MEDSURG PRACTICE QUESTIONS
Balance and coordination issues
(FINALS)
MULTIPLE SCLEROSIS
1. Select all the TRUE statements about the
pathophysiology of multiple sclerosis:
A. “The dendrites on the neuron are
overstimulated leading to the destruction of the
axon.”
B. “The myelin sheath is damaged along the
axon.”
C. “This disease affects the insulating
structure found on the neuron in the central
nervous system.”
D. “The dopaminergic neurons in the part of the
brain called substantia nigra have started to die.”
The answers are B and C. In multiple sclerosis
the myelin sheath is damaged. MS affects the
CNS (central nervous system) and when the
myelin sheath becomes damaged it leads to a
decrease in nerve transmission.
2. True or False: Multiple Sclerosis tends to
affect men more than women and occurs during
the ages of 50-70 years.
False: MS affects WOMEN more than men and
shows up during the ages of 20-40 years.
3. True or False: Patients with multiple sclerosis
have different signs and symptoms because this
disease can affect various areas of the peripheral
nervous system.
False: Yes, patients with MS have different
signs and symptoms because lesions can present
at different locations in the CENTRAL
NERVOUS SYSTEM….hence the brain and
spinal cord (not the peripheral nervous system).
4. A patient is suspected of having multiple
sclerosis. The neurologist orders various test.
The patient’s MRI results are back and show
lesions on the cerebellum and optic nerve. What
signs and symptoms below would correlate with
this MRI finding in a patient with multiple
sclerosis?
A. Blurry vision
B. Pain when moving eyes
C. Dysarthria
D.
E. “Pill rolling” of fingers and hands
G. Heat intolerance
H. Dark spots in vision
I. Ptosis
The answers are A, B C, D, and H. If lesions are
present on the optic nerves, optic neuritis can
occurs which can lead to blurry vision, pain
when moving the eyes, and dark spots in the
vision. If cerebellar lesions are found, this can
affect movement, speech, and some cognitive
abilities. This would present as dysarthria (issues
articulating words), and balance/coordination
issues. “Pill rolling” of the fingers and hands is
found in Parkinson’s disease. Ptosis is common
in myasthenia gravis, and heat intolerance in
thyroid issues.
5. You’re performing a head-to-toe assessment
on a patient with multiple sclerosis. When you
ask the patient to move the head and neck
downward the patient reports an “electric shock”
sensation that travels down the body. You would
report your finding to the doctor that the patient
is experiencing:
A. Romberg’s Sign
B. Lhermitte’s Sign
C. Uhthoff’s Sign
D. Homan’s Sign
The answer is B. This finding is known as
Lhermitte’s Sign.
6. Which finding below represents a positive
Romberg Sign in a patient with multiple
sclerosis?
A. The patient report dark spots in the visual
fields during the confrontation visual field test.
B. When the patient closes the eyes and
stands with their feet together they start to
lose their balance and sway back and forth.
C. The patient’s sign and symptoms increase
when expose to hot temperatures.
D. The patient reports an electric shock feeling
when the head and neck are moved downward.
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MAYE A.
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The answer is B. This is an example of a
positive Romberg’s Sign.
7. Your patient is scheduled for a lumbar
puncture to help diagnose multiple sclerosis. The
patient wants clarification about what will be
found in the cerebrospinal fluid during the
lumbar puncture to confirm the diagnosis of MS.
You explain that ____________ will be present
in the fluid if MS is present.
A. high amounts of IgM
B. oligoclonal bands
C. low amounts of WBC
D. oblong red blood cells and glucose
The answer is B. These specific proteins,
oligoclonal bands, which are immunoglobulins
will be found in the CSF. This demonstrates
there is inflammation in the CNS and is a
common finding in multiple sclerosis.
8. You’re developing a plan of care for a patient
with multiple sclerosis who presents with
Uhthoff’s Sign. What interventions will you
include in the patient’s plan of care? Select all
that apply:
A. Avoid movements of the head and neck
downward
B. Keep room temperature cool
C. Encourage patient to use warm packs and
heating pads for symptoms
D. Educate the patient on three ways to avoid
overheating during exercise
The answers are B and D. Uhthoff’s Sign is
where when the patient experiences too much
heat their symptoms increase and get worst.
Therefore, it is important the patient stays cool
and doesn’t overheat (overheating can come
from outside temperatures, exercise, emotional
events etc.). The room should be cool and the
patient should be encouraged to exercise but to
avoid overheating.
