Question 1

A nurse assesses a client with Alzheimer's disease who is recently admitted to the hospital.Which psychosocial assessment should the nurse complete?

Accepted Answer

As Alzheimer's disease progresses,the client experiences changes in emotional and behavioral affect.The nurse should be alert to the client's reaction to a change in environment,such as being hospitalized,because the client may exhibit an exaggerated response,such as aggression,to the event.The other assessments should be completed but are not as important as assessing the client's reaction to environmental change.

Question 2

A nurse obtains a health history on a client prior to administering prescribed sumatriptan succinate (Imitrex)for migraine headaches.Which condition should alert the nurse to hold the medication and contact the health care provider?

Accepted Answer

Sumatriptan succinate effectively reduces pain and other associated symptoms of migraine headache by binding to serotonin receptors and triggering cranial vasoconstriction.Vasoconstrictive effects are not confined to the cranium and can cause coronary vasospasm in clients with Prinzmetal's angina.The other conditions would not affect the client's treatment.

Question 3

A nurse assesses a client with Huntington disease.Which motor changes should the nurse monitor for in this client?

Accepted Answer

An imbalance between excitatory and inhibitory neurotransmitters leads to uninhibited motor movements,such as brisk,jerky,purposeless movements of the hands,face,tongue,and legs.Shuffling gait,continuous chewing motions,and tremors are associated with Parkinson disease.

Question 4

A nurse assesses a client after administering prescribed levetiracetam (Keppra).Which laboratory tests should the nurse monitor for potential adverse effects of this medication?

Accepted Answer

Adverse effects of levetiracetam include coordination problems and renal toxicity.The other laboratory tests are not affected by levetiracetam.

Question 5

A nurse witnesses a client begin to experience a tonic-clonic seizure and loss of consciousness.Which action should the nurse take?

Accepted Answer

The nurse should turn the client's head to the side to prevent aspiration and allow drainage of secretions.Anticonvulsants are administered on a routine basis if a seizure is sustained.If the seizure is sustained (status epilepticus),the client must be intubated and should be administered oxygen,0.9% sodium chloride,and IV push lorazepam or diazepam.

Question 6

A nurse obtains a focused health history for a client who is suspected of having bacterial meningitis.Which question should the nurse ask?

Accepted Answer

Meningococcal meningitis tends to occur in multiple outbreaks.It is most likely to occur in areas of high-density population,such as college dormitories,prisons,and military barracks.A tetanus vaccination would not place the client at increased risk for meningitis or protect the client from meningitis.A viral infection would not lead to bacterial meningitis but could lead to viral meningitis.Simply knowing if the client traveled out of the country does not provide enough information.The nurse should ask about travel to specific countries in which the disease is common,for example,sub-Saharan Africa.

Question 7

A nurse assesses a client with a history of epilepsy who experiences stiffening of the muscles of the arms and legs,followed by an immediate loss of consciousness and jerking of all extremities.How should the nurse document this activity?

Accepted Answer

Seizure activity that begins with stiffening of the arms and legs,followed by loss of consciousness and jerking of all extremities,is characteristic of a tonic-clonic seizure.An atonic seizure presents as a sudden loss of muscle tone followed by postictal confusion.A myoclonic seizure presents with a brief jerking or stiffening of extremities that may occur singly or in groups.Absence seizures present with automatisms,and the client is unaware of his or her environment.

Question 8

After teaching the wife of a client who has Parkinson disease,the nurse assesses the wife's understanding.Which statement by the client's wife indicates she correctly understands changes associated with this disease?

Accepted Answer

Because chewing and swallowing can be problematic,small frequent meals and a supplement are better for meeting the client's nutritional needs.A masklike face and drooling are common in clients with Parkinson disease.The client should be encouraged to continue to socialize and communicate as normally as possible.The wife should understand that the client's masklike face can be misinterpreted and additional time may be needed for the client to communicate with her or others.Excessive perspiration is also common in clients with Parkinson disease and is associated with the autonomic nervous system's response.

Question 9

A nurse cares for a client with advanced Alzheimer's disease.The client's caregiver states,"She is always wandering off.What can I do to manage this restless behavior?" How should the nurse respond?

Accepted Answer

Several strategies may be used to cope with restlessness and wandering.One strategy is to engage the client in structured activities.Another is to take the client for frequent walks.Daily naps and a mild sedative will not be as effective in the management of restless behavior.Consulting the social worker does not address the caregiver's concern.

Question 10

A nurse is teaching a client who experiences migraine headaches and is prescribed a beta blocker.Which statement should the nurse include in this client's teaching?

