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Neuro - BS NURSING

Nursing (Cagayan de Oro College)

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Answer B.

Fatigue is a common symptom in clients with multiple sclerosis.

The nurse is teaching a female client with multiple sclerosis. When
Lowering the body temperature by resting in an air-conditioned
teaching the client how to reduce fatigue, the nurse should tell the
room may relieve fatigue; however, extreme cold should be avoid-
client to:
ed. A hot bath or shower can increase body temperature, produc-
a. take a hot bath.
ing fatigue. Muscle relaxants, prescribed to reduce spasticity, can
b. rest in an air-conditioned room
cause drowsiness and fatigue. Planning for frequent rest periods
c. increase the dose of muscle relaxants.
and naps can relieve fatigue. Other measures to reduce fatigue in
d. avoid naps during the day
the client with multiple sclerosis include treating depression, using
occupational therapy to learn energy conservation techniques,
and reducing spasticity.
A female client with Guillain-Barré syndrome has paralysis affect-
ing the respiratory muscles and requires mechanical ventilation.
When the client asks the nurse about the paralysis, how should
Answer A.
the nurse respond?
a. "You may have difficulty believing this, but the paralysis caused
The nurse should inform the client that the paralysis that accom-
by this disease is temporary."
panies Guillain-Barré syndrome is only temporary. Return of motor
b. "You'll have to accept the fact that you're permanently para-
function begins proximally and extends distally in the legs.
lyzed. However, you won't have any sensory loss."
c. "It must be hard to accept the permanency of your paralysis."
d. "You'll first regain use of your legs and then your arms."
Answer A.
The nurse is working on a surgical floor. The nurse must logroll a
male client following a: The client who has had spinal surgery, such as laminectomy, must
a. laminectomy. be logrolled to keep the spinal column straight when turning. The
b. thoracotomy. client who has had a thoracotomy or cystectomy may turn himself
c. hemorrhoidectomy. or may be assisted into a comfortable position. Under normal cir-
d. cystectomy. cumstances, hemorrhoidectomy is an outpatient procedure, and
the client may resume normal activities immediately after surgery.
A female client is admitted in a disoriented and restless state
Answer D.
after sustaining a concussion during a car accident. Which nursing
diagnosis takes highest priority in this client's plan of care?
Because the client is disoriented and restless, the most important
a. Disturbed sensory perception (visual)
nursing diagnosis is risk for injury. Although the other options may
b. Self-care deficient: Dressing/grooming
be appropriate, they're secondary because they don't immediately
c. Impaired verbal communication
affect the client's health or safety.
d. Risk for injury
Answer B.
A female client with amyotrophic lateral sclerosis (ALS) tells the
This comment best supports a nursing diagnosis of Powerless-
nurse, "Sometimes I feel so frustrated. I can't do anything without
ness because ALS may lead to locked-in syndrome, characterized
help!" This comment best supports which nursing diagnosis?
by an active and functioning mind locked in a body that can't per-
a. Anxiety
form even simple daily tasks. Although Anxiety and Risk for disuse
b. Powerlessness
syndrome may be diagnoses associated with ALS, the client's
c. Ineffective denial
comment specifically refers to an inability to act autonomously. A
d. Risk for disuse syndrome
diagnosis of Ineffective denial would be indicated if the client didn't
seem to perceive the personal relevance of symptoms or danger.
Nurse Maureen witnesses a neighbor's husband sustain a fall
Answer C.
from the roof of his house. The nurse rushes to the victim and
determines the need to opens the airway in this victim by using
If a neck injury is suspected, the jaw thrust maneuver is used
which method?
to open the airway. The head tilt-chin lift maneuver produces
a. Flexed position
hyperextension of the neck and could cause complications if a
b. Head tilt-chin lift
neck injury is present. A flexed position is an inappropriate position
c. Jaw thrust maneuver
for opening the airway.
d. Modified head tilt-chin lift
The nurse is assessing the motor function of an unconscious male Answer B.
client. The nurse would plan to use which plan to use which of the
following to test the client's peripheral response to pain? Motor testing in the unconscious client can be done only by testing
a. Sternal rub. response to painful stimuli. Nail bed pressure tests a basic periph-
b. Nail bed pressure eral response. Cerebral responses to pain are tested using sternal