9. During your discharge teaching to a patient
with multiple sclerosis, you educate the patient
on how to avoid increasing symptoms and
relapses. You tell the patient to avoid:
A. Cold temperatures
B. Infection
C. Overexertion
D. Salt
F. Stress
The answer is B, C, and F. The patient should
also avoid extreme heat, which can increase
symptoms.
10. A patient with multiple sclerosis has issues
with completely emptying the bladder. The
physician orders the patient to take
___________, which will help with bladder
emptying.
A. Bethanechol
B. Oxybutynin
C. Avonex
D. Amantadine
The answer is A. This medication is a
cholinergic medication that will help with
bladder emptying.
11. A patient is receiving Interferon Beta for
treatment of multiple sclerosis. As the nurse you
will stress the importance of?
A. Physical exercise to improve fatigue
B. Low fat diet
C. Hand hygiene and avoiding infection
D. Reporting ideation of suicide
The answer is C. Interferon Beta decreases the
number of relapses of symptoms in MS patients
by decreasing the immune system response, but
it lowers the white blood cells count. Hence,
there is a risk of infection. It is very important
the nurse stresses the importance of hand
hygiene and avoiding infection.
12. Which medications below can help treat
muscle spasms in a patient with multiple
sclerosis? Select all that apply:
A. Propranolol
B. Isoniazid
C. Baclofen
D. Diazepam
E. Modafinil
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The answers are C and D. These medications 4. "I will have the chaplain come and stay with
treat muscle spasms in patients with MS. you for a while."

13. The nurse is assessing a 48-year-old client 17. The client diagnosed with multiple sclerosis
diagnosed with multiple sclerosis. Which is scheduled for a magnetic resonance imaging
clinical manifestation warrants immediate (MRI) scan of the head. Which information
intervention? should the nurse teach the client about the test?

1. The client has scanning speech and diplopia.
2. The client has dysarthria and scotomas.
3. The client has muscle weakness and
spasticity.
4. The client has a congested cough and
dysphagia.
14. The client newly diagnosed with multiple
sclerosis (MS) states, "I don't understand how I
got multiple sclerosis. Is it genetic?" On which
statement should the nurse base the response?
1. Genetics may play a role in susceptibility to
MS, but the disease may be caused by a virus.
2. There is no evidence suggesting there is any
chromosomal involvement in developing MS.
3. Multiple sclerosis is caused by a recessive
gene, so both parents had to have the gene for
the client to get MS.
4. Multiple sclerosis is caused by an autosomal
dominant gene on the Y chromosome,so only
fathers can pass it on.
15. The 30-year-old female client is admitted
with complaints of numbness, tingling, a
crawling sensation affecting the extremities, and
double vision which has occurred two(2) times
in the month. Which question is most important
for the nurse to ask the client?
1. "Have you experienced any difficulty with
your menstrual cycle?"
2. "Have you noticed a rash across the bridge of
your nose?"
3. "Do you get tired easily and sometimes
have problems swallowing?"
4. "Are you taking birth control pills to prevent
conception?"
1. The client will have wires attached to the
scalp and lights will flash off and on.
2. The machine will be loud and the client
must not move the head during the test.
3. The client will drink a contrast medium 30
minutes to one (1) hour before the test.
4. The test will be repeated at intervals during a
five (5)- to six (6)-hour period.
18. The 45-year-old client is diagnosed with
primary progressive multiple sclerosis and the
nurse writes the nursing diagnosis "anticipatory
grieving related to progressive loss." Which
intervention should be implemented?
1. Consult the physical therapist for assistive
devices for mobility.
2. Determine if the client has a legal power of
attorney.
3. Ask if the client would like to talk to the
hospital chaplain.
4. Discuss the client's wishes regarding end-
of-life care.
4. The client should make personal choices
about end-of-life issues while it is possible to do
so. This client is progressing toward immobility
and all the complications related to it.
19. The home health nurse is caring for the
client newly diagnosed with multiple sclerosis.
Which client issue is of most importance?
1. The client refuses to have a gastrostomy
feeding.
2. The client wants to discuss if she should tell
her fiancé.
3. The client tells the nurse life is not worth
living anymore
.4. The client needs the flu and pneumonia
vaccines.

16. The nurse enters the room of a client 20. The nurse and a licensed practical nurse
diagnosed with acute exacerbation of multiple (LPN) are caring for a group of clients. Which
sclerosis and finds the client crying. Which nursing task should not be assigned to the LPN?
statement is the most therapeutic response for
the nurse to make? 1. Administer a skeletal muscle relaxant to a
client diagnosed with low back pain.