Accepted Answer

Beta blockers are prescribed as prophylactic treatment to prevent the vascular changes that initiate migraine headaches.Heart rate and blood pressure will also be affected,and the client should monitor these side effects.The other responses do not discuss appropriate uses of the medication.

Question 11

After teaching a client newly diagnosed with epilepsy,the nurse assesses the client's understanding.Which statement by the client indicates a need for additional teaching?

Accepted Answer

The nurse must emphasize that antiepileptic drugs must be taken even if the client is nauseous.Discontinuing the medication can predispose the client to seizure activity and status epilepticus.The client should not drink alcohol while taking seizure medications.The client should wear a medical alert bracelet and should make the doctor aware of all medications to prevent complications of polypharmacy.

Question 12

A nurse is teaching a client with chronic migraine headaches.Which statement related to complementary therapy should the nurse include in this client's teaching?

Accepted Answer

At the onset of a migraine attack,the client may be able to alleviate pain by lying down and darkening the room.He or she may want both eyes covered and a cool cloth on the forehead.If the client falls asleep,he or she should remain undisturbed until awakening.The other options are not recognized therapies for migraines.

Question 13

A nurse assesses a client who has a history of migraines.Which clinical manifestation should the nurse identify as an early sign of a migraine with aura?

Accepted Answer

Early warning of impending migraine with aura usually consists of visual changes,flashing lights,or diplopia.The other manifestations are not associated with an impending migraine with aura.

Question 14

A nurse prepares to discharge a client with Alzheimer's disease.Which statement should the nurse include in the discharge teaching for this client's caregiver?

Accepted Answer

Clients with Alzheimer's disease have a tendency to wander,especially at night.If possible,alarms should be installed on all outside doors to alert family members if the client leaves.At a minimum,all outside doors should have deadbolt locks installed to prevent the client from going outdoors unsupervised.The client should be allowed to exercise within his or her limits.Throw rugs are a slip and fall hazard and should be removed.The client should eat a well-balanced diet.There is no need for a high-calorie or high-protein diet.

Question 15

A nurse is teaching the daughter of a client who has Alzheimer's disease.The daughter asks,"Will the medication my mother is taking improve her dementia?" How should the nurse respond?

Accepted Answer

Drug therapy is not effective for treating dementia or halting the advancement of Alzheimer's disease.However,certain drugs may help suppress emotional disturbances and psychiatric manifestations.Medication therapy may not allow the client to safely live independently.

Question 16

A nurse witnesses a client with late-stage Alzheimer's disease eat breakfast.Afterward the client states,"I am hungry and want breakfast." How should the nurse respond?

Accepted Answer

Use of validation therapy with clients who have Alzheimer's disease involves acknowledgment of the client's feelings and concerns.This technique has proved more effective in later stages of the disease,when using reality orientation only increases agitation.Telling the client that he or she already ate breakfast may agitate the client.The other statements do not validate the client's concerns.

Question 17

A nurse plans care for a client with Parkinson disease.Which intervention should the nurse include in this client's plan of care?

Accepted Answer

Elevation of the head of the bed will help prevent aspiration.The other options will not prevent aspiration,which is the greatest respiratory complication of Parkinson disease,nor do these interventions address any of the complications of Parkinson disease.Ambulation in the hallway is usually implemented to prevent venous thrombosis.Increased fluid intake flushes out toxins from the client's blood.Pursed-lip breathing increases exhalation of carbon dioxide.

Question 18

A nurse cares for a client who is experiencing status epilepticus.Which prescribed medication should the nurse prepare to administer?

Accepted Answer

Initially,intravenous lorazepam is administered to stop motor movements.This is followed by the administration of phenytoin.Atenolol,a beta blocker,and lisinopril,an angiotensin-converting enzyme inhibitor,are not administered for seizure activity.These medications are typically administered for hypertension and heart failure.

Question 19

A nurse cares for a client who has been diagnosed with the Huntington gene but has no symptoms.The client asks for options related to family planning.What is the nurse's best response?

Accepted Answer

The presence of the Huntington gene means that the trait will be passed on to all offspring of the affected person.Understanding options for contraception and conception (e.g.,surrogacy options)and implications for children may require the expertise of a genetic counselor or a reproductive specialist.The other statements are not accurate.

Question 20

After teaching a client who is diagnosed with new-onset status epilepticus and prescribed phenytoin (Dilantin),the nurse assesses the client's understanding.Which statement by the client indicates a correct understanding of the teaching?

Accepted Answer

Discontinuing antiepileptic drugs can lead to the recurrence of seizures or status epilepticus.The client does not need to drink more water and can drive while taking this medication.The medication will not stop an aura before a seizure.

Quiz 42: Care of Patients with Problems of the Central Nervous System: The Brain