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c. Pressure on the orbital rim
d. Squeezing of the sternocleidomastoid muscle
A male client with a spinal cord injury is prone to experiencing au-
tomatic dysreflexia. The nurse would avoid which of the following
measures to minimize the risk of recurrence?
a. Strict adherence to a bowel retraining program
b. Keeping the linen wrinkle-free under the client
c. Preventing unnecessary pressure on the lower limbs
d. Limiting bladder catheterization to once every 12 hours
A female client has experienced an episode of myasthenic crisis.
The nurse would assess whether the client has precipitating fac-
tors such as:
a. Getting too little exercise
b. Taking excess medication
c. Omitting doses of medication
d. Increasing intake of fatty foods
The nurse is teaching the female client with myasthenia gravis
about the prevention of myasthenic and cholinergic crises. The
nurse tells the client that this is most effectively done by:
a. Eating large, well-balanced meals
b. Doing muscle-strengthening exercises
c. Doing all chores early in the day while less fatigued
d. Taking medications on time to maintain therapeutic blood levels
Female client is admitted to the hospital with a diagnosis of
Guillain-Barre syndrome. The nurse inquires during the nursing
admission interview if the client has history of:
a. Seizures or trauma to the brain
b. Meningitis during the last 5 years
c. Back injury or trauma to the spinal cord
d. Respiratory or gastrointestinal infection during the previous
month.
A female client with Guillian-Barre syndrome has ascending
paralysis and is intubated and receiving mechanical ventilation.
Which of the following strategies would the nurse incorporate in
the plan of care to help the client cope with this illness?
a. Giving client full control over care decisions and restricting
visitors
b. Providing positive feedback and encouraging active range of
motion
c. Providing information, giving positive feedback, and encourag-
ing relaxation
d. Providing intravaneously administered sedatives, reducing dis-
tractions and limiting visitors
The nurse is teaching a client with myasthenia gravis about the
prevention of myasthenic and cholinergic crises. Which client
activity suggests that teaching is most effective?
1.Taking medications as scheduled
2.Eating large, well-balanced meals
3.Doing muscle-strengthening exercises
4.Doing all chores early in the day while less fatigued
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rub, placing upward pressure on the orbital rim, or squeezing the
clavicle or sternocleidomastoid muscle.
Answer D.
The most frequent cause of autonomic dysreflexia is a distended
bladder. Straight catheterization should be done every 4 to 6
hours, and foley catheters should be checked frequently to prevent
kinks in the tubing. Constipation and fecal impaction are other
causes, so maintaining bowel regularity is important. Other caus-
es include stimulation of the skin from tactile, thermal, or painful
stimuli. The nurse administers care to minimize risk in these areas.
Answer C.
Myasthenic crisis often is caused by undermedication and re-
sponds to the administration of cholinergic medications, such as
neostigmine (Prostigmin) and pyridostigmine (Mestinon). Cholin-
ergic crisis (the opposite problem) is caused by excess medication
and responds to withholding of medications. Too little exercise
and fatty food intake are incorrect. Overexertion and overeating
possibly could trigger myasthenic crisis
Answer D.
Clients with myasthenia gravis are taught to space out activities
over the day to conserve energy and restore muscle strength.
Taking medications correctly to maintain blood levels that are not
too low or too high is important. Muscle-strengthening exercises
are not helpful and can fatigue the client. Overeating is a cause of
exacerbation of symptoms, as is exposure to heat, crowds, erratic
sleep habits, and emotional stress.
Answer D.
Guillain-Barré syndrome is a clinical syndrome of unknown origin
that involves cranial and peripheral nerves. Many clients report
a history of respiratory or gastrointestinal infection in the 1 to 4
weeks before the onset of neurological deficits. Occasionally, the
syndrome can be triggered by vaccination or surgery.
Answer C.
The client with Guillain-Barré syndrome experiences fear and
anxiety from the ascending paralysis and sudden onset of the
disorder. The nurse can alleviate these fears by providing accurate
information about the client's condition, giving expert care and
positive feedback to the client, and encouraging relaxation and
distraction. The family can become involved with selected care
activities and provide diversion for the client as well.
1.
clients with myasthenia gravis are taught to space out activities
over the day to conserve energy and restore muscle strength.
Taking medications correctly to maintain blood levels that are not
too low or too high is important. Muscle-strengthening exercises
are not helpful and can fatigue the client. Overeating is a cause of
exacerbation of symptoms, as is exposure to heat, crowds, erratic
sleep habits, and emotional stress.
4
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The nurse is instructing a client with Parkinson's disease about The client with Parkinson's disease should be instructed regarding
preventing falls. Which client statement reflects a need for further safety measures in the home. The client should use his or her
teaching? walker as support to get to the bathroom because of bradykinesia.
1."I can sit down to put on my pants and shoes." The client should sit down to put on pants and shoes to prevent
2."I try to exercise every day and rest when I'm tired." falling. The client should exercise every day in the morning when
3."My son removed all loose rugs from my bedroom." energy levels are highest. The client should have all loose rugs in
4."I don't need to use my walker to get to the bathroom. the home removed to prevent falling.
When planning nursing care for a client with trigeminal neuralgia,
B.
the nurse should specifically:
A. Apply iced compresses to the affected area
Patient with TN can be in so much pain with just a slight movement
B. Be alert to prevent dehydration or starvation
of face that they choose not to move it all including not eating or
C. Initiate exercises of the jaw and facial muscles
drinking.
D. Emphasize the importance of brushing the teeth
To limit triggering the pain associated with trigeminal neuralgia the
nurse should instruct the client to
D.
A. Avoid oral hygiene
B. Apply warm compresses
This way the client will minimize the episode of pain.
C. Drink iced liquids
D. Chew on the unaffected side
The nurse has given suggestions to a client with trigeminal neu-
4
ralgia about strategies to minimize episodes of pain. The nurse
determines that the client needs further teaching if the client
Facial pain can be minimized by using cotton pads to wash the
makes which statement?
face and using room temperature water. The client should chew
1."I will wash my face with cotton pads."
on the unaffected side of the mouth, eat a soft diet, and take in
2."I'll have to start chewing on my unaffected side."
foods and beverages at room temperature. If brushing the teeth
3."I should rinse my mouth if toothbrushing is painful."
triggers pain, an oral rinse after meals may be helpful instead.
4."I'll try to eat my food either very warm or very cold."
the nurse is caring for a client diagnosed with trigeminal neuralgia.
4
The client asks the nurse, "Why do I have so much pain?" Which
is the appropriate response by the nurse?
The paroxysms of pain that accompany this neuralgia are trig-
1."It's a local reaction to nasal stuffiness."
gered by stimulation of the terminal branches of the trigeminal
2."It's due to a hypoglycemic effect on the cranial nerve."
nerve. Symptoms can be triggered by pressure from washing the
3."Release of catecholamines with infection or stress leads to the
face, brushing the teeth, shaving, eating, or drinking. Symptoms
pain."
also can be triggered by thermal stimuli, such as a draft of cold
4."Pain is due to stimulation of the affected nerve by pressure and
air. The remaining options are incorrect.
temperature."
4
The home health nurse has been discussing interventions to
prevent constipation in a client with multiple sclerosis. The nurse
to manage constipation, the client should take in a high-fiber diet,
determines that the client is using the information most effectively
bulk formers, and stool softeners. A fluid intake of 2000 mL/day
if the client reports which action?
is recommended. The client should initiate a bowel movement on
1.Drinking a total of 1000 mL/day
an every-other-day basis and should sit on the toilet or commode.
2.Giving herself an enema every morning before breakfast
This should be done approximately 45 minutes after the largest
3.Taking stool softeners daily and a glycerin suppository once a
meal of the day to take advantage of the gastrocolic reflex. A
week
glycerin suppository, bisacodyl suppository, or digital stimulation
4.Initiating a bowel movement every other day, 45 minutes after
may be used to initiate the process. Laxatives and enemas should
the largest meal of the day
be avoided whenever possible because they lead to dependence.
A client with a neurological impairment experiences urinary in- 3
continence. Which nursing action would be most helpful in assist-
ing the client to adapt to this alteration? A bladder retraining program, such as use of a toileting schedule,
1.Using adult diapers may be helpful to clients experiencing urinary incontinence. A
2.Inserting a Foley catheter Foley catheter should be used only when necessary because of
3.Establishing a toileting schedule the associated risk of infection. Use of diapers or pads is the least
4.Padding the bed with an absorbent cotton pad acceptable alternative because of the risk of skin breakdown.
The home care nurse is preparing to visit a client with a diagnosis 4
of trigeminal neuralgia (tic douloureux). When performing the as-
sessment, the nurse should plan to ask the client which question Trigeminal neuralgia is characterized by spasms of pain that
to elicit the most specific information regarding this disorder? start suddenly and last for seconds to minutes. The pain often is
1."Do you have any visual problems?" characterized as stabbing or as similar to an electric shock. It is
2."Are you having any problems hearing?" accompanied by spasms of facial muscles that cause twitching of
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3."Do you have any tingling in the face region?"
4."Is the pain experienced a stabbing type of pain?
The home care nurse is performing an assessment on a client
with a diagnosis of Bell's palsy. Which assessment question will
elicit specific information regarding this client's disorder?
1."Do your eyes feel dry?"
2."Do you have any spasms in your throat?"
3."Are you having any difficulty chewing food?"
4."Do you have any tingling sensations around your mouth?