1. "Why are you crying? The medication will 2. Discuss bowel regimen medications with the
help the disease." HCP for the client on strict bed rest.
2. "You seem upset. I will sit down and we 3. Draw morning blood work on the client
can talk for awhile." diagnosed with bacterial meningitis.
3. "Multiple sclerosis is a disease that has good 4. Teach self-catheterization to the client
times and bad times." diagnosed with multiple sclerosis.

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MAYE A.
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The male client diagnosed with multiple D) Respiratory Depression
sclerosis states he has been investigating
alternative therapies to treat his disease. Which
intervention is most appropriate by the nurse? 25. Which of the following symptoms you as the
nurse expect to see in the patient with primary
1. Encourage the therapy if it is not
contraindicated by the medical regimen. progressive multiple sclerosis? (Select All that
2. Tell the client only the health-care provider Apply):
should discuss this with him. A) Unilateral Vision Loss
3. Ask how his significant other feels about this
deviation from the medical regimen. B) Fatigue
4. Suggest the client research an investigational
therapy instead. C) Diarrhea
D) Intention tremors
21. The client diagnosed with an acute
exacerbation of multiple sclerosis is placed on E) Paralytic ileus
high-dose intravenous injections of
corticosteroid medication. Which nursing
intervention should be implemented?
26. The nurse is teaching the client with MS
1. Discuss discontinuing the proton pump about the use of corticosteroids for treatment.
inhibitor with the HCP. Which of the following statements, if made by
2. Hold the medication until after all cultures the patient indicates correct understanding?
have been obtained.
3. Monitor the client's serum blood glucose A) I should watch for side effects such as
levels frequently euphoria and insomnia while taking this
.4. Provide supplemental dietary sodium with medication
the client's meals.
B) This medication will need to be administered
for at least 2 weeks before I begin to see
22. The nurse writes the client problem of
"altered sexual functioning" for a male client improvements in my condition
diagnosed with multiple sclerosis (MS). Which C) The corticosteroids will reduce my chances
intervention should be implemented? of relapsing in the future
1. Encourage the couple to explore alternative D) I could see flu-like symptoms while taking
ways of maintaining intimacy. this medication
2. Make an appointment with a psychotherapist
to counsel the couple.
3. Explain daily exercise will help increase
libido and sexual arousal. 27. A patient with multiple sclerosis states
4. Discuss the importance of keeping physically "After I started taking my medication, I feel
calm during sexual intercourse. nauseous and feel fatigued. I also am also
running a fever". After looking in the patient's
chart you note that she is taking Interferon beta
23. The nurse is admitting a client diagnosed 1b (Betaseron). What is the nurses' best
with multiple sclerosis. Which clinical response?
manifestation should the nurse assess? Select all
that apply. A) "We are going to stop your medication
1. Muscle flaccidity. immediately. This is a sign of an adverse
2. Lethargy. reaction"
3. Dysmetria.
4. Fatigue. B) "It would probably be best to admit you to
5. Dysphagia. the hospital. Your MS is relapsing and we will
need to begin you on a corticosteroid regimen"

24. Which of the following is a side effect of C) "This is only a side effect of your medication.
Methylprednisolone (Solu-Medrol)? It will just eventually go away"

A) Hypovolemia D) "Taking your medication at bedtime with

a Tylenol my help reduce these symptoms"
B) Tinnitus
C) Euphoria

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28. The nurse is caring for a patient with
Multiple Sclerosis (MS) and appropriately plans
to:
A) Teach the patient to avoid all forms of weight
bearing exercise
B) Avoid the use of an eyepatch as this could
cause further damage to vision
C) Encourage the patient to consume a low-
residue diet
D) Teach the patient how to inject
medications as all MS medications are
administered via SQ or IM injection
29. Your patient has been diagnosed with MS.
You are teaching her about how to reduce
muscle spasticity. Which of the following
statements, if made by the patient would indicate
the need for further teaching?
A) Daily exercise, including weight bearing can
help relieve spasticity
B) My stretching routine can help with the
spasms
C) Taking Baclofen may help relieve these
painful spasms in my legs
D) At the end of a day, taking a nice hot bath
may relieve the muscle spasms
PARKINSON’S DISEASE
1. As the nurse you know that Parkinson’s
Disease tends to affect the _____________ of
the midbrain, which leads to the depletion of the
neurotransmitter ________________.
