LEWIS Ch 63: Chronic Neurologic Problems.

1. The nurse determines that teaching about management of migraine headaches has been effective when the patient says which of the following?

a. "I can take the (Topamax) as soon as a headache starts."

b. "A glass of wine might help me relax and prevent a headache."

c. "I will lie down someplace dark and quiet when the headaches begin."

d. "I should avoid taking aspirin and sumatriptan (Imitrex) at the same time."

c. "I will lie down someplace dark and quiet when the headaches begin."

2. The nurse expects the assessment of a patient who is experiencing a cluster headache to include

a. nuchal rigidity.

b. unilateral ptosis.

c. projectile vomiting.

d. throbbing, bilateral facial pain.

b. unilateral ptosis.

3. While the nurse is transporting a patient on a stretcher to the radiology department, the patient begins having a tonic-clonic seizure. Which action should the nurse take?

a. Insert an oral airway during the seizure to maintain a patent airway.

b. Restrain the patient's arms and legs to prevent injury during the seizure.

c. Time and observe and record the details of the seizure and postictal state.

d. Avoid touching the patient to prevent further nervous system stimulation.

c. Time and observe and record the details of the seizure and postictal state.

4. A high school teacher who has been diagnosed with epilepsy after having a generalized tonic-clonic seizure tells the nurse, "I cannot teach any more. It will be too upsetting if I have a seizure at work." Which response by the nurse specifically addresses the patient's concern?

a. "You might benefit from some psychologic counseling."

b. "Epilepsy usually can be well controlled with medications."

c. "You will want to contact the Epilepsy Foundation for assistance." d. "The Department of Vocational Rehabilitation can help with work retraining.

b. "Epilepsy usually can be well controlled with medications."

5. A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the nurse take when evaluating for adverse effects of the medication?

a. Inspect the oral mucosa.

b. Listen to the lung sounds.

c. Auscultate the bowel sounds.

d. Check pupil reaction to light.

a. Inspect the oral mucosa.

6. A patient reports feeling numbness and tingling of the left arm before experiencing a seizure. The nurse determines that this history is consistent with what type of seizure?

a. Focal

b. Atonic

c. Absence

d. Myoclonic

a. Focal

7. When obtaining a health history and physical assessment for a 36-yr-old female patient with possible multiple sclerosis (MS), the nurse should

a. assess for the presence of chest pain.

b. inquire about urinary tract problems.

c. inspect the skin for rashes or discoloration.

d. ask the patient about any increase in libido.

b. inquire about urinary tract problems

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

a. "MS symptoms may be worse after the pregnancy."

b. “Symptoms of MS may improve during pregnancy.” 

c. "MS is associated with an increased risk for congenital defects."

d. "Symptoms of MS are likely to become worse during pregnancy."

b. “Symptoms of MS may improve during pregnancy.”

9. A 33-yr-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching?

a. Recommendation to drink at least 4 L of fluid daily

b. Need to avoid driving or operating heavy machinery

c. How to draw up and administer injections of the medication

d. Use of contraceptive methods other than oral contraceptives

c. How to draw up and administer injections of the medication

10. Which information about a 60-yr-old patient with multiple sclerosis indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)?

a. The patient walks a mile each day for exercise.

b. The patient complains of pain with neck flexion.

c. The patient has an increased serum creatinine level.

d. The patient has the relapsing-remitting form of MS.

c. The patient has an increased serum creatinine level.

11. Which action will the nurse plan to take for a patient with multiple sclerosis who has urinary retention caused by a flaccid bladder?

a. Encourage a decreased evening intake of fluid.

b. Teach the patient how to self-catheterize. 

c. Suggest the use of adult incontinence briefs for nighttime only. d. Assist the patient to the commode every 2 hours during the day.

b. Teach the patient how to self-catheterize.

12. A patient with Parkinson's disease has bradykinesia. Which action will the nurse include in the plan of care?

a. Instruct the patient in activities that can be done while lying or sitting.

b. Suggest that the patient use the arms of the chair to help push up to standing.

c. Have the patient take small steps in a straight line directly in front of the feet.

d. Teach the patient to keep the feet in contact with the floor and slide them forward.

b. Suggest that the patient use the arms of the chair to help push up to standing.

