Question 1

A nurse is teaching a client with multiple sclerosis who is prescribed cyclophosphamide (Cytoxan)and methylprednisolone (Medrol).Which statement should the nurse include in this client's discharge teaching?

Accepted Answer

The client should be taught to avoid people with any type of upper respiratory illness because these medications are immunosuppressive.Warm baths will exacerbate the client's symptoms.Assistive devices may be required for safe ambulation.Medication should be taken at all times and should not be stopped.

Question 2

A nurse cares for several clients on a neurologic unit.Which prescription for a client should direct the nurse to ensure that an informed consent has been obtained before the test or procedure?

Accepted Answer

A lumbar puncture is an invasive procedure with many potentially serious complications.The other assessments or tests are considered noninvasive and do not require an informed consent.

Question 3

A nurse assesses a client with multiple sclerosis after administering prescribed fingolimod (Gilenya).For which adverse effect should the nurse monitor?

Accepted Answer

Fingolimod (Gilenya)is an antineoplastic agent that can cause bradycardia,especially within the first 6 hours after administration.Peripheral edema,black and tarry stools,and nausea and vomiting are not adverse effects of fingolimod.

Question 4

A nurse promotes the prevention of lower back pain by teaching clients at a community center.Which instruction should the nurse include in this education?

Accepted Answer

Exercise can strengthen back muscles,reducing the incidence of low back pain.The other options will not prevent low back pain.

Question 5

A nurse assesses clients at a community center.Which client is at greatest risk for lower back pain?

Accepted Answer

Osteoarthritis causes changes to support structures,increasing the client's risk for low back pain.The other clients are not at high risk.

Question 6

A nurse teaches a client with a lower motor neuron lesion who wants to achieve bladder control.Which statement should the nurse include in this client's teaching?

Accepted Answer

In clients with lower motor neuron problems such as spinal cord injury,performing a Valsalva maneuver or tightening the abdominal muscles are interventions that can initiate voiding.Stroking the inner aspect of the thigh may initiate voiding in a client who has an upper motor neuron problem.Intermittent catheterization and digital anal stimulation do not initiate voiding or bladder control.

Question 7

A nurse assesses a client who is recovering from a diskectomy 6 hours ago.Which assessment finding should the nurse address first?

Accepted Answer

A distended bladder may indicate damage to the sacral spinal nerves.The other findings require the nurse to provide care but are not the priority or a complication of the procedure.

Question 8

A nurse assesses a client with a neurologic disorder.Which assessment finding should the nurse identify as a late manifestation of amyotrophic lateral sclerosis (ALS)?

Accepted Answer

In ALS,progressive muscle atrophy occurs until a flaccid quadriplegia develops.Eventually,the respiratory muscles are involved,which leads to respiratory compromise.Dysarthria,dysphagia,and muscle weakness are early clinical manifestations of ALS.

Question 9

A nurse cares for a client who presents with an acute exacerbation of multiple sclerosis (MS).Which prescribed medication should the nurse prepare to administer?

Accepted Answer

Methylprednisolone is the drug of choice for acute exacerbations of the disease.The other drugs are not used to treat acute exacerbations of MS.Interferon beta-1b is used to treat and control MS,decrease specific symptoms,and slow the progression of the disease.Baclofen and dantrolene sodium are prescribed to lessen muscle spasticity associated with MS.

Question 10

A nurse assesses a client with early-onset multiple sclerosis (MS).Which clinical manifestation should the nurse expect to find?

Accepted Answer

Early signs and symptoms of MS include changes in motor skills,vision,and sensation.Hyperresponsive reflexes,excessive somnolence,and heat intolerance are later manifestations of MS.

Question 11

A nurse prepares a client for prescribed magnetic resonance imaging (MRI).Which action should the nurse implement prior to the test?

Accepted Answer

Metal objects are a hazard because of the magnetic field used in the MRI procedure.Morphine sulfate is not administered to prevent claustrophobia; lorazepam (Ativan)or diazepam (Valium)may be used instead.The client does not need to be NPO,and daily medications do not need to be withheld prior to MRI.