A. red nucleus, acetylcholine
B. leminisci, norepinephrine
C. substantia nigra, dopamine
D. tectum nigra, dopamine
2. True or False: Parkinson’s Disease most
commonly affects patients in young adulthood,
and there is currently no cure for the disease.
The answer is FALSE. Parkinson’s Disease
most commonly affects patients in OLDER
adulthood (60 or older), and there is currently
no cure for the disease.
3. You’re caring for a patient with Parkinson’s
Disease that has tremors. Select the option that is
INCORRECT about tremors experienced in this
disease:
A. The tremors are most likely to occur with
purposeful movements.
B. A common term used to describe the tremors
in the hands and fingers is called “pill-rolling”.
C. Tremors are one of the most common signs
and symptoms in Parkinson’s Disease.
D. Tremors in this disease can occur in the
hands, fingers, arms, legs and even the lips and
tongue.
4. While assessing a patient with Parkinson’s
Disease, you note the patient’s arms slightly jerk
as you passively move them toward the patient’s
body. This is known as:
A. Lead Pipe Rigidity
B. Cogwheel Rigidity
C. Pronate Rigidity
D. Flexor Rigidity
5. A patient with Parkinson’s Disease has slow
movements that affects their swallowing, facial
expressions, and ability to coordinate
movements. As the nurse you will document the
patient has:
A. Akinesia
B. “Freeze up” tremors
C. Bradykinesia
D. Pill-rolling
6. You’re providing free education to a local
community group about the signs and symptoms
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of Parkinson’s Disease. Select all the signs and
symptoms a patient could experience with this
disease:
A. Increased Salivation
B. Loss of smell
C. Constipation
D. Tremors with purposeful movement
E. Shuffling of gait
F. Freezing of extremities
G. Euphoria
H. Coordination issues
7. You’re providing diet education to a patient
with Parkinson’s Disease. Which statement
below demonstrates the patient understood your
teaching? Select all that apply:
A. “I will limit foods high in fiber like fruits and
vegetables in my diet.”
B. “I will be sure to drink 2 Liter of fluid per
day.”
C. “It is very common for me to experience
diarrhea with this disease.”
D. “I will avoid taking Carbidopa/Levodopa
with a protein rich meal.”
8. A patient with Parkinson Disease is
experiencing weight loss due to difficulty
chewing and swallowing. Which meal option
below is the best for this patient?
A. Scrambled eggs with a side of cottage
cheese
B. Grilled cheese with apple slices
C. Baked chicken with bacon slices
D. Tacos with refried beans
9. As the home health nurse you are helping a
patient with Parkinson’s Disease get dressed.
What item gathered by the patient to wear
should NOT be worn?
A. Velcro pants
B. Pull over sweatshirt
C. Non-slip socks
D. Rubber sole shoes
10. A spouse of a husband who has Parkinson’s
Disease explains to you that her husband
experiences episodes while walking where he
freezes and can’t move. She asks what can be
done to help with these types of episodes to
prevent injury. Select all the options that are
correct:
A. Have the husband try to change direction
of movement by moving in the opposite
direction when the freeze ups occur.
B. Use a cane with a laser point while
walking.
C. Have the husband try to push through the
freeze ups.
D. Encourage the husband to consciously lift
the legs while walking (as with marching).
11. A patient is prescribed to take
Carbidopa/Levodopa (Sinemet). As the nurse
you know that which statement is incorrect
about this medication:
A. It can take up to 3 weeks for the patient to
notice a decrease in signs and symptoms when
beginning treatment with this medication.
B. Body fluids can turn a dark color and stain
clothes.
C. This medication is most commonly
prescribed with a vitamin B6 supplement.
D. Carbidopa helps to prevent Levodopa from
being broken down in the blood before it enters
the brain. Hence, levodopa is able to enter the
brain.
12. Your patient with Parkinson’s Disease has
been taking Carbidopa/Levodopa for several
years. The patient reports that his signs and
symptoms actually become worse before the
next dose of medication is due. As the nurse,
you know what medication can be prescribed
with this medication to help decrease this for
happening?
A. Anticholinergic (Benztropine)
B. Dopamine agonists (Ropinirole)
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C. COMT Inhibitor (Entacapone)
D: Beta blockers (Metoprolol)
13. While providing discharge teaching to a
patient prescribed Ropinirole (Requip), you
make it priority to teach the patient about what
side effect?
A. Drowsiness
B. Dry mouth
C. Coughing
D. Dark sweat or saliva
14. A physician orders a patient to take
Benztropine (Cogentin). The patient has never
taken this medication before and is due to take
the first dose at 1000. What statement by the
patient requires you to hold the dose and notify
the physician?
