NCLEX Neuro Exam Questions and Answers 2024, Exams of Nursing

Download NCLEX Neuro Exam Questions and Answers 2024 and more Exams Nursing in PDF only on Docsity! NCLEX Neuro exam questions and answers 2024 updated.  Which statement is true for a patient who has pathology in Wernicke's area of the cerebrum? o Receptive speech is affected. o The parietal lobe is involved. o Sight processing is abnormal. o An abnormal Romberg test is present. - Correct answer A  The temporal, not parietal, lobe contains the Wernicke area, which is responsible for receptive speech and integration of somatic, visual, and auditory data. Sight processing occurs in the occipital lobe. The Romberg test is used to assess the position sense of the lower extremities.  After a major head trauma, the patient's respiratory and cardiac functions are affected. Which area of the brain is damaged? o Temporal lobe of the cerebrum o Brainstem o Cerebellum o Spinal nerves - Correct answer B  The brainstem includes the midbrain, pons, and medulla. The vital centers concerned with respiratory, vasomotor, and cardiac function are located in the medulla. Integration of somatic, visual, and auditory data occurs in the temporal lobe. The cerebellum coordinates voluntary movement, trunk stability, and equilibrium. Motor and spinal nerves serve particular areas of the body.  What is the purpose of the blood-brain barrier? o To protect the brain by cushioning o To inhibit damage from external trauma o To keep harmful agents away from brain tissue o To provide the blood supply to brain tissue - Correct answer C  The blood-brain barrier is a physiologic barrier between capillaries and brain tissue. The structure of the brain's capillaries is different from others, and substances that are harmful are not allowed to enter brain tissue. Lipid-soluble compounds enter the brain easily, but water-soluble and ionized drugs enter slowly. The spinal fluid and meninges help cushion the brain. The skull protects from external trauma. Blood is supplied to the brain from the internal carotid arteries and the vertebral arteries.  In a patient with a disease that affects the myelin sheath of nerves, such as multiple sclerosis, which glial cells are affected? - Correct answer D  Types of glial cells include oligodendrocytes, astrocytes, ependymal cells, and microglia, and each has specific functions. Oligodendrocytes are specialized cells that produce the myelin sheath of nerve fibers, and they are primarily found in the white matter of the central nervous system.  Drugs or diseases that impair the function of the extrapyramidal system may cause loss of o sensations of pain and temperature. o regulation of the autonomic nervous system. o integration of somatic and special sensory inputs. o automatic movements associated with skeletal muscle activity. - Correct answer D  A group of descending motor tracts carries impulses from the extrapyramidal system, which includes all motor systems (except the pyramidal system) concerned with voluntary movement. It includes descending pathways originating in the brainstem, basal ganglia, and cerebellum. The motor output exits the spinal cord through the ventral roots of the spinal nerves  An obstruction of the anterior cerebral arteries affects o visual imaging. o balance and coordination. o judgment, insight, and reasoning. o visual and auditory integration for language comprehension. - Correct answer C  The anterior cerebral artery feeds the medial and anterior portions of the frontal lobes. The anterior portion of the frontal lobe controls higher-order processes such as judgment and reasoning.  Paralysis of lateral gaze indicates a lesion of cranial nerve o II. o III. o IV. o VI. - Correct answer D  Cranial nerves III (oculomotor), IV (trochlear), and VI (abducens) are responsible for eye movement. The lateral rectus eye muscle is innervated by cranial nerve VI and is the primary muscle that is responsible for lateral eye movement  Results of stimulation of the parasympathetic nervous system are (select all that apply) o constriction of the bronchi. o dilation of skin blood vessels. o increased secretion of insulin. o increased blood glucose levels. o relaxation of the urinary sphincters - Correct answer A, B, C, D o Ask the patient to shrug the shoulders against resistance. o Ask the patient to push the tongue to either side against resistance. o Have the patient say "ah" while visualizing elevation of the soft palate - Correct answer B  The spinal accessory nerve is tested by asking the patient to shrug the shoulders against resistance and to turn the head to either side against resistance. The other options are used to test the glossopharyngeal and vagus nerves.  When assessing motor function of a patient admitted with a stroke, you notice mild weakness of the arm demonstrated by downward drifting of the extremity. How would you accurately document this finding? o Athetosis o Hypotonia o Hemiparesis o Pronator drift - Correct answer D  Downward drifting of the arm or pronation of the palm is identified as pronator drift. Hemiparesis is weakness of one side of the body, hypotonia describes flaccid muscle tone, and athetosis is a slow, writhing, involuntary movement of the extremities  A patient's sudden onset of hemiplegia has necessitated a computed tomography (CT) of her head. Which assessment should you complete before this diagnostic study? o Assess the patient's immunization history. o Screen the patient for any metal parts or a pacemaker. o Assess the patient for allergies to shellfish, iodine, or dyes. o Assess the patient's need for tranquilizers or antiseizure medications. - Correct answer C  Allergies to shellfish, iodine, or dyes contraindicate the use of contrast media for CT. The patient's immunization history is not a central consideration, and the presence of metal in the body does not preclude the use of CT as a diagnostic tool. The need to assess for allergies supersedes the need for tranquilizers or antiseizure medications in most patients.  How should you most accurately assess the position sense of a patient with a recent traumatic brain injury? o Ask the patient to close his or her eyes and slowly bring the tips of the index fingers together. o Ask the patient to maintain balance while standing with his or her feet together and eyes closed. o Ask the patient to close his or her eyes and identify the presence of a common object on the forearm. o Place the two points of a calibrated compass on the tips of the fingers and toes, and ask the patient to discriminate the points. - Correct answer B  The Romberg test is an assessment of position sense in which the patient stands with the feet together and then closes his or her eyes while attempting to maintain balance. The other tests of neurologic function do not directly assess position sense.  Why are the data regarding mobility, strength, coordination, and activity tolerance important for you to obtain? o Many neurologic diseases affect one or more of these areas. o Patients are less able to identify other neurologic impairments. o These are the first functions to be affected by neurologic disease. o Aspects of movement are the most important function of the nervous system. - Correct answer A  Many neurologic disorders can cause problems in the patient's mobility, strength, and coordination. These problems can result in changes in the patient's usual activity and exercise patterns.  During neurologic testing, the patient is able to perceive pain elicited by a pinprick. Based on this finding, which assessment may be omitted? o Position sense o Patellar reflexes o Temperature perception o Heel-to-shin movements - Correct answer C  If pain sensation is intact, assessment of temperature sensation may be omitted because both sensations are carried by the same ascending pathways.  A patient's eyes jerk while the patient looks to the left. How do you record this finding? o Nystagmus o Cranial nerve VI palsy o Oculocephalia o Ophthalmic dyskinesia - Correct answer A  Nystagmus is fine, rapid jerking movements of the eyes.  You are caring for a patient with peripheral neuropathy who is going to have electromyographic (EMG) studies tomorrow morning. What should you do to prepare the patient? o Ensure the patient has an empty bladder. o Instruct the patient that there is no risk of electric shock. o Ensure the patient has no metallic jewelry or metal fragments. o Instruct the patient that he or she may experience pain during the study. - Correct answer B  Electromyography (EMG) assesses electrical activity associated with nerves and skeletal muscles. Needle electrodes are inserted to detect muscle and peripheral nerve disease. You should inform the patient that pain and discomfort are associated with insertion of needles. There is no risk of electric shock with this procedure.  