The nurse is providing discharge education to a client diagnosed
with trigeminal neuralgia. Which medication will likely be pre-
scribed upon discharge for this condition?1.Lorazepam
2.Gabapentin
3.Carisoprodol
4.Chlordiazepoxide
The nurse is providing instructions to the client with trigeminal
neuralgia regarding measures to take to prevent the episodes of
pain. Which should the nurse instruct the client to do?
1.Prevent stressful situations.
2.Avoid activities that may cause fatigue.
3.Avoid contact with people with an infection.
4.Avoid activities that may cause pressure near the face.
The nurse is performing an assessment on a client with a diag-
nosis of Bell's palsy. The nurse should expect to observe which
finding in the client?
1.Facial drooping
2.Periorbital edema
3.Ptosis of the eyelid
4.Twitching on the affected side of the face
The nurse is preparing a plan of care for a client with a diagnosis
of amyotrophic lateral sclerosis (ALS). On assessment, the nurse
notes that the client is severely dysphagic. Which intervention
should be included in the care plan for this client? Select all that
apply.
1.Provide oral hygiene after each meal.
2.Assess swallowing ability frequently.
3.Allow the client sufficient time to eat.
4.Maintain a suction machine at the bedside.
5.Provide a full liquid diet for ease in swallowing.
A client with myasthenia gravis is having difficulty with airway
clearance and difficulty with maintaining an effective breathing
pattern. The nurse should keep which most important items avail-
able at the client's bedside?
1.Oxygen and metered-dose inhaler
2.Ambu bag and suction equipment
3.Pulse oximeter and cardiac monitor
4.Incentive spirometer and cough pillow
A client is admitted with an exacerbation of multiple sclerosis. The
nurse is assessing the client for possible precipitating risk factors.
Which factor, if reported by the client, should the nurse identify as
being unrelated to the exacerbation?
1.Annual influenza vaccination
2.Ingestion of increased fruits and vegetables
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parts of the face or mouth, or closure of the eye. The remaining
options do not elicit data specifically related to this disorder.
3
Bell's palsy is a one-sided facial paralysis caused by compression
of the facial nerve. Manifestations include facial droop from paral-
ysis of the facial muscles; increased lacrimation; painful sensa-
tions in the eye, face, or behind the ear; and speech or chewing
difficulties.
2
Trigeminal neuralgia is characterized by spasms of pain that start
suddenly and last from seconds to minutes. The pain often is
described as either stabbing or similar to an electric shock. It is
accompanied by spasms of the facial muscles that cause twitching
of parts of the face or mouth, or closure of the eye. It is treat-
ed by giving antiseizure medications, such as gabapentin, and
sometimes tricyclic antidepressants. These medications work by
stabilizing the neuronal membrane and blocking the nerve.
1
The pain that accompanies trigeminal neuralgia is triggered by
stimulation of the trigeminal nerve. Symptoms can be triggered
by pressure such as from washing the face, brushing the teeth,
shaving, eating, or drinking. Symptoms also can be triggered by
stimulation by a draft or cold air. The remaining options are not
associated with triggering episodes of pain.
1
Bell's palsy is a one-sided facial paralysis caused by the compres-
sion of the facial nerve (cranial nerve VII). Assessment findings
include facial droop from paralysis of the facial muscles; increased
lacrimation; painful sensations in the eye, face, or behind the ear;
and speech or chewing difficulty. The remaining options are not
associated findings in Bell's palsy.
1234
A client who is severely dysphagic is at risk for aspiration. Swal-
lowing is assessed frequently. The client should be given a suffi-
cient amount of time to eat. Semisoft foods are easiest to swallow
and require less chewing. Oral hygiene is necessary after each
meal. Suctioning should be available for clients who experience
dysphagia and are at risk for aspiration.
2
The client with myasthenia gravis may experience episodes of
respiratory distress if excessively fatigued or with development of
myasthenic or cholinergic crisis. For this reason, an Ambu bag,
intubation tray, and suction equipment should be available at the
bedside.
2
The onset or exacerbation of multiple sclerosis can be preced-
ed by a number of different factors, including physical stress
(e.g., vaccination, excessive exercise), emotional stress, fatigue,
infection, physical injury, pregnancy, extremes in environmental
temperature, and high humidity. No methods of primary prevention
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3.An established routine of walking 2 miles each evening
4.A recent period of extreme outside ambient temperature
A client with multiple sclerosis is experiencing muscle weakness,
spasticity, and an ataxic gait. On the basis of this information,
the nurse should include which client problem in the plan of
care?1.Inability to care for self
2.Interruption in skin integrity
3.Interruption in physical mobility
4.Inability to perform daily activities
The nurse is planning care for the client with a neurogenic bladder
caused by multiple sclerosis. The nurse plans for fluid administra-
tion of at least 2000 mL/day. Which plan would be most helpful to
this client?
1.400 to 500 mL with each meal and 500 to 600 mL in the evening
before bedtime
2.400 to 500 mL with each meal and additional fluids in the
morning but not after midday
3.400 to 500 mL with each meal, with all extra fluid concentrated
in the afternoon and evening
4.400 to 500 mL with each meal and 200 to 250 mL at midmorn-
ing, midafternoon, and late afternoon
The nurse has provided instructions to a client with a diagnosis
of myasthenia gravis about home care measures. Which client
statement indicates the need for further teaching?
1."I will rest each afternoon after my walk."
2."I should cough and deep breathe many times during the day."
3."I can change the time of my medication on the mornings when
I feel strong."
4."If I get abdominal cramps and diarrhea, I should call my health
care provider."
A client with multiple sclerosis tells a home health care nurse that
she is having increasing difficulty in transferring from the bed to a
chair. What is the initial nursing action?
1.Observe the client demonstrating the transfer technique.
2.Start a restorative nursing program before an injury occurs.
3.Seize the opportunity to discuss potential nursing home place-
ment
.4.Determine the number of falls that the client has had in recent
weeks.
The nurse is caring for a client with trigeminal neuralgia (tic
douloureux). The client asks for a snack and something to drink.
The nurse should offer which best snack to the client?
1.Cocoa with honey and toast
2.Hot herbal tea with graham crackers
3.Iced coffee and peanut butter and crackers
4.Vanilla wafers and room-temperature water
A client with myasthenia gravis arrives at the hospital emergency
department in suspected crisis. The health care provider plans
to administer edrophonium to differentiate between myasthenic
and cholinergic crises. The nurse ensures that which medication
is available in the event that the client is in cholinergic crisis?
1.Atropine sulfate
2.Morphine sulfate
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are known. Intake of fruits and vegetables is a healthy and an
unrelated item.
3
Multiple sclerosis is a chronic, nonprogressive, noncontagious
degenerative disease of the central nervous system characterized
by demyelination of the neurons. Interruption in physical mobility is
most appropriate for the client with multiple sclerosis experienc-
ing muscle weakness, spasticity, and ataxic gait. The remaining
options are not related to the data in the question.
4
Spacing fluid intake over the day helps the client with a neurogenic
bladder to establish regular times for successful voiding. Omitting
intake after the evening meal minimizes incontinence or the need
to empty the bladder during the night.
3
The client with myasthenia gravis and the family should be taught
information about the disease and its treatment. They should be
aware of the side and adverse effects of anticholinesterase med-
ications and corticosteroids and should be taught that timing of
anticholinesterase medication is critical. It is important to instruct
the client to administer the medication on time to maintain a
chemical balance at the neuromuscular junction. If it is not given
on time, the client may become too weak to even swallow. Resting
after a walk, coughing and deep-breathing many times during
the day, and calling the health care provider when experiencing
abdominal cramps and diarrhea indicate a correct understanding
of home care instructions to maintain health with thisneurological
degenerative disease.
1
Observation of the client's transfer technique is the initial inter-
vention. Starting a restorative program is important but not un-
less an assessment has been completed first. Discussing nursing
home placement would be inappropriate in view of the information
provided in the question. Determining the number of falls is an-
other important intervention, but observing the transfer technique
should be done first.
4
Because mild tactile stimulation of the face can trigger pain in
trigeminal neuralgia, the client needs to eat or drink lukewarm,
nutritious foods that are soft and easy to chew. Extremes of tem-
perature will cause trigeminal nerve pain. Therefore, the options
that include cocoa, hot herbal tea, and iced coffee are incorrect.
1
Clients with cholinergic crisis have experienced overdosage of
medication. Edrophonium will exacerbate symptoms in choliner-
gic crisis to the point at which the client may need intubation
and mechanical ventilation. Intravenous atropine sulfate is used
to reverse the effects of these anticholinesterase medications.
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Morphine sulfate and pyridostigmine bromide would worsen the
3.Protamine sulfate
symptoms of cholinergic crisis. Protamine sulfate is the antidote
4.Pyridostigmine bromide
for heparin.
3
The nurse is caring for a client with Parkinson's disease. Which
finding about gait should the nurse expect to note in the client? The parkinsonian gait is characterized by short, accelerating,
1.Walking on the toes shuffling steps. The client leans forward with the head, hips, and
2.Unsteady and staggering knees flexed and has difficulty starting and stopping. An ataxic gait
3.Shuffling and propulsive is unsteady and staggering. A dystrophic gait is broad-based and
4.Broad-based and waddling waddling. Walking on the toes can occur from shortened Achilles
tendons
The initial neurologic symptom of Guillain Barré syndrome is
A. Transient hypertension D.
B. Absent tendon reflexes
C. Dysrhythmias Paralysis that starts from feet and ascends.
D. Paresthesia of the legs
The nurse would expect a client with tic douloureux to exhibit: *

