Question 1

The nurse is caring for a 77-year-old woman with MS. She states that she is very concerned about the progress of her disease and what the future holds. The nurse should know that elderly patients with MS are known to be particularly concerned about what variables? Select all that apply.

Accepted Answer

A)   Possible nursing home placement
B)   Pain associated with physical therapy
C)   Increasing disability
D)   Becoming a burden on the family
E)   Loss of appetite A, C, D

Question 2

A patient is being admitted to the neurologic ICU with suspected herpes simplex virus encephalitis. What nursing action best addresses the patients complaints of headache?

Accepted Answer

A)   Initiating a patient-controlled analgesia (PC
A)   of morphine sulfate
B)   Administering hydromorphone (Dilaudid)  IV as needed
C)   Dimming the lights and reducing stimulation
D)   Distracting the patient with activity C

Question 3

A patient with possible bacterial meningitis is admitted to the ICU. What assessment finding would the nurse expect for a patient with this diagnosis?

Accepted Answer

A)   Pain upon ankle dorsiflexion of the foot
B)   Neck flexion produces flexion of knees and hips
C)   Inability to stand with eyes closed and arms extended without swaying
D)   Numbness and tingling in the lower extremities B

Question 4

A 73-year-old man comes to the clinic complaining of weakness and loss of sensation in his feet and legs. Assessment of the patient shows decreased reflexes bilaterally. Why would it be a challenge to diagnose a peripheral neuropathy in this patient?

Accepted Answer

A)   Older adults are often vague historians.
B)   The elderly have fewer peripheral nerves than younger adults.
C)   Many older adults are hesitant to admit that their body is changing.
D)   Many symptoms can be the result of normal aging process.

Question 5

The critical care nurse is admitting a patient in myasthenic crisis to the ICU. The nurse should prioritize what nursing action in the immediate care of this patient?

Accepted Answer

A)   Suctioning secretions
B)   Facilitating ABG analysis
C)   Providing ventilatory assistance
D)   Administering tube feedings

Question 6

A patient diagnosed with myasthenia gravis has been hospitalized to receive plasmapheresis for a myasthenic exacerbation. The nurse knows that the course of treatment for plasmapheresis in a patient with myasthenia gravis is what?

Accepted Answer

A)   Every day for 1 week
B)   Determined by the patients response
C)   Alternate days for 10 days
D)   Determined by the patients weight

Question 7

A patient diagnosed with Bells palsy is being cared for on an outpatient basis. During health education, the nurse should promote which of the following actions?

Accepted Answer

A)   Applying a protective eye shield at night
B)   Chewing on the affected side to prevent unilateral neglect
C)   Avoiding the use of analgesics whenever possible
D)   Avoiding brushing the teeth

Question 8

You are the clinic nurse caring for a patient with a recent diagnosis of myasthenia gravis. The patient has begun treatment with pyridostigmine bromide (Mestinon). What change in status would most clearly suggest a therapeutic benefit of this medication?

Accepted Answer

A)   Increased muscle strength
B)   Decreased pain
C)   Improved GI function
D)   Improved cognition

Question 9

A patient diagnosed with MS has been admitted to the medical unit for treatment of an MS exacerbation. Included in the admission orders is baclofen (Lioresal). What should the nurse identify as an expected outcome of this treatment?

Accepted Answer

A)   Reduction in the appearance of new lesions on the MRI
B)   Decreased muscle spasms in the lower extremities
C)   Increased muscle strength in the upper extremities
D)   Decreased severity and duration of exacerbations

Question 10

The nurse caring for a patient diagnosed with Guillain-Barr syndrome is planning care with regard to the clinical manifestations associated this syndrome. The nurses communication with the patient should reflect the possibility of what sign or symptom of the disease?