Which option indicates a sign of Cushing's triad, an indication of increased intracranial pressure (ICP)? o Heart rate increases from 90 to 110 beats/minute o Kussmaul respirations o Temperature over 100.4° F (38° C) o Heart rate decreases from 75 to 55 beats/minute - Correct answer D  Cushing's triad is systolic hypertension with a widening pulse pressure, bradycardia with a full and bounding pulse, and slowed respirations. The rise in blood pressure is an attempt to maintain cerebral perfusion, and it is a neurologic emergency because decompensation is imminent. The other options are not part of Cushing's triad.  The patient had an acute ischemic stroke 4 hours ago and has an elevated blood pressure. What action should you take? o Document the findings because the increased pressure is needed to perfuse the brain. o Administer an antihypertensive medication to prevent additional damage. o Hyperventilate the patient to cause vasodilatation. o Teach patient about a low sodium diet. - Correct answer A  After a stroke, temporary hypertension is needed to perfuse the area of swelling. No treatment is done unless the pressure is above 220/110 mm Hg in the first few hours. Aggressive lowering of blood pressure is not done, because if the pressure drops, it can prevent regional perfusion and lead to local tissue damage. Hyperventilation is done if hypercapnia is identified, but it is not prophylactic.  Which response can be expected in a patient with low oxygen concentration and acidosis? o Decreased cerebral fluid flow with decreased cerebral pressure o Vasodilation with increased cerebral pressure o Systemic hypotension with decreased cerebral pressure o Cerebral tissue hypertrophy with increased cerebral pressure - Correct answer B  Low concentration of oxygen ions and high concentration of hydrogen ions cause vasodilation, which can result in increased ICP if autoregulation has failed. The other options are not possible  A patient being monitored has an ICP pressure of 12 mm Hg. You understand that this pressure reflects o a severe decrease in cerebral perfusion pressure. o an alteration in the production of cerebrospinal fluid. o the loss of autoregulatory control of intracranial pressure. systemic blood pressure. Careful evaluation of the effects of elevation of the head of the bed on the ICP and the CPP is required.  Which nursing action should be implemented in the care of a patient who is experiencing increased ICP? o Monitor fluid and electrolyte status astutely. o Position the patient in a high-Fowler's position. o Administer vasoconstrictors to maintain cerebral perfusion. o Maintain physical restraints to prevent episodes of agitation. - Correct answer A  Fluid and electrolyte disturbances can have an adverse effect on ICP and must be vigilantly monitored. The head of the patient's bed should be kept at 30 degrees in most circumstances, and physical restraints are not applied unless absolutely necessary. Vasoconstrictors are not typically administered in the treatment of ICP.  Which option is most indicative of a skull fracture after blunt head trauma? o Facial edema o Epitasis o Otorrhea positive for glucose o Laceration oozing blood - Correct answer C  An indication of a basal fracture is cerebrospinal fluid (CSF) leakage from the ear, which confirms that the fracture has traversed the dura. Periorbital ecchymosis can indicate a skull fracture, but generalized facial edema does not. The head is vascular, and it is not unusual to have a nosebleed; a positive ring sign (halo sign) indicates a skull fracture. A superficial laceration does not indicate a skull fracture.  An elderly patient fell at home. Which information from the patient's history makes this patient at high risk for an intracerebral bleed? o History of a heart condition o Taking warfarin (Coumadin) o Has lost consciousness for 5 seconds o History of migraine headaches - Correct answer B  Anticoagulant use is associated with increased hemorrhage and more severe head injury. A heart condition may have caused the syncope that caused the fall, but it was not solely responsible for increased bleeding. Concussions are usually minor injuries that resolve, and the typical signs include a brief disruption in level of consciousness (LOC). If the loss of consciousness is less than 5 minutes, patients are usually discharged. Headache by itself does not indicate a risk for intracerebral bleeding.  The patient reports falling when he his foot got "stuck" on a crack in the sidewalk, hitting his head when he fell, and "passing out". The paramedics found the patient walking at the scene and talking before transporting the patient to the hospital. In the emergency department, the patient starts to lose consciousness. This is a classic scenario for which complication? o Epidural hematoma o Subdural hematoma o Subarachnoid bleed o Diffuse axial inju - Correct answer A  Epidural hematoma often results from a linear fracture crossing a major artery in the dura. The classic sign is an initial period of unconsciousness at the scene and a brief lucid interval followed by a decrease in LOC. A subdural hematoma often results from injury to the brain and veins and develops more slowly. The classic sign or symptom of subarachnoid hemorrhage is a patient describing "the worst headache of my life." Diffuse axonal injury is widespread axonal damage occurring after a traumatic brain injury.  The patient has rhinorrhea after a head injury. What action should you take? o Pack the nares with sterile gauze. o A loose collection pad may be placed under the nose. o Suction the drainage with an inline suction catheter. o Obtain a sample for culture. - Correct answer B  A loose collection pad may be placed under the nose. Do not place a dressing in the nasal cavity, and nothing should be placed inside the nostril. There is no need to culture the drainage. The concern is whether it is spinal fluid, which is determined by a test for glucose or the halo or ring sign.  The patient had a blunt head injury. What is most important for you to do before the patient's discharge? o Have the patient sign the discharge papers. o Teach the patient how to perform the Glasgow Coma Scale (GCS). o Tell the patient to return if he has a headache. o Ensure there is a responsible adult to check on the patient - Correct answer D  Complications from a head injury can arise 2 to 3 days later, and the discharged patient must have a responsible adult who can stay with or check on the patient. The patient may understand the instructions but without an objective observer, he or she would not be aware whether some of the key symptoms were occurring. A patient would not know how to do the GCS if impaired or confused. A headache is not a concern, but a worsening headache unrelieved by over-the- counter medications needs to be checked.  You are alerted to a possible acute subdural hematoma in the patient who o has a linear skull fracture crossing a major artery. o has focal symptoms of brain damage with no recollection of a head injury. o develops decreasing LOC and a headache within 48 hours of a head injury. o has an immediate loss of consciousness with a brief lucid interval followed by decreasing LOC. - Correct answer An acute subdural hematoma manifests within 24 to 48 hours of the injury. The signs and symptoms are similar to those associated with brain tissue compression by increased intracranial pressure (ICP) and include decreasing LOC and headache.  During admission of a patient with a severe head injury to the emergency department, you place the highest priority on assessment of o patency of airway. o presence of a neck injury. o neurologic status with the Glasgow Coma Scale. o cerebrospinal fluid leakage from the ears or nose. - Correct answer A  An initial priority in the emergency management of a patient with a severe head injury is for you to ensure that the patient has a patent airway.  A patient with a suspected closed head injury has bloody nasal drainage. You suspect that this patient has a cerebrospinal fluid (CSF) leak when observing which of the following? o A halo sign on the nasal drip pad o Decreased blood pressure and urinary output o A positive reading for glucose on a Test-tape strip o Clear nasal drainage along with the bloody discharge - Correct answer A  When drainage containing CSF and blood is allowed to drip onto a white pad, the blood coalesces into the center within a few minutes, and a yellowish ring of CSF encircles the blood, giving a halo effect. The presence of glucose is unreliable for determining the presence of CSF because blood also contains glucose.  