A. Excruciating facial and head pain.

A.
B. Unilateral muscle weakness.
C. Multiple petechiae.
D. Uncontrollable tremors of the eyelid.
4
Ascending paralysis is the classic symptom of Guillain-Barré syn-
Which assessment data should the nurse assess in the client
drome
diagnosed with Guillain-Barré syndrome?
1. An exaggerated startle reflex and memory changes.
1. These signs/symptoms, along with sleep disturbances and ner-
2. Cogwheel rigidity and inability to initiate voluntary movement.
vousness, support the diagnosis of Creutzfeldt-Jakob disease
3. Sudden severe unilateral facial pain and inability to chew.
.2. These signs/symptoms support the diagnosis of Parkinson's
4. Progressive ascending paralysis of the lower extremities and
disease.
numbness.
3. These are signs/symptoms of trigeminal neuralgia.
To prevent precipitating a painful attack in a client with tic
douloureux, the nurse should:
A. Discontinue oral hygiene temporarily
B
B. Avoid walking swiftly passing by the client's way
C. Keep the client in prone position
D. Massage both sides of the face frequently
2
Which statement by the client supports the diagnosis of Guil-
lain-Barré syndrome? This syndrome is usually preceded by a respiratory or gastroin-
1. "I just returned from a short trip to Japan." testinal infection one (1) to four (4) weeks prior to the onset of
2. "I had a really bad cold just a few weeks ago." neurological deficits.1. Visiting a foreign country is not a risk factor
3. "I think one of the people I work with had this." for contracting this syndrome.3. This syndrome is not a contagious
4. "I have been taking some herbs for more than a year." or a communicable disease.4. Taking herbs is not a risk factor for
developing Guillain-Barré syndrome
1

Hyporeflexia of the lower extremities is the classic clinical man-

Which assessment intervention should the nurse implement
ifestation of this syndrome. Therefore, assessing deep tendon
specifically for the diagnosis of Guillain-Barré syndrome?
reflexes is appropriate.2. A Glasgow Coma Scale is used for
1. Assess deep tendon reflexes.
clients with potential neurological deficits and used to monitor
2. Complete a Glasgow Coma Scale.
for increased intracranial pressure.3. Babinski's reflex evaluates
3. Check for Babinski's reflex.
central nervous system neurological status, which is not affected
4. Take the client's vital signs.
with this syndrome.4. Vital signs are a part of any admission
assessment but are not a specific assessment intervention for this
syndrome
The health-care provider scheduled a lumbar puncture for a client 2.
admitted with rule-out Guillain-Barré syndrome. Which pre proce-

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dure intervention has priority?
1. Keep the client NPO.
2. Instruct the client to void.
3. Place in the lithotomy position.
4. Assess the client's pedal pulse.
Which priority client problem should be included in the care plan
for the client diagnosed with Guillain-Barré syndrome?
1. High risk for injury.
2. Fear and anxiety.
3. Altered nutrition.
4. Ineffective breathing pattern.
The nurse caring for the client diagnosed with Guillain-Barré
syndrome writes the client problem "impaired physical mobility."
Which long-term goal should be written for this problem?
1. The client will have no skin irritation.
2. The client will have no muscle atrophy.
3. The client will perform range-of-motion exercises.
4. The client will turn every two (2) hours while awake.
The client diagnosed with Guillain-Barré syndrome is on a venti-
lator. Which intervention will assist the client to communicate with
the nursing staff?
1. Provide an erase slate board for the client to write on.
2. Instruct the client to blink once for "no" and twice for "yes."
3. Refer to a speech therapist to help with communication
.4. Leave the call light within easy reach of the client.
The client diagnosed with Guillain-Barré syndrome asks the
nurse, "Will I ever get back to normal?I am so tired of being sick."
Which statement is the best response by the nurse?
1. "You should make a full recovery within a few months to a year."
2. "Most clients with this syndrome have some type of residual
disability."
3. "This is something you should discuss with the health-care
team."
4. "The rehabilitation is short and you should be fully recovered
within a month."
The client admitted with rule-out Guillain-Barré syndrome has
just had a lumbar puncture. Which intervention should the nurse
implement post procedure?
1. Monitor the client for hypotension.
2. Apply pressure to the puncture site..
3. Test the client's cerebrospinal fluid.
4. Increase the client's fluid intake.
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The client should void prior to this procedure to help prevent acci-
dental puncture of the bladder during the procedure.1. The client
does not need to be NPO prior to this procedure.3. The lithotomy
position has the client lying flat with the legs in stirrups, such as
when Pap smears are obtained.4. The pedal pulses should be
assessed postprocedure, not prior to the procedure.
4
Guillain-Barré syndrome has ascendingparalysis causing respi-
ratory failure.Therefore, breathing pattern is priority.1. Safety is an
important issue for the client,but this is not the priority client prob-
lem.2. The client's psychological needs are important, but psy-
chosocial problems are not priority over physiological problems.3.
Clients with this syndrome may have choking episodes and are at
risk for inability to swallow as a result of the disease process, but
this is not the priority nursing problem because weight loss is not
an expected complication of this syndrome.
2
The client with Guillain-Barré syndrome will not be able to move
the extremities; therefore, preventingmuscle atrophy is an appro-
priate long-term goal1. This is an appropriate long-term goal for
the client problem "impaired skin integrity."3. The client will not
be able to move the extremities. Therefore, the nurse will have to
do passive range-of-motion exercises;this is an intervention, not
a goal.4. This is a nursing intervention, not a goal,and the client
should be turned while sleeping unless the client is on a special
immobility bed
2
The client will not be able to use the arms as a result of the
paralysis but can blink the eyes as long as the nurse asks simple
"yes-or-no" questions.1.The ascending paralysis has reached the
client's respiratory muscles; therefore, the client will not be able
to use the hands to write.3. A speech therapist will not be able to
help the client communicate while the client is on the ventilator.4.
The ascending paralysis has reached the respiratory muscles;
therefore, the client will not be able to use the hands to push the
call light
1
Clients with this syndrome usuallyhave a full recovery, but it may
take upto one (1) year.2. Only about 10% of clients are left with
permanent residual disability.3. This is "passing the buck." The
nurse should answer the client's question honestly, which helps
establish a trusting nurse-client relationship.4. This indicates the
nurse does not under-stand the typical course for a client diag-
nosed with Guillain-Barré syndrome.
4
Increased fluid intake will help prevent a postprocedure headache,
which may occur after a lumbar puncture.1. Very little cere-
brospinal fluid is removed the client. Therefore, hypotension is not
a potential complication of this procedure.2. A bandage is placed
over the puncture site,and pressure does not need to be applied
to the site.3. The laboratory staff, not the nurse, complete tests on
the cerebrospinal fluid; the nurse could label the specimens and
take them to the laboratory
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3