A. “I forgot to tell the doctor I take eye drops
for my glaucoma.”
B. “I had a PET scan last week.”
C. “I take aspirin once day.”
D. “My hands are experiencing tremors at rest.”
15. A patient is taking Rasagiline “Azilect” for
treatment of Parkinson’s Disease. What foods do
the patient want to limit in their diet? Select all
that apply:
A. Liver
B. Aged Cheese
C. Sweetbread
D. Beer
E. Fermented foods
F. Shellfish
16. The nurse is assessing an older adult client.
Which finding should cause the nurse to suspect
the client has Parkinson disease (PD)? (Select all
that apply.)
A. The client has hand tremors at rest.
B. The client does not remember what he ate
for breakfast.
C. The client's blood pressure increases when
the client stands up.
D. The client has a slurred speech.
E. The client's facial expression shows no
emotion.
17. Which is the main pathology of Parkinson
disease that causes changes in muscular and
sensory function?
A. Reduction of acetylcholine in the brain
B. Reduction of dopamine in the brain
C. Genetic predisposition
D. Presence of Lewy bodies
18. Which clinical manifestation would be
required to confirm the diagnosis of Parkinson
disease?
A. Tremors at rest and bradykinesia
B. Bradykinesia only
C. Rigidity only
D. Tremor at rest and flaccidity
19. Which symptom for a client with Parkinson
disease (PD) is due to the lack of automatic
muscle movement?
A. Diminished voice volume
B. Reduced ability to swallow
C. Alterations in sleep pattern
D. Diminished physical mobility
20. A client newly diagnosed with Parkinson
disease asks the nurse, "What does dopamine do
in the brain?" Which is the most appropriate
response?
A. "Dopamine enhances the action of
acetylcholine."
B. "Dopamine causes spinal cord neurons to
transmit impulses."
C. "Dopamine stimulates the neurons to transmit
sensory and motor impulses."
D. "Dopamine helps maintain coordinated
motor movement."
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21. Which type of therapy is used to manage
problems with eating and swallowing?
A. Physical
B. Occupational
C. Speech
D. Nutritional
22. An older adult client with Parkinson disease
uses a walker, speaks in a slurred manner with
poor articulation, but tries to speak louder to
accommodate for this impairment. The client
states, "I catch my daughter looking at me
angrily sometimes, but she doesn't say
anything." Which nursing diagnosis is the
priority?
A. Communication: Verbal, Impaired
B. Caregiver Role Strain
C. Falls, Risk for
D. Nutrition, Imbalanced: Less than Body
Requirements
23. The healthcare provider of an older adult
client with advancing Parkinson disease
suggested that the client start an exercise regime.
Which exercise should the nurse recommend?
A. T'ai chi
B. Running
C. Weight lifting
D. Football
24. An older adult client was diagnosed with
Parkinson disease 3 months ago. Since the
diagnosis, the client has not gone out of the
house. Which statement by the nurse is most
appropriate?
A. "Tell your family to come and take you out of
the house."
B. "Can I ask why you aren't going out of the
house?"
C. "You need to start getting out."
D. "Getting out of the house will help you to feel
less depressed."
25. The daughter of an older adult client with
advancing Parkinson disease tells the nurse that
they need to dress their mother each morning,
because the mother is "not fast enough." Which
is the most appropriate response from the nurse?
A. "It is important for you to get to work on
time."
B. "Can you let her dress herself?
C. "It is best for you to let your mother dress
herself for as long as she can."
D. "That is really quite normal."
26. A client with Parkinson disease (PD) is
prescribed an anticholinergic agent to treat
tremors and rigidity. The nurse should teach the
client about which adverse effect they may
experience from this medication? (Select all that
apply.)
A. Drooling
B. Dry mouth
C. Rigidity
D. Loss of perspiration
E.Tremors
27. A nurse is preparing a presentation on
Parkinson disease (PD) for a health fair at a local
community center. Which information should
the nurse include in the presentation?
A. Parkinson disease affects both men and
women at the same rate.
B. Parkinson disease is the result of an infection.
C. Parkinson disease is inherited in over 50% of
those affected.
D. Parkinson disease usually affects people
older than the age of 60 years
28. Which health promotion activity should be
the focus of teaching for a client with Parkinson
disease (PD)? (Select all that apply.)