You are caring for a patient admitted with a subdural hematoma after a motor vehicle accident. Which change in vital signs would you interpret as a manifestation of increased intracranial pressure? o Tachypnea o Bradycardia o Hypotension o Narrowing pulse pressure - Correct answer B  Changes in vital signs indicative of increased ICP are known as Cushing's triad, which consists of increasing systolic pressure with a widening pulse pressure, bradycardia with a full and bounding pulse, and irregular respirations.  You are providing care for a patient who has been admitted to the hospital with a head injury who requires regular neurologic vital signs. Which assessments are components of the patient's score on the Glasgow Coma Scale (select all that apply)? o Eye opening o Abstract reasoning o Best verbal response  You are caring for a patient admitted for evaluation and surgical removal of a brain tumor. You plan interventions for this patient based on knowledge that brain tumors can lead to which complications (select all that apply)? o Vision loss o Cerebral edema o Pituitary dysfunction o Parathyroid dysfunction o Focal neurologic deficits - Correct answer A,B,C,E  Depending on the location, brain tumors can have a wide variety of clinical manifestations, including vision loss and focal neurologic deficits. Tumors that put pressure on the pituitary can lead to dysfunction of the gland. As the tumor grows, clinical manifestations of increased ICP and cerebral edema can appear. Parathyroid glands are not regulated by the cerebral cortex or the pituitary.  Magnetic resonance imaging (MRI) has revealed a brain tumor in a patient. You recognize the patient's likely need for which treatment modality? o Surgery o Chemotherapy o Radiation therapy o Pharmacologic treatment - Correct answer A  Surgical removal is the preferred treatment for brain tumors.  What is most important finding for you to act on for a patient who had a craniotomy? o Sodium: 134 mEq/L o While blood cell (WBC) count: 11,000/μL o Urine specific gravity: 1.001 o Blood urea nitrogen (BUN): 25 mg/dL - Correct answer C  Patients need frequent monitoring for sodium regulation, onset of diabetes insipidus, and severe hypovolemia. Normal specific gravity for urine should not be below 1.003 and this low value is a priority.  What action should you take as part of care for a patient who had a craniotomy? o Use promethazine (Phenergan) for nausea. o Position the patient on the operative side if a bone flap was removed. o Administer phenytoin (Dilantin) by rapid intravenous push (IVP) every 6 hours. o Keep the head in alignment with the trunk. - Correct answer D  The primary goal of care after cranial surgery is prevention of increased intracranial pressure (ICP), which includes keeping the body in alignment. Use of promethazine is discouraged because it can increase somnolence and alter the accuracy of a neurologic assessment. The patient is not positioned on the operative side if a bone flap was removed (craniectomy). Dilantin is administered slowly, no faster than 25 to 50 mg/min.  Reference: 1450  Preventing which problem is a priority nursing goal for a patient who had cranial surgery today? o Pain o Increased ICP o Infection o Malnutrition - Correct answer B  The primary goal of care after cranial surgery is prevention of increased ICP. Other priorities are monitoring neurologic function, fluid and electrolyte levels, and serum osmolality. The brain does not have pain receptors, although the patient can have a headache. However, increased ICP remains a priority. Infection is not a priority the day of surgery, and nutrition is important, but increased ICP is the priority.  What is the most likely cause of a brain abscess? o Secondary metastasis from another site o Infection from a tick or mosquito bite o Direct extension from a sinus infection o Spread of Neisseria meningitidis infection - Correct answer C  The primary cause of a brain abscess is direct extension from ear, tooth, mastoid, or sinus infection. Secondary metastasis is the source of brain tumors. Tick or mosquito bites are associated with viral meningitis. N. meningitidis is a cause of bacterial meningitis.  The following patients are in the emergency department. Which one is a priority for treatment? o A college student with suspected bacterial meningitis o A teenager who had a partial seizure an hour earlier and is now awake o Patient with a history of stroke last year with residual hemiparesis o Patient with suspected trigeminal neuralgia (tic douloureux) - Correct answer A  Bacterial meningitis is considered a medical emergency. The other patients are currently stable.  What is a key clinical manifestation of classic bacterial meningitis? o Temperature o Nystagmus o Tachycardia o Nuchal rigidity - Correct answer D  Fever, severe headache, vomiting, and nuchal rigidity (neck stiffness) are key clinical manifestations of meningitis.  The patient is admitted with a diagnosis of bacterial meningitis. The patient has a temperature of 101° F and a headache rated as an 8. Which prescription has a priority for you to administer? o IV cefuroxime (Ceftin) o Vital signs o PO acetaminophen (Tylenol) o Neurologic check - Correct answer A  Bacterial meningitis is a medical emergency, and treating the cause is a priority over treating the symptoms or further assessing effects of the disease process. The antibiotic may be given after cultures are obtained but before the diagnosis is confirmed.  A wife indicates she has been providing care to her husband, who was diagnosed with bacterial meningococcal meningitis. What is your most important action related to the wife? o Teach airborne isolation precautions. o Assess her for respiratory infection. o Explain the signs of meningitis. o Provide prophylactic antibiotics. - Correct answer D  Persons who have close contact with anyone who has bacterial meningitis should be given prophylactic antibiotics, and this supersedes all other actions because she has been exposed. Meningococcal meningitis is highly contagious.  The patient with bacterial meningitis has irritation of cranial nerve (CN) II. What symptom would you expect the patient to have? o Inability to hear whispered words o Abnormal pronation and supination test result o Papilledema o Dysphagia - Correct answer CN II is the optic nerve, and when compressed from the increased ICP, papilledema (swelling of the optic disc) is often present and blindness may occur. The acoustic nerve is CN VIII. Assessing abnormal pronation or supination is a coordination/balance test for cerebellar function. Dysphagia can be a symptom of CN IX and CN X abnormalities.  You are assigned to four patients on the clinical unit. Which patient should you assess first? o Patient with a skull fracture whose nose is bleeding o Elderly patient with a stroke who is confused and whose daughter is present o Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0 to 10 scale o Patient who had a craniotomy for a brain tumor 3 days earlier and has continued emesis - Correct answer C  The patient has West Nile virus encephalitis and seizures for which phenytoin (Dilantin) is prescribed. What is essential for you do regarding administration? o Dilute the intravenous (IV) drug in 5% dextrose. o Assist the patient to maintain good oral hygiene. o Notify the health care provider if the patient becomes drowsy during IV administration. o Verify that the levels are between 40 and 60 μg/mL before administration. - Correct answer B  A side effect of Dilantin is gingival hyperplasia, and good oral care minimizes this side effect. The IV drug is diluted in normal saline and will precipitate in D5W. Drowsiness is an expected side effect of IV administration of the drug. Therapeutic levels are between 10 and 20 μg/mL.  Which assessment finding is most important for you to follow-up in a newly admitted adult patient diagnosed with viral encephalitis? o Positive Babinski sign o Negative Kernig sign o Doll's-eye reflex o Deep tendon reflex 2+ - Correct answer A  Adults have a negative Babinski sign (toes curl downward, plantar reflex). A positive sign in an adult can indicate disease of the brain or spinal cord. The other signs are normal findings.  