The client diagnosed with Guillain-Barré syndrome is having dif-
ficulty breathing and is placed on a ventilator. Which situation
warrants immediate intervention by the nurse?
1. The ventilator rate is set at 14 breaths per minute.
2. A manual resuscitation bag is at the client's bedside.
3. The client's pulse oximeter reading is 85%.
4. The ABG results are pH 7.40, PaO288, PaCO235, and
HCO324.
The client diagnosed with Guillain-Barré syndrome is on a venti-
lator. When the wife comes to visit she starts crying uncontrollably,
and the client starts fighting the ventilator because his wife is
upset. Which action should the nurse implement?
1. Tell the wife she must stop crying.
2. Escort the wife out of the room.
3. Medicate the client immediately.
4. Acknowledge the wife's fears.
A pulse oximeter reading of less than 93% warrants immediate
intervention;a 90% peripheral oxygen saturation indicates a PaO2
of about 60 (normal,80 to 100). When the client is placed on the
ventilator, this should cause the client's oxygen level to improve.1.
The rate of ventilation is usually 12 to 15 breaths per minute in
adults who are on ventilators, so this rate does not require im-
mediate intervention.2. A manual resuscitation (Ambu) bag must
be at the client's bedside in case the ventilator malfunctions; the
nurse must bag the client.4. These ABGs are within normal limits
and do not warrant immediate intervention.
4
It is scary for a wife to see her loved one with a tube down
his mouth and all the machines around them. The nurse should
help the wife by acknowledging her fears1. This action does not
address the wife's fears, and telling her to stop crying will not help
the situation.2. Making the wife leave the room will further upset
the client and the client's wife.3. Medicating the client will not help
the wife, but if the nurse can calm the wife,then it is hoped the
client will calm down.
1, 3, 4, 5

1.The physical therapist is an important part of the rehabilitation

team who addresses the client's muscle deterioration resulting
from the disease process and immobility.
The client diagnosed with Guillain-Barré syndrome is admitted
to the rehabilitation unit after 23 days in the acute care hospital.
3.The social worker could help with financial concerns, job issues,
Which interventions should the nurse implement?Select all that
and issues concerning the long rehabilitation time for this syn-
apply.
drome.
1. Refer client to the physical therapist.
2. Include the speech therapist in the team.
4.Pain may or may not be an issue with this syndrome. Each client
3. Request a social worker consult.
is different,but a plan needs to be established to address pain if it
4. Implement a regimen to address pain control.
occurs.
5. Refer the client to the Guillain-Barré Syndrome Foundation
5.This is an excellent resource for the client and the family

2. There is no residual speech deficit fromGuillain-Barré syn-

drome; therefore, this referral is not appropriate.
Nurse Jona is assessing Janet, a 38-year-old client, diagnosed
of multiple sclerosis. Which of the following symptoms would the
nurse expect to find? *
Vision changes Vision changes
Flaccid muscles
Tremors at rest
Absent deep tendon reflexes
The nurse instructs Ms. Mariaha's husband about daily adminis-
tration of Glatiramer Acetate (Copaxone). The nurse advises the
patient to administer the drug via: *
Intramuscular route Subcutaneous route
Subcutaneous route
Intravenous route
Oral route
Ingrid, a female executive diagnosed of Diabetes Mellitus, fre-
quently consumes "Coke Zero" with meals to satisfy her cravings
for soda. This may place her at risk for developing Multiple Sclero-
sis because of her consumption of which component of diet soda? Aspartame
*
Monosodium Glutamate
Benzoate/Nitrate
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Sodium Cyclamate (Magic Sugar)
Aspartame
Neuropathic pain that radiates from the neck down to the spine
and to the extremities is known as: *
+) Uhtoff' Sign
(+) Lhermitte's Sign
(+) Macewen's Sign
(+) Lhermitte's Sign
(+) Charcot's Sign
A nurse is teaching a class of nursing students on the unit about
the pathophysiology of MS. To evaluate their understanding, the
nurse asks the students, "Which part of a neuron would be the
most damaged in a patient with multiple sclerosis?" The students'
best response would be which of the following components of the
Myelin sheath
nervous system? *
Nucleus
Myelin sheath
Cell body
Dendrite
In studying the predisposing factor of multiple sclerosis, it is
emphasized by Gwyneth that it can be attributed on the presence
of a specific cluster of human leukocyte antigens on the cell wall.
In other words, this is attributed on the:
Genes
Presence of infection
Severe stress
Environment
Genes
The physician came up with multiple sclerosis as the final diag-
nosis of Ms. Dionisia. She asked her nurse if there is an available
cure for her disease. Gwyneth is right in giving which of these
statements as her reply?
A. There is currently no drugs that can cure MS but it can be
C.
reversed with surgery.
None, only treatment for the prevention of new attacks is available.
B. Yes, there is a known cure for your disease but it is quite
expensive.
C. None, only treatment for the prevention of new attacks is
available.
D. Yes, but it is not yet available in the country.
The nurse instructor discussed in a Medical-Surgical Nursing
class important points to remember about Gullain Barré Syn-
drome, Multiple Sclerosis and Amyotropic Lateral Sclerosis. What
do these neurologic conditions have in common? *

A. They all result from genetic mutation .

B. These diseases involve demyelination of nerves in either/both B

Central and/or Peripheral Nervous System.

C. These diseases primarily attack the nerve cells of the Central

Nervous System.