A. Participating in occupational therapy
B. Improving balance
C. Avoiding exercise
D. Preventing injury from falls
E. Promoting independence
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29. The nurse observed a client with Parkinson
disease frequently wiping their mouth with a
handkerchief. After the nurse requested a
prescription for an anticholinergic medication
from the healthcare provider, the client asked, "I
feel better, why do I need another medication?"
Which response by the nurse is correct?
A. "It helps dopamine work better."
B. "It will make you feel better."
C. "The healthcare provider thinks it will help
your symptoms."
D. "It will help reduce tremors and
uncontrolled drooling."
30. Which recommendation should the nurse
make to a client with Parkinson disease who
reports constipation? (Select all that apply.)
A. Decreasing fiber intake
B. Limiting exercise
C. Decreasing fluid intake
D. Increasing fluid intake
E. Increasing fiber intake
31. The nurse is performing passive range of
motion exercises for a client with Parkinson
disease. Which nursing goal does this
intervention address? (Select all that apply.)
A. The client will remain free from injury.
B. The client will participate in speech therapy
for swallowing and verbal communication.
C. The client will demonstrate normal bowel
elimination patterns.
D. The client will participate in occupational
therapy to integrate assistive devices for self-
care.
E. The client will participate in physical
therapy to improve walking and balance.
32. The nurse is assessing a client with
Parkinson disease (PD). Which factor should the
nurse include in the assessment? (Select all that
apply.)
A. Difficulty waking
B. Response to medication
C. Cognitive deficits
D. Dizziness when sitting
E. Bowel changes
33. Which recommendation should the nurse
make to the client with Parkinson disease (PD)
to improve gait and balance? (Select all that
apply.)
A. Looking ahead instead of down
B. Not moving too quickly
C. Not using an assistive device
D. Standing straight
E. Placing the heel on the ground before the
toes
34. A client with Parkinson disease (PD)
complains of increased tremor while eating.
Which action should the nurse recommend?
A. Having someone feed them
B. Liquefying all meals and drinking them
through a straw
C. Holding a piece of bread in the other hand
while eating
D. Using their nondominant hand to eat
35. The nurse is caring for a client with
Parkinson disease (PD) who reports problems
with stiffness and the ability to move. Which
action by the nurse will address the client's
mobility?
A. Ask the client if they know about the
medications to treat the stiffness
B. Advise bedrest for muscle recovery
C. Tell the client that this is part of the disease
process that cannot be stopped
D. Recommend a regular exercise routine and
walking
MYASTHENIA GRAVIS
1. Myasthenia gravis occurs when antibodies
attack the __________ receptors at the
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neuromuscular junction leading to
____________.
5. You’re preparing to help the neurologist with
A. metabotropic; muscle weakness conducting a Tensilon test. Which antidote will
you have on hand in case of an emergency?
B. nicotinic acetylcholine; muscle weakness
A. Atropine
C. dopaminergic adrenergic; muscle contraction
B. Protamine sulfate
D. nicotinic adrenergic; muscle contraction
C. Narcan
D. Leucovorin
2. You’re educating a patient about the
pathophysiology of myasthenia gravis. While
explaining the involvement of the thymus gland,
6. Which patient below is MOST at risk for
the patient asks you where the thymus gland is
developing a cholinergic crisis?
located. You state it is located?
A. A patient with myasthenia gravis is who is
A. behind the thyroid gland
not receiving sufficient amounts of their
anticholinesterase medication.
B. within the adrenal glands B. A patient with myasthenia gravis who reports
not taking the medication Pyridostigmine for 2
C. behind the sternum in between the lungs
weeks.
D. anterior to the hypothalamus
C. A patient with myasthenia gravis who is
experiencing a respiratory infection and recently
had left hip surgery.
3. A patient with myasthenia gravis will be
eating lunch at 1200. It is now 1000 and the D. A patient with myasthenia gravis who
patient is scheduled to take Pyridostigmine. At reports taking too much of their
what time should you administer this medication anticholinesterase medication.
so the patient will have the maximum benefit of
this medication?
7. Which meal option would be the most
A. As soon as possible
appropriate for a patient with myasthenia gravis?
B. 1 hour after the patient has eaten (at 1300)
A. Roasted potatoes and cubed steak
C. 1 hour before the patient eats (at 1100)
B. Hamburger with baked fries
D. at 1200 right before the patient eats
C. Clam chowder with mashed potatoes
D. Fresh veggie tray with sliced cheese cubes
4. The neurologist is conducting a Tensilon test
(Edrophonium) at the bedside of a patient who is
experiencing unexplained muscle weakness, 8. Select all the signs and symptoms below that
double vision, difficulty breathing, and ptosis. can present in myasthenia gravis:
Which findings after the administration of
A. Respiratory failure
Edrophonium would represent the patient has
myasthenia gravis? B. Increased salivation
A. The patient experiences worsening of the C. Diplopia
muscle weakness.
