Chapter 37Degenerative Neurological Dysfunction: Nursing Management My Nursing Test Banks

Chapter 37Degenerative Neurological Dysfunction: Nursing Management

MULTIPLE CHOICE

1.A client is diagnosed with a headache from a secondary cause. The nurse realizes this type of headache can be caused by:

1.

a tumor.

2.

tension.

3.

a migraine.

4.

cluster

ANS: 1

Primary headaches are identified when no organic cause can be found. A tumor headache is caused by a tumor and is classified as a secondary headache.

PTS: 1 DIF: Analyze REF: Headache

2.The nurse should instruct a client diagnosed with migraine headaches to be careful not to overdose on acetaminophen (Tylenol). Which drug should the nurse tell the patient to avoid?

1.

Aleve

2.

Aspirin

3.

Ibuprofen

4.

Vicodin

ANS: 4

Vicodin, although a narcotic analgesic, also contains acetaminophen (Tylenol). It is very easy to overdose on the acetaminophen (Tylenol) component, which can lead to kidney damage. Aleve does not contain acetaminophen (Tylenol). Aspirin and ibuprofen do not contain acetaminophen (Tylenol).

PTS: 1 DIF: Apply REF: Headache: Pharmacology

3.A client is diagnosed with seizures occurring because of hepatic encephalopathy. The nurse realizes that the cause for this clients seizures would be:

1.

physiological.

2.

iatrogenic.

3.

idiopathic.

4.

psychokinetic.

ANS: 1

The three major causes for seizures are physiological, iatrogenic, and idiopathic. Physiological seizures include those that occur with an acquired metabolic disorder such as hepatic encephalopathy. Iatrogenic causes include new medications or drug or alcohol use. Idiopathic causes include fevers, fatigue, or strong emotions. Psychokinetic is not a cause for seizures.

PTS: 1 DIF: Analyze REF: Table 37-4 Seizure Causes

4.A client tells the nurse that he sees flashing lights that occur prior to the onset of a seizure. Which of the following phases of a seizure is this client describing to the nurse?

1.

Prodromal phase

2.

Aural phase

3.

Ictal phase

4.

Postictal phase

ANS: 2

In the aural phase a sensation or warning occurs, which the patient often remembers. This warning can be visual, auditory, gustatory, or visceral in nature. The prodromal phase of a seizure includes the signs or activity before the seizure such as a headache or feeling depressed. The ictal phase of a seizure is the actual seizure. The postictal phase is the period immediately following the seizure.

PTS: 1 DIF: Analyze REF: Seizures: Assessment with Clinical Manifestations

5.A client is experiencing a grand mal seizure. Which of the following should the nurse do during this seizure?

1.

Protect the clients head.

2.

Leave the client alone.

3.

Give water to the client to avoid dehydration.

4.

Place a finger in the clients mouth to avoid swallowing the tongue.

ANS: 1

One of the most important interventions for a nurse to perform during a seizure is to protect the clients head from injury. Never give a client a drink during a seizure. Placing a finger in the clients mouth could be very dangerous to the client and the nurse. Do not leave the client unattended during a seizure

PTS: 1 DIF: Apply REF: Seizures: Planning and Implementation

6.A client is prescribed phenytoin (Dilantin) for a seizure disorder. Which of the following would indicate that the client is adhering to the medication schedule?

1.

The client is sleepy.

2.

The client is not experiencing seizures.

3.

The client no longer has headaches.

4.

The client is eating more food.

ANS: 2

Phenytoin (Dilantin) is a medication to control seizures. The absence of seizures indicates that the client is adhering to the medication schedule. Sleepiness, lack of headaches, or improved appetite are not indications that the medication is being used as prescribed.

PTS: 1 DIF: Analyze REF: Seizures: Table 37-6 Medications to Treat Seizures

7.The nurse is unable to insert an intravenous access line into a client who is currently experiencing a seizure. Which of the following routes can the nurse use to provide medication to the client at this time?

1.

Oral

2.

Intranasal

3.

Rectal

4.

Intramuscular

ANS: 2

For a client experiencing a seizure, oral medications and sharp objects can be dangerous and should not be used. Intranasally administered drugs are rapid and effective in treating a client experiencing an acute seizure. Intranasal delivery is more effective than rectal.