13. A 62-yr-old patient who has Parkinson's disease is taking bromocriptine (Parlodel). Which information obtained by the nurse may indicate a need for a decrease in the dosage?

a. The patient has a chronic dry cough.

b. The patient has four loose stools in a day.

c. The patient develops a deep vein thrombosis.

d. The patient's blood pressure is 92/52 mm Hg.

ANS: D

Hypotension is an adverse effect of bromocriptine, and the nurse should check with the health care provider before giving the medication

14. The nurse advises a patient with myasthenia gravis (MG) to

a. perform physically demanding activities early in the day.

b. anticipate the need for weekly plasmapheresis treatments.

c. do frequent weight-bearing exercise to prevent muscle atrophy.

d. protect the extremities from injury due to poor sensory perception.

a. perform physically demanding activities early in the day.

15. Which medication taken by a patient with restless legs syndrome should the nurse discuss with the patient?

a. Ibuprofen

b. Multivitamin

c. Acetaminophen

d. Diphenhydramine

d. Diphenhydramine

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

a. Observe for agitation and paranoia.

b. Assist with active range of motion (ROM).

c. Give muscle relaxants as needed to reduce spasms.

d. Use simple words and phrases to explain procedures.

b. Assist with active range of motion (ROM).

17. A 40-yr-old patient is diagnosed with early Huntington's disease (HD). When teaching the patient, spouse, and adult children about this disorder, the nurse will provide information about the

a. use of levodopa-carbidopa (Sinemet) to help reduce HD symptoms.

b. prophylactic antibiotics to decrease the risk for aspiration pneumonia.

c. option of genetic testing for the patient's children to determine their own HD risks.

d. lifestyle changes of improved nutrition and exercise that delay disease progression.

c. option of genetic testing for the patient's children to determine their own HD risks.

18. When a 74-yr-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling-type tremor, the nurse will anticipate teaching the patient about

a. oral corticosteroids.

b. antiparkinsonian drugs.

c. magnetic resonance imaging (MRI).

d. electroencephalogram (EEG) testing.

b. antiparkinsonian drugs.

19. A 22-yr-old patient seen at the health clinic with a severe migraine headache tells the nurse about having similar headaches recently. Which initial action should the nurse take?

a. Teach about the use of triptan drugs.

b. Refer the patient for stress counseling.

c. Ask the patient to keep a headache diary.

d. Suggest the use of muscle-relaxation techniques.

c. Ask the patient to keep a headache diary.

20. A hospitalized patient complains of a bilateral headache (4/10 on the pain scale) that radiates from the base of the skull. Which prescribed PRN medications should the nurse administer initially?

a. Lorazepam (Ativan)

b. Acetaminophen (Tylenol)

c. Morphine sulfate (MS Contin)

d. Butalbital and aspirin (Fiorinal)

b. Acetaminophen (Tylenol)

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

a. Discuss the need to stop taking the acetaminophen.

b. Suggest the use of biofeedback for headache control.

c. Describe the use of botulism toxin (Botox) for headaches.

d. Teach the patient about magnetic resonance imaging (MRI).

a. Discuss the need to stop taking the acetaminophen.

22. The health care provider is considering the use of sumatriptan (Imitrex) for a 54-yr-old male patient with migraine headaches. Which information obtained by the nurse is most important to report to the health care provider?

a. The patient drinks 1 to 2 cups of coffee daily.

b. The patient had a recent acute myocardial infarction.

c. The patient has had migraine headaches for 30 years.

d. The patient has taken topiramate (Topamax) for 2 months.

b. The patient had a recent acute myocardial infarction.

23. The nurse observes a patient ambulating in the hospital hall when the patient's arms and legs suddenly jerk and the patient falls to the floor. The nurse will first

a. assess the patient for a possible injury.

b. give the scheduled divalproex (Depakote).

c. document the timing and description of the seizure.

d. notify the patient's health care provider about the seizure.

a. assess the patient for a possible injury.