D. Ptosis
B. The patient experiences wheezing along with
facial flushing. E. Slurred speech

C. The patient reports a tingling sensation in the F. Restlessness

eyelids and sudden ringing in the ears. G. Mask-like appearance of looking sleepy
D. The patient experiences improved muscle H. Difficulty swallowing
strength.

ASMADUN, YLAIZA
MAYE A.
BSN-3E

9. You’re providing teaching to a group of
patients with myasthenia gravis. Which of the
following is not a treatment option for this
condition?
A. Plasmapheresis
B. Cholinesterase medications
C. Thymectomy
D. Corticosteroids
10. You’re a home health nurse providing care
to a patient with myasthenia gravis. Today you
plan on helping the patient with bathing and
exercising. When would be the best time to visit
the patient to help these tasks?
A. Mid-afternoon
B. Morning
C. Evening
D. Before bedtime
11. You are teaching your patient diagnosed
with myasthenia gravis about treatments. Which
of the following statements, if made by the
patient indicates the need for further teaching?
A) Plasmapheresis is way to reduce symptoms
but will need to be done every day
B) A thymectomy is a removal of my thymus
gland and will show some immediate relieving
of my symptoms
C) Corticosteroids can be used for short periods
of time to help improve my symptoms, but it
isn't good for long periods of time
D) I need to take my Mestinon four times a day
at the same time each day.
12. The patient with myasthenia gravis arrives to
the clinic and states that he is experiencing
nausea and diarrhea. His blood pressure is
125/85 HR 70 Temp 100.0 R 19 O2 97%. What
is the nursing priority?
A) Prepare the patient for intubation. He is about
to go into a myasthenic crisis.
B) Perform teaching on medication side effects
C) Assess for signs of infection
D) Further assess for other thymectomy
complications
13. The patient with myasthenia gravis is
complaining about dealing with muscle
weakness. Which of the following could the
nurse do for this patient?
A) Administer antispasmodic medication
B) Teach the patient to do physical exercise for
several hours each day to help strengthen
muscles
C) Teach the patient it is important to avoid all
forms of physical activity whenever possible
D) Help the patient form a plan to take
medications on time
14. The client is experiencing a myasthenic
crisis. Which of the following is a priority action
of the following ordered actions?
A) Insert NG tube
B) Administer Ativan
C) Monitor I&O
D) Immediately stop anticholinesterase
medications
15. The nurse is teaching a client about
myasthenia gravis. Which statement, if made by
the patient indicates the need for further
teaching?
A) The doctor will take me off of my beta
blocker because it could exacerbate my
symptoms
B) I should report any signs of infection to my
PCP
C) I can take a ibuprofen to help with pain
that may occur with spasms
D) I should avoid taking long walks
16. Which of the following would be most likely
given as a top nursing diagnosis for a patient
experiencing a cholinergic crisis?
A) Impaired Gas Exchange
ASMADUN, YLAIZA
MAYE A.
BSN-3E
B) Acute Fatigue
C) Ineffective airway clearance
D) Altered mental status
17. Your patient has just been diagnosed with
myasthenia gravis. Which of the following
orders should be questioned?
A) Prednisone PO daily
B) Eyepatch to be worn every night
C) Pyrodostigmine bromide (Mestinon) 4 times
daily PO
D) Procaine (Novocain) SQ stat to reduce
pain in lower limb
18. Which of the following is a side effect of
Methylprednisolone (Solu-Medrol)?
A) Hypovolemia
B) Tinnitus
C) Euphoria
D) Respiratory Depression
19. Your patient diagnosed with Myasthenia
Gravis begins taking Mestinon. During the first
week, the dosage is changed frequently. While
the dosage is being adjusted, the nurse's priority
intervention is to:
A) Administer the medication with food or an 8
oz. glass of water
B) Evaluate the client's muscle strength hourly
after medication
C) Take a full set of vital signs every 15 minutes
D) Administer the medication exactly on time
HEAD INJURY
1. The client diagnosed with a mild concussion
is being discharged from the emergency
department. which discharge instruction should
the nurse teach the clients significant other?
1. awake in the client every 2 hours.
2. monitor for increased intracranial pressure.