PTS: 1 DIF: Apply REF: Red Flag: Intranasal Drug Delivery

8.One of the most important things a nurse can teach a client about seizure control is to:

1.

take the medication every day as prescribed by the doctor.

2.

eat a balanced diet.

3.

get lots of exercise.

4.

take naps during the day.

ANS: 1

Medication is effective only if it is taken as prescribed, and suddenly stopping the medication can trigger an increase in seizure activity. Diet and exercise are important to a healthy lifestyle but do little to control seizure activity.

PTS: 1 DIF: Apply REF: Seizures: Planning and Implementation

9.The nurse is instructing a client newly diagnosed with multiple sclerosis (MS). To determine the effectiveness of his teaching, the nurse would expect the client to state:

1.

It is best for me to be in a cold environment.

2.

I should avoid taking a hot bath.

3.

I should eat foods low in salt.

4.

I should be better in a week.

ANS: 2

The clinical manifestations of MS can be exacerbated by being in a hot, humid environment or by taking a hot bath. A cold environment and low-salt foods do not impact the symptoms of multiple sclerosis. If the client states that they will improve in a week, instruction has not been effective.

PTS:1DIF:Analyze

REF:Multiple Sclerosis: Assessment with Clinical Manifestations

10.An adult female in her 30s complains of numbness and tingling in the hands, fatigue, loss of coordination, incontinence, nystagmus, and ataxia. Which of the following health problems do these symptoms suggest to the nurse?

1.

Brain tumor

2.

Myasthenia gravis

3.

Multiple sclerosis

4.

Diabetes

ANS: 3

Multiple sclerosis is more common in women of this age. These are symptoms, along with the age and sex of the patient, that are common to MS. These symptoms are not necessarily associated with a brain tumor. Weakness is the primary symptom associated with myasthenia gravis. Symptoms of diabetes include weight loss, blurred vision, excessive urination, thirst, and hunger.

PTS: 1 DIF: Analyze REF: Table 37-8 Clinical Manifestations of MS

11.For a client diagnosed with Parkinsons disease, which of the following might be contraindicated?

1.

Performing range-of-motion exercises

2.

Drinking bottled water

3.

Instituting fall precautions

4.

Taking naps

ANS: 2

Some clients diagnosed with Parkinsons disease develop swallowing difficulties. Powders to thicken liquids and using an upright position will help with these difficulties. Clients diagnosed with Parkinsons disease will benefit from range-of-motion exercises and resting. The client diagnosed with Parkinsons disease should be placed on fall precautions.

PTS: 1 DIF: Apply REF: Parkinsons Disease: Planning and Implementation

12.A client diagnosed with Parkinsons disease is beginning medication therapy. The nurse realizes that the goal of treatment for Parkinsons disease is to:

1.

improve sleep.

2.

reduce appetite.

3.

control tremor and rigidity.

4.

reduce the need for joint replacement surgery.

ANS: 3

The goal of pharmacologic treatment for the client diagnosed with Parkinsons disease is to control tremor and rigidity and to improve the clients ability to carry out the activities of daily living. Medications for Parkinsons disease are not provided to improve sleep, reduce appetite, or reduce the need for joint replacement surgery.

PTS: 1 DIF: Analyze REF: Parkinsons Disease: Pharmacology

13.A client presents complaining of abnormal muscle weakness and fatigability. The physician suspects myasthenia gravis. Which drug can be used to test for this disease?

1.

Pyridostigmine (Mestinon)

2.

Neostigmine (Prostigmin)

3.

Ambenonium (Mytelase)

4.

Edrophonium (Tensilon)

ANS: 4

Tensilon, a short-acting anticholinesterase agent, is the drug of choice for diagnosing myasthenia gravis. The clients response is a rapid improvement of manifestations within 15 to 30 seconds that last 5 minutes. The other medications are used to treat clients diagnosed with myasthenia gravis.

PTS:1DIF:Apply

REF: Myasthenia Gravis: Diagnostic Tests; Pharmacology

MULTIPLE RESPONSE

1.A client is diagnosed with tonic-clonic seizures. Which are the characteristics of these types of seizures? (Select all that apply.)

1.

Progressing through all of the seizure phases

2.

Beginning before age 5

3.