D. They are all consequences of cellular aberrations in the Ner-

vous System.
Mr. Parker, a 72-year old male patient was admitted because of
bruises and cut he incurred when he tumbled down the sidewalk
while he was walking. After providing treatment to his wounds
and injuries, the R.O.D. noticed some manifestations of Mr. Parker
consistent with Parkinson's Disease. He then referred him to a
Neurologist and a diagnosis of Parkinson's Disease was made.

Supporting coping abilities is an important consideration in man-

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aging Mr. Parker's condition. This could be promoted in doing the
actions listed below, apart from: *

A. Providing complete assistance to Mr. Parker to make sure his

needs are all met.
A
B. Patient is encouraged to set achievable goals.
C. Patient should remain as an active participant in his/her ther-
apeutic program.
D. There should be a planned program of activity throughout the
day.
A patient with Parkinson's disease has decreased tongue mobility
and an inability to move the facial muscles. The nurse recognizes
that these impairments commonly contribute to the nursing diag-
nosis of: *
B.
A. impaired oral mucous membranes related to inability to swal-
low.
B. impaired verbal communication related to difficulty articulating.
C. disuse syndrome related to loss of muscle control.
D. self-care deficit related to bradykinesia and rigidity.
The client with Parkinson's disease has a nursing diagnosis of risk
for falls related to an abnormal gait documented in the nursing
care plan. The nurse assesses the client expecting to observe
which type of gait? *
Shuffling and propulsive
Broad based and waddling
Steady and staggering
Shuffling and propulsive
Accelerating with walking on toes
When evaluating the extent of Parkinson's disease, a nurse ob-
serves for which of the following conditions? *

Diminished distal sensation Muscle rigidity

Muscle rigidity
Increased dopamine levels
Bulging eyeballs
Based on the nursing care plan prepared by Nurse James, im-
paired physical mobility has been identified as the nursing diag-
nosis. Which of these assessment data served as the bases of
the nurse in formulating the diagnosis? *
Muscle rigidity
Depression and dysfunction
Inability to move facial muscles
Muscle rigidity
Disease progression
Parkinsonian disease (PD) is referred to as an extrapyramidal
syndrome because it manifests which of the following clinical
symptoms? *
Tremor and bradykinesia
Somnolence and poor gait
Constipation and hypotension
Diarrhea and sweating
Tremor and bradykinesia
Looking at the nursing interventions listed by Nurse James in
response to the identified nursing diagnosis, which of these would
least likely be included in improving the mobility of Mr. Parker? *
Supervised walking
Supervised walking
Environmental modifications

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Range of motion exercise
Riding a bicycle stationary
A client has been started on benztropine (Cogentin) for relief of
parkinsonian symptoms. Which of the following statements made
by the client best indicates the drug is producing a therapeutic
effect?
"My hands aren't as shaky as they used to be."
I feel so calm and relaxed."
"My hands aren't as shaky as they used to be."
"I can tie my shoes now without difficulty."
"That annoying lip smacking is much less frequent."
Which of the following drugs would be ordered for persons with
Parkinsonian disease? *

Carisoprodol (Rela) Carbidopa/Levodopa (Sinemet)

CarbenicillinIndanyl sodium (Geocillin)
Carbidopa/Levodopa (Sinemet)
Carboplatin (Paraplatin)
A picture of the human brain is shown to Mr. Parker to identify the
affected area involved in his disease. Which of these should be
pinpointed by the nurse? *
Basal Ganglia
Hippocampus
Basal Ganglia
Corpus Callosum
Frontal Cerebrum
FALSE:
True or False: Guillain-Barré Syndrome occurs when the body's
immune system attacks the myelin sheath on the nerves in the
Guillain-Barré Syndrome is an autoimmune neuro condition
central nervous system.*
where the immune system attacks the nerves in the PERIPHERAL
True
NERVOUS SYSTEM and cranial nerves. This condition does NOT
False
occur in the central nervous system (CNS).
During nursing report you learn that the patient you will be caring
for has Guillain-Barré Syndrome. As the nurse you know that this
The answer is D.
disease tends to present with:*
A. signs and symptoms that are unilateral and descending that
GBS signs and symptoms will most likely start in the lower extrem-
start in the lower extremities
ities (ex: feet), be symmetrical, and will gradually spread upward
B. signs and symptoms that are symmetrical and ascending that
(ascending) to the head. There are various forms of Guillain-Barré
start in the upper extremities
Syndrome. Acute inflammatory demyelinating polyradiculoneu-
C. signs and symptoms that are asymmetrical and ascending that
ropathy (AIDP) is the most common type in the U.S. and this is
start in the upper extremities
how this syndrome tends to present.
D. signs and symptoms that are symmetrical and ascending that
start in the lower extremities
You're assessing a patient's health history for risk factors associ-
ated with developing Guillain-Barré Syndrome. Select all the risk
factors below:* The answers are: A, C, and E.
A. Recent upper respiratory infection
B. Patient's age: 3 years old Risk factors for developing Guillain-Barré Syndrome include: ex-
C. Positive stool culture Campylobacter Jejuni periencing upper respiratory infection, GI infection (especially
D. Hyperthermia from Campylobacter Jejuni), Epstein-Barr infection, HIV/AIDS,
E. Epstein-Barr vaccination (flu or swine flu) etc.
F. Diabetes
G. Myasthenia Gravis
The answer is B.
A 25 year-old presents to the ER with unexplained paralysis from
the hips downward. The patient explains that a few days ago her
The patient's signs and symptoms in this scenario are typical with
feet were feeling weird and she had trouble walking and now she is
Guillain-Barré Syndrome. The syndrome tends to start in the lower
unable to move her lower extremities. The patient reports suffering
extremities (with paresthesia that will progress to paralysis) and
an illness about 2 weeks ago, but has no other health history. The
migrate upward. The respiratory system can be affected leading
physician suspects Guillain-Barré Syndrome and orders some
to respiratory failure. Therefore, the nurse should assess for any
diagnostic tests. Which finding below during your assessment
signs and symptoms that the respiratory system may be com-
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promised (ex: weak cough, shortness of breath, dyspnea...patient
requires immediate nursing action?*
says it is hard to breath etc.). The nurse should immediately
A. The patient reports a headache.
report this to the MD because the patient may need mechanical
B. The patient has a weak cough.
ventilation. Absent reflexes is common in GBS and paresthesia
C. The patient has absent reflexes in the lower extremities.
can extend to the upper extremities as the syndrome progresses.
D. The patient reports paresthesia in the upper extremities.
A headache is not common.
The answers are A and C.
A patient with Guillain-Barré Syndrome has a feeding tube for
nutrition. Before starting the scheduled feeding, it is essential the
Some patients who experience GBS will need a feeding tube
nurse? Select all that apply:*
because they are no longer able to swallow safely due to paralysis
A. Assesses for bowel sounds
of the cranial nerves that help with swallowing. GBS can lead to a
B. Keeps the head of bed less than 30' degrees
decrease in gastric motility and paralytic ileus. Therefore, before
C. Checks for gastric residual
starting a scheduled feeding the nurse should always assess for
D. Weighs the patient
bowel sounds and check gastric residual.
You're educating a patient about treatment options for Guil-
lain-Barré Syndrome. Which statement by the patient requires you
to re-educate the patient about treatment?*
A. "Treatments available for this syndrome do not cure the condi-
tion but helps speed up recovery time." The answer is B.
B. "Plasmapheresis or immunoglobin therapies are treatment op-
tions available for this syndrome but are most effective when given This statement is incorrect. Plasmapheresis and immunoglobin
within 4 weeks of the onset of symptoms." therapies are treatment options available for GBS, BUT they are
C. "When I start plasmapheresis treatment a machine will filter my only really effective when given within 2 weeks from the onset of
blood to remove the antibodies from my plasma that are attacking symptoms (not 4 weeks).
the myelin sheath."
D. "Immunoglobulin therapy is where IV immunoglobulin from a
donor is given to a patient to stop the antibodies that are damaging
the nerves.
Which tests below can be ordered to help the physician diagnose
Guillain-Barré Syndrome? Select all that apply:*
The answers are C, D, and E.
A. Edrophonium Test
B. Sweat Test
These are the tests that can be ordered to help the MD determine
C. Lumbar puncture
if the patient is experiencing GBS.
D. Electromyography
E. Nerve Conduction Studies
You're teaching a group of nursing students about Guillain-Barré
Syndrome and how it can affect the autonomic nervous system.
Which signs and symptoms verbalized by the students demon-
strate they understood the autonomic involvement of this syn- The answers are A, C, D, and E.
drome? Select all that apply:*
A. Altered body temperature regulation All these are some signs and symptoms that can present in severe
B. Inability to move facial muscles cases of GBS when the autonomic nervous system is involved.
C. Cardiac dysrhythmias
D. Orthostatic hypotension
E. Bladder distension
You're about to send a patient for a lumbar puncture to help rule
out Guillain-Barré Syndrome. Before sending the patient you will The answer is C.
have the patient?*
A. Clean the back with antiseptic The patient will need to void and empty the bladder before going
B. Drink contrast dye for a LP. This will help decrease the chances of the bladder
C. Void becoming punctured during the procedure.
D. Wash their hair
Your patient is back from having a lumbar puncture. Select all the The answers are B and D.
correct nursing interventions for this patient?*
A. Place the patient in lateral recumbent position. The patient will need to stay flat after the procedure for a pre-
B. Keep the patient flat. scribed amount of time to prevent a headache, and the nurse
C. Remind the patient to refrain from eating or drinking for 4 hours. will need to encourage the patient to drink fluids regularly to help
D. Encourage the patient to consume liquids regularly. replace the fluid lost during the lumbar puncture.
The patient's lumbar puncture results are back. Which finding
below correlates with Guillain-Barré Syndrome?*
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A. high glucose with normal white blood cells
B. high protein with normal white blood cells
B
C. high protein with low white blood cells
D. low protein with high white blood cells
B
Myasthenia gravis occurs when antibodies attack the
In myasthenia gravis, either the nicotinic acetylcholine receptors
__________ receptors at the neuromuscular junction leading to
are attacked by antibodies created by the immune system (hence
____________.*
why this disease is considered autoimmune) or antibodies are in-
A. metabotropic; muscle weakness
hibiting the function of muscle-specific kinase (which is a receptor
B. nicotinic acetylcholine; muscle weakness
tyrosine kinase that helps with maintaining and building the neu-
C. dopaminergic adrenergic; muscle contraction
romuscular junction). Either way this leads to the neurotransmitter
D. nicotinic adrenergic; muscle contraction
acetylcholine from being able to communicate with the muscle
fiber to make it contract.
You're educating a patient about the pathophysiology of myasthe-
nia gravis. While explaining the involvement of the thymus gland,
the patient asks you where the thymus gland is located. You state c
it is located?*
A. behind the thyroid gland The thymus is located anteriorly in the upper part of the chest
B. within the adrenal glands behind the sternum in between the lungs.
C. behind the sternum in between the lungs
D. anterior to the hypothalamus
C