24. Which prescribed intervention will the nurse implement first for a patient in the emergency department who is experiencing continuous tonic-clonic seizures?

a. Give phenytoin (Dilantin) 100 mg IV.

b. Monitor level of consciousness (LOC).

c. Administer lorazepam (Ativan) 4 mg IV.

d. Obtain computed tomography (CT) scan.

c. Administer lorazepam (Ativan) 4 mg IV.

25. The home health registered nurse (RN) is planning care for a patient with a seizure disorder related to a recent head injury. Which nursing action can be delegated to a licensed practical/vocational nurse (LPN/LVN)?

a. Make referrals to appropriate community agencies.

b. Place medications in the home medication organizer.

c. Teach the patient and family how to manage seizures.

d. Assess for use of medications that may precipitate seizures.

b. Place medications in the home medication organizer.

26. A patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which information indicates a need for change in the medication or dosage?

a. Shuffling gait

b. Tremor at rest

c. Cogwheel rigidity of limbs

d. Uncontrolled head movement

d. Uncontrolled head movement

27. Which nursing diagnosis is of highest priority for a patient with Parkinson's disease who is unable to move the facial muscles?

a. Activity intolerance

b. Self-care deficit: toileting

c. Ineffective self-health management

d. Imbalanced nutrition: less than body requirements

d. Imbalanced nutrition: less than body requirements

28. Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis?

a. Pupil size

b. Grip strength

c. Respiratory effort

d. Level of consciousness

c. Respiratory effort

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

a. Auscultate the patient's bowel sounds.

b. Notify the patient's health care provider.

c. Administer the prescribed PRN antiemetic drug.

d. Give the scheduled dose of prednisone (Deltasone).

b. Notify the patient's health care provider

30. A hospitalized patient with a history of cluster headache awakens during the night with a severe stabbing headache. Which action should the nurse take first?

a. Put a moist hot pack on the patient's neck.

b. Start the prescribed PRN O2 at 6 L/min.

c. Give the ordered PRN acetaminophen (Tylenol).

d. Notify the patient's health care provider immediately.

b. Start the prescribed PRN O2 at 6 L/min.

31. Which intervention will the nurse include in the plan of care for a patient with primary restless legs syndrome (RLS) who is having difficulty sleeping?

a. Teach about the use of antihistamines to improve sleep.

b. Suggest that the patient exercise regularly during the day.

c. Make a referral to a massage therapist for deep massage of the legs.

d. Assure the patient that the problem is transient and likely to resolve.

b. Suggest that the patient exercise regularly during the day.

32. Which information about a patient who has a new prescription for phenytoin (Dilantin) indicates that the nurse should consult with the health care provider before administration of the medication?

a. Patient has tonic-clonic seizures.

b. Patient experiences an aura before seizures.

c. Patient has minor elevations in the liver function tests.

d. Patient's most recent blood pressure is 156/92 mm Hg.

c. Patient has minor elevations in the liver function tests.

33. After change-of-shift report, which patient should the nurse assess first?

a. Patient with myasthenia gravis who is reporting increased muscle weakness

b. Patient with a bilateral headache described as "like a band around my head"

c. Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin)

d. Patient with Parkinson's disease who has developed cogwheel rigidity of the arms

a. Patient with myasthenia gravis who is reporting increased muscle weakness

34. A patient who has been treated for status epilepticus in the emergency department will be transferred to the medical nursing unit. Which equipment should the nurse have available in the patient's assigned room (select all that apply)?

a. Side-rail pads

b. Tongue blade

c. Oxygen mask

d. Suction tubing

e. Urinary catheter

f. Nasogastric tube

a. Side-rail pads

c. Oxygen mask

d. Suction tubing

35. A patient with Parkinson's disease is admitted to the hospital for treatment of pneumonia. Which nursing interventions will be included in the plan of care (select all that apply)?

a. Provide an elevated toilet seat.

b. Cut patient's food into small pieces.

c. Serve high-protein foods at each meal.

d. Place an armchair at the patient's bedside.

e. Observe for sudden exacerbation of symptoms.

ANS: A, B, D

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