Lasting 2 to 3 minutes

4.

Causing injury to the client

5.

Occurring at any time, day or night

6.

Being highly variable

ANS: 1, 3, 4, 5, 6

Tonic-clonic seizures are the most common type of generalized seizure. The seizure will progress through all of the seizure phases and last 2 to 3 minutes. Because these seizures begin suddenly, there is an increased incidence of injury associated with them. These seizures can occur any time of the day or night, whether the client is awake or not. Seizure frequency is highly variable.

PTS:1DIF:AnalyzeREF:Generalized Seizures

2.Which of the following nursing interventions would be appropriate for a client diagnosed with Alzheimers disease? (Select all that apply.)

1.

Make changes to the room often to stimulate memory function.

2.

Assign simple tasks to be completed by the client.

3.

Assist the client with any needs associated with activities of daily living (ADLs).

4.

Have personal/familiar items around the client.

5.

Do complex games and puzzles to improve memory.

ANS: 2, 3, 4

Alzheimers disease progressively alters the clients ability to function in the normal ways of living. Personal and familiar items help to keep the client oriented, and simple tasks keep the client functioning at the highest levels as long as possible.

PTS:1DIF:Apply

REF: Alzheimers Disease: Planning and Implementation; Evaluation of Outcomes

3.A client has been diagnosed with Parkinsons disease. Which of the following will the nurse most likely assess in this client? (Select all that apply.)

1.

Tremor

2.

Muscle rigidity

3.

Akinesia

4.

Mask-like face

5.

Dysphagia

6.

Reduced appetite

ANS: 1, 2, 3, 4, 5

Signs and symptoms of Parkinsons disease include tremor, muscle rigidity, akinesia, mask-like face, and dysphagia. Reduced appetite is not a sign or symptom of Parkinsons disease.

PTS:1DIF:Analyze

REFarkinsons Disease: Assessment with Clinical Manifestations

4.The nurse is planning care for a client diagnosed with myasthenia gravis. Which of the following should be included in this clients plan of care? (Select all that apply.)

1.

Monitor activities frequently and assist as needed.

2.

Encourage progressive increase in activities.

3.

Determine the best communication method.

4.

Monitor weight.

5.

Restrict fluids.

6.

Instruct in energy conservation measures.

ANS: 1, 3, 4, 6

Care for the client diagnosed with myasthenia gravis includes frequent monitoring of activities and assisting as needed, determining the best communication method, monitoring weight, and instructing in energy conservation methods. Encouraging a progressive increase in activities and restricting fluids are not appropriate interventions for a client diagnosed with myasthenia gravis.

PTS: 1 DIF: Apply REF: Myasthenia Gravis: Planning and Implementation

5.The nurse is instructing a client and family regarding the diagnosis of amyotrophic lateral sclerosis. Which of the following should be included in this teaching? (Select all that apply.)

1.

The length of the curative treatment

2.

That exercise and physical therapy can help the patient maximize function

3.

The physical, emotional, and social aspects of the disease

4.

End-of-life issues

5.

The use of devices to prevent aspiration pneumonia

6.

The use of a speech therapist to aid with communication

ANS: 2, 3, 4, 5, 6

Currently, no cure for this disease exists. Because of the progressive, degenerative nature of the disease, the supportive and educative role of the nurse is important. End-of-life issues need to be discussed before an emergency situation occurs. Other topics of instruction should include the purpose of physical therapy and speech therapy; the use of devices to prevent aspiration; and the emotional and social aspects of the disease.

PTS:1DIF:Apply

REF:Amyotrophic Lateral Sclerosis: Planning and Implementation

6.The nurse is caring for a client diagnosed with Huntingtons disease. Which of the following are considered hallmark clinical manifestations of this disorder? (Select all that apply.)

1.

Intellectual decline

2.

Weight loss

3.

Decreased appetite

4.

Reduced blood pressure

5.

Nausea

6.

Abnormal movements

ANS: 1, 6

The hallmark clinical manifestations of Huntingtons disease are intellectual decline and abnormal movements. Weight loss, decreased appetite, reduced blood pressure, and nausea are not clinical manifestations of this disorder.

PTS:1DIF:Analyze

REF:Huntingtons Disease: Assessment with Clinical Manifestations

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