Pyridostigmine is an anticholinesterase medication that will help

A patient with myasthenia gravis will be eating lunch at 1200. It is
now 1000 and the patient is scheduled to take Pyridostigmine. At
what time should you administer this medication so the patient will
have the maximum benefit of this medication?*
A. As soon as possible
B. 1 hour after the patient has eaten (at 1300)
C. 1 hour before the patient eats (at 1100)
D. at 1200 right before the patient eats
The neurologist is conducting a Tensilon test (Edrophonium) at
the bedside of a patient who is experiencing unexplained muscle
weakness, double vision, difficulty breathing, and ptosis. Which
findings after the administration of Edrophonium would represent
the patient has myasthenia gravis?*
A. The patient experiences worsening of the muscle weakness.
B. The patient experiences wheezing along with facial flushing.
C. The patient reports a tingling sensation in the eyelids and
sudden ringing in the ears.
D. The patient experiences improved muscle strength.
You're preparing to help the neurologist with conducting a Tensilon
test. Which antidote will you have on hand in case of an emer-
gency?*
A. Atropine
B. Protamine sulfate
C. Narcan
D. Leucovorin
Which patient below is MOST at risk for developing a cholinergic
crisis?*
A. A patient with myasthenia gravis is who is not receiving suffi-
cient amounts of their anticholinesterase medication.
B. A patient with myasthenia gravis who reports not taking the
medication Pyridostigmine for 2 weeks.
C. A patient with myasthenia gravis who is experiencing a respi-
improve muscle strength. It is important the patient has maximum
muscle strength while eating for the chewing and swallowing
process. Therefore, the medication should be given 1 hour before
the patient eats because this medication peaks (has the maximum
effect) at approximately 1 hour after administration. How does the
medication improve muscle strength? It does this by preventing
the breakdown of acetylcholine. Remember the nicotinic acetyl-
choline receptors are damaged and the patient needs as much
acetylcholine as possible to prevent muscle weakness. Therefore,
this medication will allow more acetylcholine to be used...hence
improving muscle strength.
d
During a Tensilon test Edrophonium is administered. This med-
ication prevents the breakdown of acetylcholine, which will allow
more of the neurotransmitter acetylcholine to be present at the
neuromuscular junction....hence IMPROVING muscle strength IF
myasthenia gravis is present. Therefore, if a patient with MG is
given this medication they will have improved muscle strength.
A
Atropine will help reverse the effects of the drug given during a
Tensilon test, which is Edrophonium, in case an emergency aris-
es. Edrophonium is a short-acting cholinergic drug, while atropine
is an anticholinergic.
D
Remember patients who experience a cholinergic crisis are
most likely to because they've received too much of their anti-
cholinesterase medications (example Pyridostigmine). However,
on the other hand, patients who have received insufficient amount
of their anticholinesterase medication or have experienced an