The patient is newly diagnosed with encephalitis caused by herpes simplex virus (HSV) infection. What is essential for you to do? o Administer penicillin. o Administer acyclovir. o Perform a Glasgow Coma Scale assessment. o Facilitate a magnetic resonance imaging (MRI) study. - Correct answer B  Encephalitis is usually viral, and it is treated with antiviral acyclovir (Zovirax). For maximum benefit, the drug should be started in a timely manner. Penicillin is used for bacterial meningitis. Because the diagnosis is known, treatment of the cause is more important than additional assessment.  What is the most effective measure for rabies after a patient has sustained a bite by an animal thought to be infected? o Antibiotic administration o Contact isolation o Wound irrigation o Rapid postexposure prophylaxis - Correct answer D  Rabies usually is fatal. Management efforts are directed at preventing the transmission and onset of the disease, and postexposure prophylaxis is administered. It is more effective than the other measures.  The patient had an ischemic stroke 5 hours earlier. What treatment do you anticipate? o Administer nicardipine (Cardene) for the patient's blood pressure of 200/100 mm Hg. o Administer systemic thrombolytic tissue plasminogen activator (tPA). o Make patient NPO. o Administer acetaminophen (Tylenol) prophylactically. - Correct answer C  About 25% of patients worsen in the first 24 to 48 hours after a stroke. Patients should have nothing by mouth (NPO) until the stroke has stabilized to ensure there is no progression to loss of gag reflex and aspiration. Elevated blood pressure is common immediately after a stroke and may be a protective response to maintain cerebral perfusion. A drug is not used to lower blood pressure unless the systolic pressure is more than 220 mm Hg. Systemic tPA must be administered within 3 to 4.5 hours of stroke onset. The patient's temperature is treated, but not prophylactically.  The patient had an ischemic stroke and is undergoing rehabilitation. He is diagnosed with homonymous hemianopsia. What should you do? o Better arrange the environment to suit the patient's needs. o Teach the patient to turn his head to scan the environment. o Obtain prescriptive glasses for the patient. o Have the patient wear an eye patch. - Correct answer B  Homonymous hemianopsia (blindness in the same half of each visual field) is a common problem. Persistent disregard of objects in part of the visual field should alert you to this possibility. In rehabilitation, the patient should learn to compensate by consciously attending to or by scanning the neglected side. Early immediate intervention involves arranging the environment within the patient's perceptual field. Glasses do not help the problem. Diplopia (double vision) can be a problem and is treated with an eye patch.  The patient says, "The smoodle pinkered, and I want him square, and I want to plunthery him." What impairment do you suspect? o Wernicke's aphasia o Broca's aphasia o Dysarthria o Aphasia - Correct answer A  Wernicke's aphasia is damage to the left temporal lobe, although it can result in damage to the right lobe. The patient may speak in long sentences that have no meaning, add unnecessary words, or even create words. In Broca's aphasia, the patient is able to understand but speaks only in short phrases that are difficult to produce. Dysarthria is a disturbance in the muscular control of speech. Impairments may involve pronunciation, articulation, and phonation. This condition does not affect meaning or comprehension of language but does affect the mechanics of speech. Aphasia is a total loss of comprehension and use of language or total inability to communicate.  The patient had a stroke on the left side of the brain (right hemiplegia). He is eating dinner and suddenly bursts into tears. How do you respond? o Ask the patient about his feelings. o Give him a tissue. o Distract the patient. o Obtain an antidepressant for patient. - Correct answer C  Patients who have had strokes often exhibit emotional responses that are not appropriate for the situation. The behavior is out of context and often is unrelated to the underlying emotional state of the patient. Initially it is important to just distract the patient.  Which modifiable risk factors for stroke are most important for you to include when planning a community education program? o Hypertension o Hyperlipidemia o Alcohol consumption o Oral contraceptive use - Correct answer A  Hypertension is the single most important modifiable risk factor, but it is still often undetected and inadequately treated.  You would expect to find which clinical manifestation in a patient admitted with a left-brain stroke? o Impulsivity o Impaired speech o Left-sided neglect o Short attention span - Correct answer B  Clinical manifestations of left-sided brain damage include right hemiplegia, impaired speech and language aphasias, impaired right and left discrimination, and slow and cautious performance. The other options are all manifestations of right-sided brain damage.  You are discharging a patient admitted with a transient ischemic attack (TIA). For which medications do you expect to provide discharge instructions (select all that apply)? o Clopidogrel (Plavix) o Enoxaparin (Lovenox) o Dipyridamole (Persantine) o Enteric-coated aspirin (Ecotrin) o Tissue plasminogen activator (tPA) - Correct answer A,C,D  Aspirin is the most frequently used antiplatelet agent. Other drugs used to prevent clot formation include clopidogrel (Plavix), ticlopidine (Ticlid), dipyridamole (Persantine), combined dipyridamole and aspirin (Aggrenox), and anticoagulant drugs, such as oral warfarin (Coumadin). The tPA is a fibrinolytic medication used to treat acute ischemic stroke, not prevent TIAs. o vertebral artery. o left middle cerebral artery. o right middle cerebral artery. - Correct answer C  If the middle cerebral artery is involved in a stroke, the expected clinical manifestations include aphasia, motor and sensory deficit, and hemianopsia on the dominant side and include neglect, motor and sensory deficit, and hemianopsia on the nondominant side.  You explain to the patient with a stroke who is scheduled for angiography that the test is used to determine the o presence of increased intracranial pressure (ICP). o site and size of the infarction. o patency of the cerebral blood vessels. o presence of blood in the cerebrospinal fluid. - Correct answer C  Angiography provides visualization of cerebral blood vessels, can provide an estimate of perfusion, and can detect filling defects in the cerebral arteries.  A patient experiencing TIAs is scheduled for a carotid endarterectomy. You explain that this procedure is done to o decrease cerebral edema. o reduce the brain damage that occurs during a stroke in evolution. o prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow. o provide a circulatory bypass around thrombotic plaques obstructing cranial circulation. - Correct answer C  In carotid endarterectomy, the atheromatous lesions are removed from the carotid artery to improve blood flow.  For a patient with a suspected stroke, which important piece of information should you obtain? o Time of the patient's last meal o Time at which stroke symptoms first appeared o Patient's hypertension history and management o Family history of stroke and other cardiovascular diseases - Correct answer B  During initial evaluation, the single most important point in the patient's history is the time of onset of stroke symptoms. If the stroke is ischemic, recombinant tissue plasminogen activator (tPA) must be administered within 3 to 4.5 hours of the onset of clinical signs; tPA reestablishes blood flow through a blocked artery and prevents brain cell death in patients with an acute onset of symptoms.  Bladder training for a male patient who has urinary incontinence after a stroke includes o limiting fluid intake. o keeping a urinal in place at all times. o assisting the patient to stand to void. o catheterizing the patient every 4 hours. - Correct answer C  In the acute stage of stroke, the primary urinary problem is poor bladder control and incontinence. Nurses should promote normal bladder function and avoid the use of indwelling catheters. A bladder retraining program consists of (1) adequate fluid intake, with most given between 8:00 AM and 7:00 PM; (2) scheduled toileting every 2 hours using a bedpan, commode, or bathroom; and (3) observing signs of restlessness, which may indicate the need for urination. Intermittent catheterization may be used for urinary retention (not urinary incontinence). During the rehabilitation phase after a stroke, nursing interventions focused on urinary continence include (1) assessment for bladder distention by palpation; (2) offering the bedpan, urinal, commode, or toilet every 2 hours during waking hours and every 3 to 4 hours at night; (3) focusing the patient on the need to urinate with a direct command; (4) assistance with clothing and mobility; (5) scheduling most fluid intake between 7:00 AM and 7:00 PM; and (6) encouraging the usual position for urinating (standing for men and sitting for women).  