Question 12

An emergency room nurse initiates care for a client with a cervical spinal cord injury who arrives via emergency medical services.Which action should the nurse take first?

Accepted Answer

The first priority for a client with a spinal cord injury is assessment of respiratory status and airway patency.Clients with cervical spine injuries are particularly prone to respiratory compromise and may even require intubation.The other assessments should be performed after airway and breathing are assessed.

Question 13

After teaching a client with a spinal cord injury,the nurse assesses the client's understanding.Which client statement indicates a correct understanding of how to prevent respiratory problems at home?

Accepted Answer

Often,the person with a spinal cord injury will have weak intercostal muscles and is at higher risk for developing atelectasis and stasis pneumonia.Using an incentive spirometer every 2 hours helps the client expand the lungs more fully and prevents atelectasis.Clients should drink fluids that they can tolerate; usually thick fluids are easier to tolerate.The client should be encouraged to cough and clear secretions.Clients should be placed in high-Fowler's position to prevent aspiration.

Question 14

A nurse assesses a client who is recovering from anterior cervical diskectomy and fusion.Which complication should alert the nurse to urgently communicate with the health care provider?

Accepted Answer

Postoperative swelling can narrow the trachea,cause a partial airway obstruction,and manifest as stridor.The client may also have trouble swallowing,but maintaining an airway takes priority.Weak pedal pulses and an inability to shrug the shoulders are not complications of this surgery.

Question 15

An emergency department nurse cares for a client who experienced a spinal cord injury 1 hour ago.Which prescribed medication should the nurse prepare to administer?

Accepted Answer

Methylprednisolone (Medrol)should be given within 8 hours of the injury.Clients who receive this therapy usually show improvement in motor and sensory function.The other medications are inappropriate for this client.

Question 16

A nurse assesses a client with a spinal cord injury at level T5.The client's blood pressure is 184/95 mm Hg,and the client presents with a flushed face and blurred vision.Which action should the nurse take first?

Accepted Answer

The client is manifesting symptoms of autonomic dysreflexia.Common causes include bladder distention,tight clothing,increased room temperature,and fecal impaction.If persistent,the client could experience neurologic injury.Precipitating conditions should be eliminated and the physician notified.The other actions would not be appropriate.

Question 17

A nurse teaches a client who is recovering from a spinal fusion.Which statement should the nurse include in this client's postoperative instructions?

Accepted Answer

Clients who undergo spinal fusion are fitted with a brace that they must wear throughout the healing process (usually 3 to 6 months)whenever they are out of bed.The client should not lift anything.The client does not need to remain in bed.Medications for rejection prevention are not necessary for this procedure.

Question 18

A nurse plans care for a client with lower back pain from a work-related injury.Which intervention should the nurse include in this client's plan of care?

Accepted Answer

Heat increases blood flow to the affected area and promotes healing of injured nerves.Stretching and ice will not promote healing,and there is no need to avoid warm baths or showers.

Question 19

A nurse is caring for a client with paraplegia who is scheduled to participate in a rehabilitation program.The client states,"I do not understand the need for rehabilitation; the paralysis will not go away and it will not get better." How should the nurse respond?

Accepted Answer

Participation in rehabilitation programs has many purposes,including prevention of disability,maintenance of functional ability,and restoration of function.The other responses do not meet this client's needs.

Question 20

A nurse cares for a client with a spinal cord injury.With which interdisciplinary team member should the nurse consult to assist the client with activities of daily living?

Accepted Answer

The occupational therapist instructs the client in the correct use of all adaptive equipment.In collaboration with the therapist,the nurse instructs family members or the caregiver about transfer skills,feeding,bathing,dressing,positioning,and skin care.The other team members are consulted to assist the client with unrelated issues.

Quiz 43: Care of Patients with Problems of the Central Nervous System: The Spinal Cord

A nurse is teaching a client with multiple sclerosis who is prescribed cyclophosphamide (Cytoxan) and methylprednisolone (Medrol) .Which statement should the nurse include in this client's discharge teaching?