3. observe frequently for hypervigilance.
4. offer the client food every 3 to 4 hours.
2. The resident in a long term care facility Fell
during the previous shift and has a laceration in
the occiptal area that has been closed with steri
strips. Which signs or symptoms would warrant
transferring the resident to the emergency
department?
1. A 4 centimeters area of bright red drainage on
the dressing.
2. A weak pulse, shallow respirations, and
cool pale skin.
3. pupils that are equal, react to light, and
accommodate.
4. Complaints of a headache that's resolved with
medication.
3. The nurse is caring for the following clients.
Which client what the nurse assess first after
receiving the shift report?
1. The 22 year old male client diagnosed with a
concussion who is complaining someone is
waking him up every 2 hours.
2. The 36 year old female client admitted with
complaints of left sided weakness who is
scheduled for an MRI scan.
3. The 45-year-old client admitted with blunt
trauma to the head after a motorcycle
accident who has a Glasgow Coma Scale
score of 6.
4. The 62-year-old client diagnosed with CVA
who has expressive aphasia.
4. The client has sustained a severe closed head
injury and the neurosurgeon is determining if the
client is brain dead. Which data support That the
client is brain dead?
1. The clients head is turned to the right, the
eyes turn to the right.
2. the EEG has identifiable waveforms.
3. There is no Eye activity when the cold
caloric test is performed.
4. the client assumes decorticate posturing when
painful stimuli are applied.
ASMADUN, YLAIZA
MAYE A.
BSN-3E
5. The client is admitted to the medical floor
with a diagnosis of closed head injury. Which
nursing intervention has priority?
1. Assess neurological status.
2. Monitor pulse, respiration, and blood
pressure. 3. Initiate an intravenous access.
4. Maintain an adequate airway.
6. The client diagnosed with a closed head injury
is admitted to the rehabilitation department.
Which medication order with the nurse
question? 1. A subcutaneous anti-coagulant.
2. An intravenous osmotic diuretics.
3. An oral anticonvulsant.
4. An oral proton pump inhibitor.
7. The clients diagnosed with a gunshot wound
to the head assumes decorticate posturing when
the nurse applies painful stimuli. Which
assessment data obtained 3 hours later would
indicate the client is improving?
1. Purposeless movement in response to
painful stimuli.
2. flaccid paralysis in all four extremities.
3. Decerebrate posturing when painful stimuli
are applied.
4. Pupils that are 6 millimeters in size and
nonreactive to painful stimuli.
8. The nurse is caring for a client diagnosed with
epidural hematoma. Which nursing interventions
should the nurse implement? Select all that
apply. 1. Maintain the head of the bed at 60
degrees.
2. Administer stool softeners daily.
3. Ensure that pulse oximeter reading is
higher than 93 percent.
4. Perform deep Nasal suction every 2 hours.
5. Administer mild sedative.
9. The client with a closed head injury has clear
fluid draining from the nose. Which action
should the nurse implement first?
1. Notify the health-care provider immediately.
2. Prepare to administer an antihistamine.
3. Test the drainage for presence of glucose.
4. Place 2x2 Gauze under the nose to collect
drainage.
10. The nurse is enjoying a day out at the lake
and witnesses a water skier hit the boat ramp.
The water skier is in the water not responding to
verbal stimuli. The nurse is the first health care
provider to respond to the accident. Which
intervention should be implemented first?
1. Assess the clients loc.
2. Organize onlookers to remove the client from
the lake.
3. Perform a head to toe assessment to determine
injuries.
4. Stabilize the clients cervical spine.
11. The client is diagnosed with a closed head
injury and is in a coma. The nurse writes the
client problem as high risk for immobility
complications. Which intervention would be
included in the plan of care?
1. Position the client with the head of the bed
elevated at intervals.
2. Performed active range of motion exercises
every 4 hours.
3. Turn the client every shift and massage bony
prominences.
4. Explain all procedures to the client before
performing them.
12. The 29-year-old client that was employed as
a forklift operator sustains a traumatic brain
injury secondary to a motor vehicle accident.
The client is being discharged from the
rehabilitation unit after 3 months and has
cognitive deficits. Which goal would be more
realistic for this client?
1. The client will return to work within 6
months. 2. The client is able to focus and stay
on task for 10 minutes.
3. The client will be able to dress self without
assistance.
4. The client will regain power and bladder
control.
ASMADUN, YLAIZA
MAYE A.
BSN-3E
ASMADUN, YLAIZA
MAYE A.
BSN-3E