What are the common psychosocial reactions of the patient to the stroke (select all that apply)? o Depression o Disassociation o Intellectualization o Sleep disturbances o Denial of the severity of the stroke - Correct answer A,D,E  The patient with a stroke may experience many losses, including sensory, intellectual, communicative, functional, role behavior, emotional, social, and vocational losses. Some patients experience long-term depression and symptoms such as anxiety, weight loss, fatigue, poor appetite, and sleep disturbances. The time and energy required to perform previously simple tasks can result in anger and frustration. Frustration and depression are common in the first year after a stroke. A stroke is usually a sudden, extremely stressful event for the patient, caregiver, family, and significant others. The family is often affected emotionally, socially, and financially, as well as changing roles and responsibilities. Reactions vary considerably but may involve fear, apprehension, denial of the severity of the stroke, depression, anger, and sorrow.  When is dementia usually diagnosed? o Two brain functions are impaired. o Memory is affected. o Positive result is obtained on a computed tomography (CT) study. o The patient fails the Benton Visual Form Discrimination Test (BVFD). - Correct answer A  Dementia is usually diagnosed when two or more brain functions, such as memory loss or language skills, are significantly impaired. The Mini-Mental State Examination (MMSE) is used to assess cognitive effect. Although tests help to make the diagnosis, no single clinical test can be used to diagnose dementia, and it is primarily a diagnosis of exclusion.  What are the two most common causes of dementia? o Diabetes mellitus and hypercholesterolemia o Neurodegenerative conditions and vascular disorders o Effects of smoking and coronary artery disease o Metabolic syndrome and systemic diseases - Correct answer B  The two most common causes of dementia are neurodegenerative conditions (e.g., Alzheimer's disease) and vascular disorders. Risk factors include advanced age, family history, history of smoking, cardiac dysrhythmias, hypertension, hypercholesterolemia, diabetes mellitus, and coronary artery disease, and metabolic syndrome.  Which statement is true regarding dementia? o The patient is often the first one to be aware of the problem. o Onset is usually relatively sudden. o Initial memory loss consists of long-term memories. o Thyroid deficiency is ruled out before the diagnosis. - Correct answer D  Screening for cobalamin (vitamin B12) deficiency and hypothyroidism are usually done before making the diagnosis. It is often a family member, particularly the spouse, who reports the patient's declining memory to the heath care provider. The onset is usually insidious and gradual. In dementia, the memory loss initially relates to recent events, with long-term (remote) memories still intact. With time and progression of the dementia, memory loss includes short-term (recent) and long-term (remote) memory.  Which nursing intervention is most appropriate when caring for patients with dementia? o Avoid direct eye contact. o Lovingly call the patient "honey" or "sweetie." o Give simple directions, focusing on one thing at a time. o Treat the patient according to their age-related behavior. - Correct answer C  When dealing with patients with dementia, tasks should be simplified, giving directions using gestures or pictures and focusing on one thing at a time. It is best to treat these patients as adults, with respect and dignity, even when their behavior is childlike. You should use gentle touch and direct eye contact. Calling the patient "honey" or "sweetie" can be condescending and does not demonstrate respect.  Dementia is defined as a o syndrome that results only in memory loss. o disease associated with abrupt changes in behavior. o disease that is always due to reduced blood flow to the brain.  Cholinesterase inhibitors are used to slow the rate of decline of the disease and the worsening of symptoms. There is no cure for AD, which is a chronic, progressive disease. Treating depression that is often associated with AD may improve cognitive ability, and antidepressants are prescribed.  You approach the patient with AD to provide her bath. The patient states, "Go away! I'm not taking a bath." What is your initial response? o Leave and reapproach in a few minutes. o Ask the patient why she feels that way. o Inform the patient that the physician will be notified. o Obtain additional help and proceed with the bath. - Correct answer A  Behavioral problems occur in about 90% of patients with AD. They can respond to redirection, reapproach, distraction, and reassurance. Persons with AD have limited verbal skills and are not able to respond to "why" questions. You should not threaten with restraints or to call the physician. It is always preferable to try a nonthreatening approach first, especially for something that is not absolutely essential.  The patient with AD is significantly more agitated and restless today. What action should you take first? o Look at urine characteristics. o Assess room temperature. o Reassure the patient that she is safe. o Allow the patient an area to pace in. - Correct answer A  Behavioral problems are often the patient's way of responding to a precipitating factor. Initially, the physical status should be evaluated. Urinary problems and pneumonia are the most common causes. Assessing the environment and reassuring the patient should then take place. The behavior should not be allowed to continue without trying to assess a cause for it.  Reference: 1529  When providing community health care teaching regarding the early warning signs of AD, which signs would you advise family members to report (select all that apply)? o Misplacing car keys o Loses the sense of time o Difficulty performing familiar tasks o Problems with performing basic calculations o Becoming lost in a usually familiar environment - Correct answer B,C,D,E  Difficulty performing familiar tasks, problems with performing basic calculations, and becoming lost in a usually familiar environment are early warning signs of AD. Misplacing car keys is a normal frustrating event for many people.  Which statement by the wife of a patient with AD demonstrates an accurate understanding of her husband's medication regimen? o "I'm really hoping his medications will slow down his mental losses." o "We're both holding out hope that this medication will cure his disease." o "I know that this won't cure him, but we learned that it may prevent a bodily decline while he declines mentally." o "I learned that if we are vigilant about his medication schedule, he may not experience the physical effects of his disease." - Correct answer A  There is no cure for AD, and drug therapy aims at improving or controlling the decline in cognition. Medications do not directly address the physical manifestations of AD.  Reference: 1525  For which patient should you prioritize an assessment for depression? o A patient in the early stages of AD o A patient who is in the final stages of AD o A patient experiencing delirium resulting from dehydration o A patient who has become delirious after an atypical drug response - Correct answer A  Patients in the early stages of AD are particularly susceptible to depression, because the patient is aware of his or her cognitive changes and the expected disease trajectory. Delirium is typically a short-term health problem that does not typically pose a heightened risk of depression.  Reference: 1527  The early stage of AD is characterized by o no noticeable change in behavior. o memory problems and mild confusion. o increased time spent sleeping or in bed. o incontinence, agitation, and wandering behavior. - Correct answer B  An initial sign of AD is a subtle deterioration in memory.  