Accepted Answer

A)   Intermittent hearing loss
B)   Tinnitus
C)   Tongue enlargement
D)   Vocal paralysis

Question 11

A patient presents at the clinic complaining of pain and weakness in her hands. On assessment, the nurse notes diminished reflexes in the upper extremities bilaterally and bilateral loss of sensation. The nurse knows that these findings are indicative of what?

Accepted Answer

A)   Guillain-Barr syndrome
B)   Myasthenia gravis
C)   Trigeminal neuralgia
D)   Peripheral nerve disorder

Question 12

To alleviate pain associated with trigeminal neuralgia, a patient is taking Tegretol (carbamazepine). What health education should the nurse provide to the patient before initiating this treatment?

Accepted Answer

A)   Concurrent use of calcium supplements is contraindicated.
B)   Blood levels of the drug must be monitored.
C)   The drug is likely to cause hyperactivity and agitation.
D)   Tegretol can cause tinnitus during the first few days of treatment.

Question 13

The nurse caring for a patient in ICU diagnosed with Guillain-Barr syndrome should prioritize monitoring for what potential complication?

Accepted Answer

A)   Impaired skin integrity
B)   Cognitive deficits
C)   Hemorrhage
D)   Autonomic dysfunction

Question 14

A middle-aged woman has sought care from her primary care provider and undergone diagnostic testing that has resulted in a diagnosis of MS. What sign or symptom is most likely to have prompted the woman to seek care?

Accepted Answer

A)   Cognitive declines
B)   Personality changes
C)   Contractures
D)   Difficulty in coordination

Question 15

The nurse is working with a patient who is newly diagnosed with MS. What basic information should the nurse provide to the patient?

Accepted Answer

A)   MS is a progressive demyelinating disease of the nervous system.
B)   MS usually occurs more frequently in men.
C)   MS typically has an acute onset.
D)   MS is sometimes caused by a bacterial infection.

Question 16

The nurse is teaching a patient with Guillain-Barr syndrome about the disease. The patient asks how he can ever recover if demyelination of his nerves is occurring. What would be the nurses best response?

Accepted Answer

A)   Guillain-Barr spares the Schwann cell, which allows for remyelination in the recovery phase of the disease.
B)   In Guillain-Barr, Schwann cells replicate themselves before the disease destroys them, so remyelination is possible.
C)   I know you understand that nerve cells do not remyelinate, so the physician is the best one to answer your question.
D)   For some reason, in Guillain-Barr, Schwann cells become activated and take over the remyelination process.

Question 17

The nurse is caring for a patient who is hospitalized with an exacerbation of MS. To ensure the patients safety, what nursing action should be performed?

Accepted Answer

A)   Ensure that suction apparatus is set up at the bedside.
B)   Pad the patients bed rails.
C)   Maintain bed rest whenever possible.
D)   Provide several small meals each day.

Question 18

The nurse is creating a plan of care for a patient who has a recent diagnosis of MS. Which of the following should the nurse include in the patients care plan?

Accepted Answer

A)   Encourage patient to void every hour.
B)   Order a low-residue diet.
C)   Provide total assistance with all ADLs.
D)   Instruct the patient on daily muscle stretching.

Question 19

A 48-year-old patient has been diagnosed with trigeminal neuralgia following recent episodes of unilateral face pain. The nurse should recognize what implication of this diagnosis?

Accepted Answer

A)   The patient will likely require lifelong treatment with anticholinergic medications.
B)   The patient has a disproportionate risk of developing myasthenia gravis later in life.
C)   The patient needs to be assessed for MS.
D)   The disease is self-limiting and the patient will achieve pain relief over time.

Question 20

A patient with metastatic cancer has developed trigeminal neuralgia and is taking carbamazepine (Tegretol) for pain relief. What principle applies to the administration of this medication?

Accepted Answer

A)   Tegretol is not known to have serious adverse effects.
B)   The patient should be monitored for bone marrow depression.
C)   Side effects of the medication include renal dysfunction.
D)   The medication should be first taken in the maximum dosage form to be effective.

Exam 68: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies