Question 1

What action should the nurse implement when a patient falls to the floor in a generalized seizure?

Accepted Answer

The nurse should cradle the patient's head to prevent injury during a seizure, but should not insert an object between the teeth or manually restrain the limbs, as this can cause further harm to the patient. It is also not advisable to keep the patient on their back, as this can lead to aspiration if the patient vomits during the seizure.

Question 2

A nurse caring for an immobilized patient with a brain tumor stimulates the patient several times a day with range-of-motion exercises and changes his position every 2 hours to try to prevent a disuse syndrome.What signs and symptoms does disuse syndrome include? (Select all that apply.)

Accepted Answer

Disuse syndrome can lead to complications such as pooling of pulmonary secretions due to inactivity, which can cause respiratory issues, and pressure ulcers from prolonged pressure on the skin, especially in immobilized patients.

Question 3

The ______ of the seizure is characterized by stiffening of the muscles or extremities with loss of consciousness.

Accepted Answer

tonic phase

Question 4

A patient with Parkinson disease is depressed because his drug protocol of L-dopa and Sinemet is no longer controlling his symptoms.What is the best response by the nurse?

Accepted Answer

Other drugs such as MAO-B inhibitors, dopamine agonists, and COMT inhibitors can be combined with L-dopa to increase its effectiveness and control Parkinson symptoms.

Question 5

Which intervention supports nutritional intake in a patient with Parkinson disease?

Accepted Answer

Thickening liquids can help patients with Parkinson's disease swallow more safely, reducing the risk of aspiration.

Question 6

A patient with generalized convulsive disorder is unaware about the side effects of phenytoin (Dilantin).Which instruction would be most appropriate?

Accepted Answer

Taking medication with food can help to reduce GI irritation that can be a common side effect of phenytoin. Brushing teeth vigorously can actually worsen gingival hyperplasia, a possible side effect of phenytoin. Limiting fluids and eating foods that reduce diarrhea may not be relevant to the side effects of phenytoin. Reduction of stimuli and warm baths may be helpful in managing seizures, but this does not address the specific issue of side effects from the medication.

Question 7

What should the nurse implement before giving an enteral feeding to a patient?

Accepted Answer

Elevating the head of the bed to 30 degrees helps prevent aspiration during enteral feedings. Palpating the abdomen for residual feeding should be done after the feeding. Warming the feeding may be necessary depending on the type of feeding, but it is not a necessary step before giving the feeding. Asking the patient to tip their head forward is not necessary for an enteral feeding.

Question 8

A patient in the emergency department states that she fell and hit her head and blacked out for a while but became alert again.The nurse suspects an epidural hematoma.For what should the nurse be diligent to assess?

Accepted Answer

The answer of A patient in the emergency department states...

Question 9

A family member asks the nurse what would be an appropriate gift for a patient with Parkinson disease.What is the most useful suggestion?

Accepted Answer

The answer of A family member asks the nurse what...

Question 10

Why is a patient with amyotrophic lateral sclerosis (ALS)uniquely prone to depression?

Accepted Answer

ALS affects motor neurons, leading to physical decline while leaving cognitive functions intact, which can contribute to depression as patients are fully aware of their progressive physical limitations.

Question 11

A patient with Parkinson disease is considering taking St.John's wort, an herbal remedy for depression, in addition to Sinemet and L-dopa.What is the most appropriate nursing response?

Accepted Answer

Herbal remedies, including St.John's wort, can interfere with the effectiveness of prescription drugs, including those used to treat Parkinson's disease. It is essential to inform the patient of the potential risks and advise them to consult with their healthcare provider before taking any new medications or herbal remedies.

Question 12

Which nursing assessment would indicate a need for suctioning a patient with Guillain-Barré who is experiencing impaired breathing patterns because of neuromuscular failure?

Accepted Answer

Increased pulse rate and adventitious breath sounds indicate that the patient is having difficulty breathing and may have excessive secretions that need to be suctioned. A decreased pulse rate or respiration rate would not necessarily indicate a need for suctioning. Abdominal breathing may indicate respiratory distress, but it is not specifically related to the need for suctioning in a patient with Guillain-Barré syndrome.

Question 13

A(n)______ hematoma forms in the space between the inner surface of the skull and the outermost meningeal covering of the brain.

Accepted Answer

The answer of A(n)______ hematoma forms in the space between...

Question 14

A nurse is caring for a patient with meningitis who has a positive Brudzinski sign.Which assessment led to this conclusion?

Accepted Answer

A positive Brudzinski sign is indicated by the flexion of the patient's hips and knees when the nurse flexes the patient's neck. This is a sign of meningitis, as the inflammation of the meninges in the brain and spinal cord can cause irritation and pain when the neck is flexed. The other options do not relate to a Brudzinski sign.

Question 15

A nurse is evaluating the effectiveness of teaching for a patient with multiple sclerosis (MS).Which statement by the patient indicates that accurate patient learning has taken place?

Accepted Answer

The answer of A nurse is evaluating the effectiveness of...

Question 16

The nurse is caring for a patient with symptoms of a migraine headache.What assessment information supports this diagnosis? (Select all that apply.)

Accepted Answer

Migraine headaches are typically associated with symptoms such as nausea, photosensitivity, and tearing. Bilateral pain in the temples can also occur, but the absence of this symptom does not rule out a migraine diagnosis. Elevated WBC count is not typically associated with migraines.

Question 17

A nurse is careful about limb position in caring for an unconscious patient who sustained a head injury 10 days ago.What is the nurse trying to prevent?

Accepted Answer

The nurse is trying to prevent flexion deformities, which can occur when muscles become contracted and shortened due to being held in a fixed position for too long. This can happen to unconscious patients who are not able to change their position on their own, and can be particularly problematic for patients with head injuries.

Quiz 22: Neurologic Disorders