What is a major goal of treatment for the patient with AD? o To maintain patient safety o To maintain or increase body weight o To return to a higher level of self-care o To enhance functional ability over time - Correct answer A  The overall goals are that the patient with AD will (1) maintain functional ability for as long as possible, (2) be maintained in a safe environment with a minimum of injuries, (3) have personal care needs met, and (4) have dignity maintained. You should emphasize patient safety while planning and providing nursing care.  Reference: 1527  Along with dementia, what additional symptom is characteristic of Lewy body dementia? o Myasthenia gravis o Extrapyramidal signs o Ataxia o Multiple sclerosis - Correct answer B  Lewy body dementia has Lewy bodies in the brainstem and cortex. In addition to dementia, it is characterized by at least two of the following: extrapyramidal signs, fluctuating cognitive ability, and hallucinations.  What is a common priority nursing need for a patient with Lewy body dementia? o Dysphasia o Apraxia o Visual agnosia o Dysphagia - Correct answer D  Patients with Lewy body dementia have problems with dysphagia and immobility. Swallowing problems can lead to impaired nutrition. All dementia patients can have problem with comprehending language and oral communication (dysphasia), inability to manipulate objects or perform purposeful acts (apraxia), and inability to recognize objects of sight (visual agnosia). Dysphagia (trouble with swallowing) is a priority.  What is the classic source for transmission of the small infectious pathogen (prion protein) in Creutzfeldt-Jakob disease? o Dogs o Ticks o Seafood o Cows - Correct answer D  The source is beef obtained from animals contaminated with bovine spongiform encephalopathy. The disease is also known as mad cow disease.  Reference: 1533  What distinguishes Creutzfeldt-Jakob disease from Alzheimer disease (AD)? o A curative drug exists. o Rheumatoid arthritis develops. o Involuntary muscle jerks are present. o A fine, papular, pink rash develops. - Correct answer C  Creutzfeldt-Jakob disease is a rare and fatal brain disorder. The earliest symptom may be memory impairment and behavioral changes. The disease progresses rapidly, with mental deterioration, involuntary movement (muscle jerks), weakness in the limbs, blindness, and eventually coma. There is no treatment.  Reference: 1533  Creutzfeldt-Jakob disease is characterized by o remissions and exacerbations over many years. o memory impairment, muscle jerks, and blindness. o Parkinsonian symptoms including muscle rigidity and tremors at rest. intensive care unit, lack of a watch or calendar, absence of reading glasses, and untreated pain. Precipitating factors are eliminated. Assess for drug and alcohol withdrawal, fluid and electrolyte imbalance, nutritional deficiencies, and infection. Care includes protecting from harm, increasing familiarity with the environment, and reorientation and behavioral interventions. Polypharmacy is a common cause; drugs are not used prophylactically for this problem.  After you administer a dose of risperidone (Risperdal) to a patient with delirium, which intended effect of the medication do you assess for? o Lying quietly in bed o Alleviation of depression o Reduction in blood pressure o Disappearance of confusion - Correct answer A  Risperidone is an antipsychotic drug that reduces agitation and produces a restful state in patients with delirium. However, it should be used with caution  Which patient may be at greatest risk for delirium? o A patient with fibromyalgia whose chronic pain has recently worsened o An elderly patient whose recent computed tomography study shows brain atrophy o A patient with a fracture who has spent the night in the emergency department o An elderly patient who takes multiple medications for various health problems - Correct answer D  Polypharmacy is implicated in many cases of delirium, and this phenomenon is especially common among older adults. Brain atrophy, if associated with cognitive changes, is indicative of dementia. Alterations in sleep and environment and pain may cause delirium, but this is less of a risk than taking multiple medications by an older adult.  Benzodiazepines are indicated in the treatment of cases of delirium that have which cause? o Polypharmacy o Cerebral hypoxia o Alcohol withdrawal o Electrolyte imbalances - Correct answer C  Benzodiazepines can be used to treat delirium associated with sedative and alcohol withdrawal. However, these drugs may worsen delirium caused by other factors and must be used cautiously.  Which patient is most at risk for delirium? o A 50-year-old woman with cholecystitis o A 19-year-old man with a fractured femur o A 42-year-old woman having an elective hysterectomy o A 78-year-old man admitted to the medical unit with complications related to heart failure - Correct answer D  Risk factors that can precipitate delirium include age 65 years or older, male gender, and severe, acute illness (e.g., heart failure). The 78-year-old man has the most risk factors for delirium.  During the nursing assessment the patient states that she is experiencing headaches bilaterally that are described as pressing or tightening. The headaches last from a few minutes to days and the pain is described as a 5 on a scale of 1 to 10. These signs and symptoms are consistent with which type of headache? o Sinus o Cluster o Tension o Migraine - Correct answer C  Tension-type headache, the most common type of headache, is characterized by its bilateral location and pressing/tightening quality. Tension-type headaches are usually of mild or moderate intensity and not aggravated by physical activity.  Which of the following are characteristic of a tension-type headache? o The patient experiences an aura. o They are aggravated by physical activity. o Nausea and vomiting are present. o They involve photosensitivity. - Correct answer D  Tension-type headaches are usually of mild or moderate intensity and not aggravated by physical activity. Tension-type headaches are subcategorized as episodic or chronic. Tension-type headaches can last from minutes to days. There is no prodrome (early manifestation of impending disease) in tension-type headache. The headache does not involve nausea or vomiting but may involve sensitivity to light (photophobia) or sound (phonophobia).  The pain reliever of choice for patients experiencing a tension type headache is o meperidine hydrochloride (Demerol). o morphine sulfate (Morphine). o codeine sulfate (Codeine). o acetaminophen (Tylenol). - Correct answer D  Drug treatment for tension-type headache usually involves a nonopioid analgesic (e.g., aspirin, acetaminophen) used alone or in combination with a sedative, muscle relaxant, tranquilizer, or codeine.  You would identify which tool as the most useful for diagnosing a tension headache? o CT scan o Electromyography (EMG) o Careful history taking o Assessment of deep tendon reflexes - Correct answer C  Careful history taking is probably the most important tool for diagnosing tension- type headache. Electromyography (EMG) may be performed. This test may reveal sustained contraction of the neck, scalp, or facial muscles. However, many patients may not show increased muscle tension with this test, even when the test is done during the actual headache.  Reference: 1486  . During the nursing assessment the patient identifies experiencing episodic headaches with pain described as a 10 on a scale of 1 to 10. The patient describes the pain as unilateral and located on the left side, lasting for 2 to 3 days. The patient also experiences nausea. You would determine the patient was experiencing which type of headache? o Sinus o Cluster o Tension o Migraine - Correct answer D  Migraine headache is a recurring headache characterized by unilateral (sometimes bilateral) throbbing pain, a triggering event or factor, strong family history, and manifestations associated with neurologic and autonomic nervous system dysfunction.  When presenting information to a nursing student regarding migraine headaches, you would identify which age group as most affected by migraine headaches? o Adolescents o 20 to 30 year olds o 40 to 50 year olds o Older adults aged 60 and greater - Correct answer B  The most common age for onset of migraine is between the ages of 20 and 30 years. Migraine affects as many as 17% of females and 6% of males in the United States.  