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illness/stress/surgery are most likely to experience a myasthenia
ratory infection and recently had left hip surgery.
crisis. Both conditions will lead to muscle weakness and respira-
D. A patient with myasthenia gravis who reports taking too much
tory failure but from different causes, which is why a Tensilon test
of their anticholinesterase medication.
is used to help differentiate between the two conditions.
C.
Which meal option would be the most appropriate for a patient
with myasthenia gravis?* Patients with MG have weak muscles and this can include the
A. Roasted potatoes and cubed steak muscles that are used for chewing and swallowing. The patient
B. Hamburger with baked fries should choose meal options that require the least amount of
C. Clam chowder with mashed potatoes chewing and that are easy to swallow. Option C is a thick type of
D. Fresh veggie tray with sliced cheese cubes soup and the mashed potatoes are soft....both are very easy to
eat and swallow compared to the other options.
Select all the signs and symptoms below that can present in
myasthenia gravis:*
A. Respiratory failure
B. Increased salivation
C. Diplopia
A, C, D, E, F, G, H
D. Ptosis
E. Slurred speech
F. Restlessness
G. Mask-like appearance of looking sleepy
H. Difficulty swallowing
You're providing teaching to a group of patients with myasthenia
gravis. Which of the following is not a treatment option for this B
condition?*
A. Plasmapheresis These medications are not used to treat MG, but ANTI-
B. Cholinesterase medications cholinesterase medications (like Pyridostigmine) are used to treat
C. Thymectomy this condition.
D. Corticosteroids
You're a home health nurse providing care to a patient with myas- B.
thenia gravis. Today you plan on helping the patient with bathing
and exercising. When would be the best time to visit the patient to Patients with MG tend to have the best muscle strength in the
help these tasks?* morning after sleeping or resting rather than at the end of the
A. Mid-afternoon day....the muscles are tired from being used and the muscle
B. Morning become weaker as the day progresses etc. Therefore any rigorous
C. Evening activities are best performed in the morning or after the patient
D. Before bedtime has rested.
Tic douloureux is characterized by paroxysms of pain and burning
sensations. It is a disorder of which cranial nerve?
B. Trigeminal neuralgia is a condition of the fifth cranial nerve that
A. Third
is characterized by paroxysms of pain in the area innervated by
B. Fifth
any of the three branches.
C. Seventh
D. Eighth
C.
Which of the following drugs is used for trigeminal neuralgia? *
A. Riluzole (Rilutek) Antiseizure agents, such as carbamazepine (Tegretol), relieve
B. Levodopa (Larodopa) pain in most patients with trigeminal neuralgia by reducing the
C. Carbamazepine (Tegretol) transmission of impulses at certain nerve terminals. Options A
D. Ceftriaxone sodium (Rocephin) and D are for Amyotrophic Lateral Sclerosis (ALS). Option B is
for Parkinson's disease
A male client with Bell's Palsy asks the nurse what has caused
this problem. The nurse's response is based on an understanding A.
that the cause is: *
A. Unknown, but possibly includes ischemia, viral infection, or an Bell's palsy is a one-sided facial paralysis from compression of the
autoimmune problem facial nerve. The exact cause is unknown but may include vascular
B. Unknown, but possibly includes long-term tissue malnutrition ischemia, infection, exposure to viruses such as herpes zoster or
and cellular hypoxia herpes simplex, autoimmune disease, or a combination of these
C. Primary genetic in origin, triggered by exposure to meningitis factors.
D. Primarily genetic in origin, triggered by exposure to neurotoxins

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4. The nurse has given the male client with Bell's palsy instructions
on preserving muscle tone in the face and preventing denervation.
A. Exposure to cold or drafts is avoided. Local application of heat
The nurse determines that the client needs additional information
to the face may improve blood flow and provide comfort.Options
if the client states that he or she will: *
B and C: Prevention of muscle atrophy with Bell's palsy is ac-
A. Exposure to cold and drafts
complished with facial massage, facial exercises, and electrical
B. Massage the face with a gentle upward motion
stimulation of the nerves.
C. Perform facial exercises
D. Wrinkle the forehead, blow out the cheeks, and whistle
The nurse is assessing a child diagnosed with a brain tumor.
Which of the following signs and symptoms would the nurse
expect the child to demonstrate? Select all that apply. * A, B AND D.
A. Head tilt
B. Vomiting Head tilt, vomiting, and lethargy are classic signs assessed in a
C. Polydipsia child with a brain tumor. Clinical manifestations are the result of
D. Lethargy location and size of the tumor.
E. Increased appetite
F. Increased pulse
B.
A female client with a suspected brain tumor is scheduled for
computed tomography (CT). What should the nurse do when Because CT commonly involves the use of a contrast agent, the
preparing the client for this test? * nurse should determine whether the client is allergic to iodine,
A. Immobilize the neck before the client is moved onto a stretcher. contrast dyes, or shellfish. Option A: Neck immobilization is nec-
B. Determine whether the client is allergic to iodine, contrast dyes, essary only if the client has a suspected spinal cord injury. Option
or shellfish. C: Placing a cap over the client's head may lead to misinterpreta-
C. Place a cap on the client's head. tion of test results; instead, the hair should be combed smoothly.
D. Administer a sedative as ordered Option D: The physician orders a sedative only if the client can't
be expected to remain still during the CT scan.
B.
Which nursing diagnosis takes highest priority for a client with
In Parkinson's crisis, dopamine-related symptoms are severely
Parkinson's crisis? *
exacerbated, virtually immobilizing the client. A client confined to
A. Imbalanced nutrition: Less than body requirements
bed during such a crisis is at risk for aspiration and pneumonia.
B. Ineffective airway clearance
Also, excessive drooling increases the risk of airway obstruction.
C. Impaired urinary elimination
Because of these concerns, the nursing diagnosis of Ineffective
D. Risk for injury
airway clearance takes highest priority. Although the other options
also are appropriate, they aren't immediately life-threatening.
When evaluating the extent of Parkinson's disease, a nurse ob-
D. Parkinson's disease is characterized by the slowing of voluntary
serves for which of the following conditions? *
muscle movement, muscular rigidity, and resting tremor. Bulging
A. Bulging eyeballs
eyeballs occur in Grave's disease. Diminished distal sensation
B. Diminished distal sensations
doesn't occur in Parkinson's disease. Dopamine is deficient in this
C. Increased dopamine levels
disorder.
D. Muscle rigidity
Which of the following clinical manifestations suggest ALS? *
A. Fatigue, progressive muscle weakness, cramps, fasciculations
A.
(twitching), and incoordination
B. Tremor, rigidity, bradykinesia (abnormally slow movements),
Chief symptoms of ALS are fatigue, progressive muscle weak-
and postural instability
ness, cramps, fasciculations (twitching), and incoordination. Op-
C. Paralysis of the facial muscles, increased lacrimation (tearing),
tion B describes Parkinson's disease. Option C is Bell's Palsy.
and painful sensations in the face, behind the ear, and in the eye
Option D describes Trigeminal neuralgia.
D. Involuntary contraction of the facial muscles causing sudden
closing of the eye or twitching of the mouth
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,C
B. "The myelin sheath, which is made up of Schwann cells, is
damaged along the axon."
C. "This disease affects the insulating structure found on the
neuron in the central nervous system."

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D. "The dopaminergic neurons in the part of the brain called
substantia nigra have started to die."
True or False: Multiple Sclerosis tends to affect men more than
women and occurs during the ages of 50-70 years.*
False
True
False

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