Deck 59: Nursing Management: Chronic Neurologic Problems

Question 1

When a patient is experiencing a cluster headache, the nurse will plan to assess for

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

Answer 1

unilateral eyelid swelling.

Question 2

An elementary teacher who has just been diagnosed with epilepsy after having a generalized tonic-clonic seizure tells the nurse, "I cannot teach anymore, it will be too upsetting if I have a seizure at work." Which response by the nurse is best?

A) "You may want to contact the Epilepsy Foundation for assistance."
B) "You might benefit from some psychologic counseling at this time."
C) "The Department of Vocational Rehabilitation can help with work retraining."
D) "Most patients with epilepsy are well controlled with antiseizure medications."

Answer 2

"Most patients with epilepsy are well controlled with antiseizure medications."

Question 3

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) oral corticosteroids.
B) antiparkinsonian drugs.
C) the purpose of electroencephalogram (EEG) testing.
D) preparation for magnetic resonance imaging (MRI).

Answer 3

antiparkinsonian drugs.

Question 4

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 (Topamax) as soon as any headaches start."
B) "I should avoid taking aspirin and sumatriptan (Imitrex) at the same time."
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."

Question 5

Which action will the nurse take when evaluating a patient who is taking phenytoin (Dilantin) for adverse effects of the medication?

A) Inspect the oral mucosa.
B) Listen to the lung sounds.
C) Auscultate the bowel tones.
D) Check pupil reaction to light.

Question 6

A patient with multiple sclerosis (MS) has urinary retention caused by a flaccid bladder. Which action will the nurse plan to take?

A) Teach the patient how to use the Credé method.
B) Decrease the patient's fluid intake in the evening.
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 7

A patient who is seen in the outpatient clinic complains of restless legs syndrome. Which of the following over-the-counter medications that the patient is taking routinely should the nurse discuss with the patient?

A) multivitamin (Stresstabs)
B) acetaminophen (Tylenol)
C) ibuprofen (Motrin, Advil)
D) diphenhydramine (Benadryl)

Question 8

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

A) Assist with active range of motion.
B) Observe for agitation and paranoia.
C) Give muscle relaxants as needed to reduce spasms.
D) Use simple words and phrases to explain procedures.

Question 9

A hospitalized patient complains of a moderate bilateral headache that radiates from the base of the skull. Which of these prescribed PRN medications should the nurse administer initially?

A) lorazepam (Ativan)
B) acetaminophen (Tylenol)
C) morphine sulfate (Roxanol)
D) butalbital and aspirin (Fiorinal)

Question 10

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

A) assess for the presence of chest pain.
B) inquire about any urinary tract problems.
C) inspect the skin for rashes or discoloration.
D) question the patient about any increase in libido.

Question 11

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. Which initial action should the nurse take?

A) Refer the patient for stress counseling.
B) Ask the patient to keep a headache diary.
C) Suggest the use of muscle-relaxation techniques.
D) Teach about the effectiveness of the triptan drugs.

Question 12

Which information about a patient with MS indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine ( Ampyra )?

A) The patient has relapsing-remitting MS.
B) The patient enjoys walking for relaxation.
C) The patient has an increased creatinine level.
D) The patient complains of pain with neck flexion.

Question 13

A patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching?

A) Recommendation to drink at least 3 to 4 L daily
B) Need to avoid driving or operating heavy machinery
C) How to draw up and administer injections of the medication
D) Use of contraceptive methods other than oral contraceptives

Question 14

A patient has a tonic-clonic seizure while the nurse is in the patient's room. Which action should the nurse take?

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.

Question 15

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

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

Question 16

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 17

A 28-year-old woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate?

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

Question 18

A patient with Parkinson's disease has a nursing diagnosis of impaired physical mobility related to bradykinesia. Which action will the nurse include in the plan of care?

A) Instruct the patient in activities that can be done while lying or sitting.
B) Suggest that the patient 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 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 what type of seizure?

A) Atonic
B) Partial
C) Absence
D) Myoclonic

Question 20

A patient has a new prescription for bromocriptine (Parlodel) to control symptoms of Parkinson's disease. Which information 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 four 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 21

When the home health RN is planning care for a patient with a seizure disorder, which nursing action can be delegated to an LPN/LVN?

A) Make referrals to appropriate community agencies.
B) Place medications in the home medication organizer.
C) Teach the patient and family how to manage seizures.
D) Assess for use of medications that may precipitate seizures.

Question 22

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) Start the ordered PRN oxygen at 6 L/min.
B) Put a moist hot pack on the patient's neck.
C) Give the ordered PRN acetaminophen (Tylenol).
D) Notify the patient's health care provider immediately.

Question 23

A patient with Parkinson's disease has decreased tongue mobility and an inability to move the facial muscles. Which nursing diagnosis is of highest priority?

A) Activity intolerance
B) Self-care deficit: toileting
C) Ineffective self-health management
D) Imbalanced nutrition: less than body requirements

Question 24

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

Question 25

A patient tells the nurse about using acetaminophen (Tylenol) several times every day for recurrent bilateral headaches. Which action will the nurse plan to take first?

A) Discuss the need to stop taking the acetaminophen.
B) Suggest the use of biofeedback for headache control.
C) Teach the patient about magnetic resonance imaging (MRI).
D) Describe the use of botulism toxin (BOTOX) for headaches.

Question 26

When the nurse is assessing a patient with myasthenia gravis, which action will be most important to take?

A) Check pupillary size.
B) Monitor grip strength.
C) Observe respiratory effort.
D) Assess level of consciousness.

Question 27

Following a thymectomy, a patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first?

A) Auscultate the patient's bowel sounds.
B) Notify the patient's health care provider.
C) Administer the prescribed PRN antiemetic drug.
D) Give the scheduled dose of prednisone (Deltasone).

Question 28

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) Siderail pads
B) Tongue blade
C) Oxygen mask
D) Suction tubing
E) Nasogastric tube

Question 29

Which of these prescribed interventions will the nurse implement first for a hospitalized patient who is experiencing continuous tonic-clonic seizures?

A) Give phenytoin ( Dilantin ) 100 mg IV.
B) Monitor level of consciousness ( LOC ).
C) Obtain computed tomography ( CT ) scan.
D) Administer lorazepam ( Ativan ) 4 mg IV.

Question 30

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

Question 31

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

Question 32

Which information about a patient who is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease is most important for the nurse to report to the health care provider?

A) Shuffling gait
B) Tremor at rest
C) Cogwheel rigidity of limbs
D) Uncontrolled head movement