Reference: 1487  . The patient with migraines asks you why "everyone always asks if anyone in the family has a history of migraines." Your priority response is o "It is standard practice to assess a person's history to identify potential health risks" o "Around 70% of individuals with migraines have a relative who also has migraines." o "Assessing your history identifies the treatment plan." o "This assessment provides a baseline for future assessments." - Correct answer B  Approximately 70% of those with migraine have a first-degree relative who also had migraine headaches.  Reference: 1487 o abrupt withdrawal of all nonopioid medications. - Correct answer D  Medication overuse headache (MOH) is the term used to describe an analgesic rebound headache. Drugs known to cause this problem are acetaminophen, aspirin, NSAIDs (e.g., ibuprofen), butalbital, sumatriptan, and opioids. Treatment involves abrupt withdrawal of the offending drug (except for opioids, which need to be tapered) and initiation of alternative drugs such as amitriptyline.  A 50-year-old man complains of recurring headaches. He describes these as sharp, stabbing, and located around his left eye. He also reports that his left eye seems to swell and get teary when these headaches occur. Based on this history, you suspect that he has o cluster headaches. o tension headaches. o migraine headaches. o medication overuse headaches. - Correct answer A  Cluster headaches involve repeated headaches that can occur for weeks to months at a time, followed by periods of remission. The pain of cluster headache is sharp and stabbing; the intense pain lasts from a few minutes to 3 hours. Headaches can occur every other day and as often as 8 times a day. The clusters occur with regularity, usually occurring at the same time each day, during the same seasons of the year. Typically a cluster lasts 2 weeks to 3 months, and then the patient goes into remission for months to years. The pain is generally located around the eye, radiating to the temple, forehead, cheek, nose, or gums. Other manifestations may include swelling around the eye, lacrimation (tearing), facial flushing or pallor, nasal congestion, and constriction of the pupil. During the headache, the patient is often agitated and restless, unable to sit still or relax.  Reference: 1487-1488  You are called to the patient's room and find the patient in a clonic reaction. Your priority action is to o record the time sequence of all of the patient's movements and responses as they occur. o turn the patient to the side. o call the health care provider. o start oxygen by mask at 6 L/miN - Correct answer A  When a seizure occurs, you should carefully observe and record details of the event because the diagnosis and subsequent treatment often rest solely on the seizure description. All aspects of the seizure should be noted. What events preceded the seizure? When did the seizure occur? How long did each phase (aural [if any], ictal, postictal) last?  Reference: 1499  You would correctly identify which age group as most often affected by absence seizures? o Infants o Children o Young adults o Older adults - Correct answer The absence (petit mal) seizure usually occurs only in children and rarely continues beyond adolescence. This type of seizure may cease altogether as the child matures, or it may evolve into another type of seizure.  Reference: 1493  . Which characteristic of a patient's recent seizure indicates a partial seizure? o The patient lost consciousness during the seizure. o The seizure involved lipsmacking and repetitive movements. o The patient fell to the ground and became stiff for 20 seconds. o The etiology of the seizure involved both sides of the patient's brain. - Correct answer B  The most common complex partial seizure involves lip smacking and automatisms (repetitive movements that may not be appropriate). Loss of consciousness, bilateral brain involvement, and a tonic phase are associated with generalized seizure activity.  Reference: 1494  The patient has been receiving scheduled doses of phenytoin (Dilantin) and begins to experience diplopia. You immediately assess the patient for o an aura. o nystagmus or confusion. o abdominal pain or cramping. o irregular pulse or palpitations - Correct answer B  Diplopia is a sign of phenytoin toxicity. You should assess for other signs of toxicity, which include neurologic changes such as nystagmus, ataxia, confusion, dizziness, or slurred speech.  Reference: 1496  The patient has an order for phenytoin (Dilantin) 100 mg q8hr IV. Available is a phenytoin injection containing 50 mg/mL. How many milliliters of solution should you draw up for the dose? o 0.5 o 2 o 5 o 20 - Correct answer B  100 mg ÷ 50 mg/mL = 2 mL.  The nursing student reports to the nurse in charge that the patient experienced a generalized tonic-clonic seizure. This means that the patient is exhibiting o a momentary loss of consciousness. o jerking movements throughout the body. o rigidity for several seconds, then flaccidity. o rigidity of muscles followed by muscle jerking. - Correct answer D  The most common generalized seizure is the generalized tonic-clonic (formerly known as grand mal) seizure. Tonic-clonic seizure is characterized by loss of consciousness and falling to the ground if the patient is upright, followed by stiffening of the body (tonic phase) for 10 to 20 seconds and subsequent jerking of the extremities (clonic phase) for another 30 to 40 seconds  During the postictal period of a seizure, you would expect the patient to o demonstrate minor jerking and eye fluttering. o sleep for several hours. o be incontinent of urine and feces. o require ventilator assistance. - Correct answer B  In the postictal phase the patient usually has muscle soreness, is very tired, and may sleep for several hours. Some patients may not feel normal for several hours or days after a seizure. The patient has no memory of the seizure.  Reference: 1493  A classic sign of an absence (petit mal) seizure is o blank stare. o frequent smacking of lips. o urinary incontinence. o asking the same question over and over. - Correct answer A  The typical clinical manifestation is a brief staring spell that lasts only a few seconds, so it often occurs unnoticed. There may be an extremely brief loss of consciousness.  Reference: 1493  ou recognize that status epilepticus is a medical emergency because o seizures continue without a return of consciousness. o fractures of a limb may occur. o urinary fecal incontinence may occur. o heart rate becomes bradycardic. - Correct answer A  Status epilepticus is a state of continuous seizure activity or a condition in which seizures recur in rapid succession without return to consciousness between seizures. It is the most serious complication of epilepsy and is a neurologic emergency. Status epilepticus can occur due to any type of seizure. During repeated seizures the brain uses more energy than can be supplied.  The patient is seen in the clinic due to an increase in the frequency of seizure activity. In addition to a thorough health history you should draw blood for o anemia. o serum drug levels. o arterial blood gases. o electrolytes. - Correct answer B o Provide the patient with a minced or pureed diet that is high in potassium and low in sodium. - Correct answer C  Nutritional support is a priority in the care of individuals with PD. Such patients may benefit from meals that are smaller and more frequent than normal and which are easy to chew and swallow. Multivitamins are not necessary at each meal, and vitamin intake, along with protein intake, must be monitored to prevent contraindications with medications. It is likely premature to introduce a minced or pureed diet and a low carbohydrate diet is not indicated.  Reference: 1509  What is the cause of the clinical manifestations of Parkinson's disease? o Decreased levels of dopamine o Decreased levels of acetylcholine o Increased levels of angiotensinogen o Increased levels of relaxin - Correct answer A  The pathologic process of PD involves degeneration of the dopamine-producing neurons in the substantia nigra of the midbrain.  Reference: 1506  he classic symptoms of Parkinson's disease include (select all that apply) o tremor. o rigidity. o loss of balance. o bradykinesia. o nystagmus. - Correct answer A,B,D  The classic manifestations of PD often include tremor, rigidity, and bradykinesia, which are often called the triad of PD.  Reference: 150  The patient asks you, "How can I be certain I have Parkinson's disease?" Your response is based on the knowledge that the absolute confirmation of the diagnosis is o decreased serum dopamine level. o positive response to medication administration. o nerve biopsy. o electromyography (EMG). - Correct answer B  The ultimate confirmation of PD is a positive response to antiparkinsonian drugs.  