a(n) _____ seizure.

A) absence
B) simple partial
C) complex partial
D) generalized myoclonic

Question 20

When a patient experiences a generalized tonic-clonic seizure in the emergency department after a head injury, all of the following orders are received. Which one will the nurse implement first?

A) Send to radiology for computed tomography (CT) scan.
B) Administer midazolam (Versed).
C) Check capillary blood glucose.
D) Monitor level of consciousness (LOC).

Question 21

A patient with myasthenia gravis (MG) is admitted to the hospital with severe weakness and acute respiratory insufficiency. The health care provider performs a Tensilon test to distinguish between myasthenic crisis and cholinergic crisis. During the test, it will be most important to monitor the patient's

A) pupillary size.
B) muscle strength.
C) respiratory function.
D) level of consciousness (LOC).

Question 22

When teaching a patient with myasthenia gravis (MG) about management of the disease, the nurse advises the patient to

A) anticipate the need for weekly plasmapheresis treatments.
B) protect the extremities from injury due to poor sensory perception.
C) do frequent weight-bearing exercise to prevent muscle atrophy.
D) perform necessary physically demanding activities in the morning.

Question 23

A patient with amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care?

A) Observing for agitation and paranoia
B) Assisting the patient with active range of motion (ROM)
C) Using simple words and phrases to explain procedures
D) Administer muscle relaxants as needed for muscle spasms

Question 24

A patient is seen in the health clinic with symptoms of a stooped posture, shuffling gait, and pill rolling-type tremor. The nurse will anticipate teaching the patient about

A) preparation for an MRI.
B) purpose of EEG testing.
C) antiparkinsonian drugs.
D) oral corticosteroids.

Question 25

A hospitalized 24-year-old patient with a history of cluster headache awakens during the night with a severe stabbing headache. Which action should the nurse take first?

A) Notify the patient's health care provider immediately.
B) Start the ordered PRN oxygen at 9 L/min.
C) Give the ordered prn acetaminophen (Tylenol).
D) Put a moist hot pack on the patient's neck.

Question 26

When preparing to admit a patient who has been treated for status epilepticus in the emergency department, which equipment should the nurse have available in the room? (Select all that apply.)

A) Suction tubing
B) Oxygen mask
C) Nasogastric tube
D) Siderail pads
E) Tongue blade
F) Oral airway

Question 27

A patient has a new prescription for levodopa (L-dopa) to control symptoms of Parkinson's disease. Which assessment data obtained by the nurse may indicate a need for a decrease in the dose?

A) The patient has a chronic dry cough.
B) The patient has 4 loose stools in a day.
C) The patient develops a deep vein thrombosis.
D) The patient's blood pressure is 90/46 mm Hg.

Question 28

A patient with Parkinson's disease is admitted to the hospital for treatment of an acute infection. Which nursing interventions will be included in the plan of care? (Select all that apply.)

A) Cut patient's food into small pieces.
B) Provide high protein foods at each meal.
C) Observe for sudden exacerbation of symptoms.
D) Remind the patient to keep eyes ahead when ambulating.
E) Place an arm chair at the patient's bedside.
F) Use an elevated toilet seat.

Question 29

Which information obtained about a 75-year-old patient with new-onset seizures will be of concern to the nurse when the patient is being started on therapy with phenytoin (Dilantin)?

A) The patient has a history of chronic hepatitis C.
B) The patient experienced menopause at age 52.
C) The patient lives alone in an assisted living facility.
D) The patient has had a recent right hemisphere stroke.

Question 30

A 42-year-old patient who was adopted at birth is diagnosed with early Huntington's disease (HD). When teaching the patient, spouse, and children about this disorder, the nurse will provide information about the

A) use of levodopa-carbidopa (Sinemet) to help reduce HD symptoms.
B) need to take prophylactic antibiotics to decrease the risk for pneumonia.
C) lifestyle changes, such as increased exercise, that delay disease progression.
D) availability of genetic testing to determine the HD risk for the patient's children.

Question 31

A patient with restless legs syndrome (RLS) tells the nurse, "My leg pain and twitching keep me awake so much of the night, I am tired most of the day. Is there anything I can do?" Based on this information, which nursing diagnosis is most appropriate?

A) Ineffective role performance related to fatigue
B) Chronic pain related to RLS
C) Anxiety related to lack of knowledge about RLS treatment
D) Sleep deprivation related to leg pain and involuntary movement

Question 32

A patient with Parkinson's disease has decreased tongue mobility and an inability to move the facial muscles. The nurse recognizes that these impairments commonly contribute to the nursing diagnosis of

A) disuse syndrome related to loss of muscle control.
B) self-care deficit related to bradykinesia and rigidity.
C) impaired verbal communication related to difficulty articulating.
D) impaired oral mucous membranes related to inability to swallow.

Question 33

A hospitalized patient with myasthenia gravis (MG) has a nursing diagnosis of imbalanced nutrition: less than body requirements related to impaired swallowing. To promote nutrition, the nurse suggests that before meals the patient should avoid

A) watching television.
B) talking on the phone.
C) typing on the computer.
D) ambulating in the halls.