Reference: 1508  The patient with Parkinson's disease is beginning therapy with carbidopa/levodopa (Sinemet).What teaching should you provide to this patient? o The medication should be taken every other day. o It may take several weeks for effects to be observed. o Side effects are limited to rash and photophobia. o Constipation may occur. - Correct answer B  Effects of carbidopa/levodopa (Sinemet) may be delayed for several weeks to months.  Reference: 1508  Which nursing diagnosis is more appropriate for a patient with advanced Parkinson's disease? o Urinary urge incontinence related to effects of drug therapy o Ineffective breathing pattern related to diaphragm fatigue o Risk for aspiration related to impaired swallowing o Risk for injury related to limited vision - Correct answer C  You would correctly identify the advantage of Sinemet in the treatment of Parkinson's disease is its ability to o restore deficient dopamine. o increase the effect of levodopa. o block the breakdown of dopamine. o block uptake of catecholamines. - Correct answer A  Sinemet is the preferred drug because it also contains carbidopa, an agent that inhibits the enzyme dopa-decarboxylase in the peripheral tissues. Dopa- decarboxylase breaks down levodopa before it reaches the brain. The net result of the combination of levodopa and carbidopa is that more levodopa reaches the brain, and therefore less drug is needed.  Reference: 1508  A 65-year-old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is o searching the Internet for educational videos. o evaluating the home for environmental safety. o promoting physical exercise and a well-balanced diet. o designing an exercise program to strengthen and stretch specific muscles. - Correct answer C  Promotion of physical exercise and a well-balanced diet are major concerns for nursing care for patients with Parkinson's disease.  Reference: 1509  You would correctly identify the pathophysiologic etiology of myasthenia gravis as a deficit of o dopamine. o acetylcholine. o myelin. o albumin. - Correct answer B  MG is caused by an autoimmune process in which antibodies attack acetylcholine (ACh) receptors, resulting in a decreased number of ACh receptor (AChR) sites at the neuromuscular junction. This prevents ACh molecules from attaching and stimulating muscle contraction.  Reference: 1510  Which nursing diagnosis is likely to be a priority in the care of a patient with myasthenia gravis? o Acute confusion o Bowel incontinence o Activity intolerance o Disturbed sleep pattern - Correct answer C  The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG, and while sleep disturbance is likely, activity intolerance is usually of primary concern.  You would correctly identify that the most common early symptom(s) of myasthenia gravis are o weakness, fatigue, and ptosis. o significant unilateral weakness. o nausea, dizziness, and dysphagia. o numbness and tingling of the extremities. - Correct answer A  he primary feature of MG is fluctuating weakness of skeletal muscle. Strength is usually restored after a period of rest. The muscles most often involved are those used for moving the eyes and eyelids, chewing, swallowing, speaking, and breathing.  Reference: 1512  When administering a Tensilon test to a patient with a possible diagnosis of myasthenia gravis, you would realize the test is positive if the patient o reports improved muscle strength. o demonstrates improved cognition. o experiences a surge of energy. o exhibits enhanced vision. - Correct answer A  Tensilon test in a patient with MG reveals improved muscle contractility after intravenous injection of the anticholinesterase agent edrophonium chloride (Tensilon). (Anticholinesterase blocks the enzyme acetylcholinesterase.)  Reference: 1512  The priority nursing intervention for the patient with myasthenia gravis who is receiving pyridostigmine (Mestinon) includes o timing drug administration so that chewing and swallowing are enhanced. o withholding the drug if muscle function improves. o assessing for constipation and paralytic ileus. o monitoring renal and hepatic function. - Correct answer A  Scheduling doses of drugs so that peak action is reached at mealtime may make eating less difficult.  Reference: 1513  Which statement is true regarding the prevalence of amyotrophic lateral sclerosis (ALS)? o Death occurs in less than one year o Survival rate is less than two years o Rates are higher in males than females o Rates are highest in the age group of 20 to 30 year olds - Correct answer C  Amyotrophic lateral sclerosis (ALS) is a rare progressive neurologic disorder characterized by loss of motor neurons. ALS usually leads to death within 2 to 6 years after diagnosis, but many patients may survive for more than 10 years. The onset is usually between 40 and 70 years of age. ALS is more common in men than women by a ratio of 2:1.  An important nursing diagnosis for the patient with amyotrophic lateral (ALS) is o impaired gas exchange related to paralysis of respiratory muscles. o hypothermia related to impaired regulation by the hypothalamus. o impaired memory related to cognitive changes. o dysreflexia related to loss of sympathetic nervous tone - Correct answer A  Death usually results from respiratory infection secondary to compromised respiratory function.  When working with the family of a patient with amyotrophic lateral sclerosis (ALS) in the later stages of the disease, what teaching should you reinforce? o Perform frequent passive range of motion to maintain joint function. o Communicate with patient normally because cognition remains intact. o Provide foods high in fiber to prevent constipation. o Speak in a loud clear voice to facilitate the patient's hearing. - Correct answer B  The illness trajectory for ALS is devastating because the patient remains cognitively intact while wasting away. Active range of motion is needed to maintain muscle function. Foods high in fiber may be difficult to chew. Patients with ALS usually do not have a hearing impairment.  Social effects of a chronic neurologic disease include (select all that apply) o divorce. o job loss. o depression. o role changes. o loss of self-esteem. - Correct answer ALL OF THEM  Social problems related to chronic neurologic disease may include changes in roles and relationships (such as divorce, job loss, and role changes); other psychologic problems (such depression and loss of self-esteem) may also have social effects.  You are counseling the family of a patient with Huntington's disease (HD) about the genetics involved in the disease. You would be correct in informing the family that the genetic risk for manifestation of the disease in genetic transmission is o 1 in every 4 pregnancies. o 1 in every 2 pregnancies. o only evident in male children. o impossible to predict. - Correct answer B  HD is a genetically transmitted, autosomal dominant disorder that affects both men and women of all races. The offspring of a person with this disease have a 50% risk of inheriting it.  Which statement is true regarding the prevalence of Huntington's disease? o Death occurs in less than one year. o Survival rate is less than two years. o Rates are higher in males than females. o Onset occurs in the 30 to 50 year old age group. - Correct answer D  The onset of HD is usually between 30 and 50 years of age. HD is a genetically transmitted, autosomal dominant disorder that affects both men and women of all races. Death usually occurs 10 to 20 years after the onset of symptoms.  You know the pathologic process of Huntington's disease (HD) involves a deficiency of o acetylcholine. o dopamine. o serotonin. o endorphins. - Correct answer A  The pathologic process of HD involves the basal ganglia and the extrapyramidal motor system. However, instead of a deficiency of dopamine, HD involves a deficiency of the neurotransmitters acetylcholine and γ-aminobutyric acid (GABA).  ne major goal of treatment for the patient with Huntington's disease is o disease cure. o symptomatic relief. o maintaining employment. o improving muscle strength. - Correct answer B  Because there is no cure for Huntington's disease (HD), collaborative care is palliative and based on symptom relief. The goal of nursing management is to provide the most comfortable environment possible for the patient and the caregiver by maintaining physical safety, treating the physical symptoms, and providing emotional and psychological support.  Reference: 1515-1516