Question 1

The nurse is caring for a client with myasthenia gravis who has had a thymectomy and receives the usual dose of pyridostigmine. An hour later, the client has nausea and severe abdominal cramps. Which of the following actions should the nurse take first?
A)Auscultate the client's bowel sounds.
B)Notify the client's health care provider.
C)Administer the prescribed PRN antiemetic drug.
D)Give the scheduled dose of prednisone.

Accepted Answer

The client's history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed. The other actions will be appropriate if the client is not experiencing a cholinergic crisis.

Question 2

The nurse is caring for a client with Parkinson's disease who is admitted to the hospital for treatment of an acute infection. Which of the following nursing interventions will be included in the plan of care? (Select all that apply.)
A)Use an elevated toilet seat.
B)Cut client's food into small pieces.
C)Provide high protein foods at each meal.
D)Place an arm chair at the client's bedside.
E)Observe for sudden exacerbation of symptoms.

Accepted Answer

Since the client with Parkinson's has difficulty chewing, food should be cut into small pieces. An armchair should be used when the client is seated so that the client can use the arms to assist with getting up from the chair. An elevated toilet seat will facilitate getting on and off the toilet. High protein foods will decrease the effectiveness of L-dopa.
Parkinson's is a steadily progressive disease without acute exacerbations.

Question 3

The nurse is caring for a client with a history of cluster headache who awakens during the night with a severe stabbing headache. Which of the following actions should the nurse take first?
A)Start the prescribed PRN oxygen at 8 L/minute.
B)Put a moist hot pack on the client's neck.
C)Give the prescribed PRN acetaminophen.
D)Notify the client's health care provider immediately.

Accepted Answer

Acute treatment for cluster headache is administration of 100% oxygen at 8-12 L/min for 15 minutes. If the client obtains relief with the oxygen, there is no immediate need to notify the health care provider. Cluster headaches last only 60-90 minutes, so oral pain medications have minimal effect. Hot packs are helpful for tension headaches but are not as likely to reduce pain associated with a cluster headache.

Question 4

The nurse is assessing a client with myasthenia gravis. Which of the following parameters is most important for the nurse to assess?
A)Check pupillary size.
B)Monitor grip strength.
C)Observe respiratory effort.
D)Assess level of consciousness.

Accepted Answer

Because respiratory insufficiency may be life threatening, it will be most important to monitor respiratory function. The other data also will be assessed but are not as critical.

Question 5

Which of the following information about a client who is being treated with carbidopa/levodopa for Parkinson's disease is most important for the nurse to report to the health care provider?
A)Shuffling gait
B)Tremor at rest
C)Cogwheel rigidity of limbs
D)Uncontrolled head movement

Accepted Answer

Dyskinesia is an adverse effect of the carbidopa/levodopa, indicating a need for a change in medication or decrease in dose. The other findings are typical with Parkinson's disease.

Question 6

A client tells the nurse about using acetaminophen several times every day for recurrent bilateral headaches. Which of the following actions should the nurse take first?
A)Discuss the need to stop taking the acetaminophen.
B)Suggest the use of biofeedback for headache control.
C)Teach the client about magnetic resonance imaging (MRI).
D)Describe the use of botulism toxin (BOTOX) for headaches.

Accepted Answer

The headache description suggests that the client is experiencing medication overuse headache. The initial action will be withdrawal of the medication. The other actions may be needed if headaches persist.

Question 7

The nurse is teaching a client with Parkinson's disease preventive measures to reduce the risk of a fall. Which of the following instructions should the nurse include in the teaching session?
A)Point the toes downward when stepping.
B)Take two steps backward and three steps forward.
C)Rock from front to back when walking.
D)Drop rice kernels and step over them.

Accepted Answer

Patients who are risk for falling and tend to freeze while walking are at risk of falling. Have the client learn to drop rice kernels and focus on stepping over them to help prevent falls. Other measures include: pointing the toes upward, take one step backwards and two steps forward; and, rock from side to side, rather than from front to back.

Question 8

The nurse is preparing to admit a client who has been treated for status epilepticus in the emergency department. Which of the following equipment should the nurse have available in the room? (Select all that apply.)
A)Side rail pads
B)Tongue blade
C)Oxygen mask
D)Suction tubing
E)Nasogastric tube

Accepted Answer

The client is at risk for further seizures, and oxygen and suctioning may be needed after any seizures to clear the airway and maximize oxygenation. The bed's side rails should be padded to minimize the risk for client injury during a seizure. Insertion of a nasogastric (NG) tube is not indicated because the airway problem is not caused by vomiting or abdominal distention. Use of tongue blades during a seizure is contraindicated.

Question 9

Which of the following prescribed interventions will the nurse implement first for a hospitalized client who is experiencing continuous tonic-clonic seizures?
A)Give phenytoin 100 mg IV.
B)Monitor level of consciousness.
C)Obtain computed tomography scan.
D)Administer lorazepam 4 mg IV.

Accepted Answer

To prevent ongoing seizures, the nurse should administer rapidly acting antiseizure drugs such as the benzodiazepines. A CT scan is appropriate, but prevention of any seizure activity during the CT scan is necessary. Phenytoin also will be administered, but it is not rapidly acting. Clients who are experiencing tonic-clonic seizures are nonresponsive, although the nurse should assess LOC after the seizure.

Question 10

The nurse witnesses a client with a seizure disorder as the client suddenly jerks the arms and legs, falls to the floor, and regains consciousness immediately. Which of the following actions is priority for the nurse to take initially?
A)Assess the client for a possible head injury.
B)Give the scheduled dose of divalproex.
C)Document the timing and description of the seizure.
D)Notify the client's health care provider about the seizure.

Accepted Answer

The client who has had a myoclonic seizure and fall is at risk for head injury and should be evaluated and treated for this possible complication first. Documentation of the seizure, notification of the seizure, and administration of antiseizure drugs also are appropriate actions, but the initial action should be assessment for injury.

Question 11

The partner of a client with Parkinson's disease (PD) is upset and asks the nurse why he is no longer able to read the affectionate notes that the client writes for him. Which of the following information is the basis for the nurse's response?
A)Characteristic slow speech makes it difficult for the client with PD to put his or her thoughts on paper.
B)Cogwheel rigidity makes it hard for the client to hold a pen.
C)Micrographia is common in clients with PD.
D)Depression often seen in PD leads to denying affectionate feelings.

Accepted Answer

The best answer is that the nurse's response will be based upon the fact that micrographia is handwriting deterioration and often occurs in clients with Parkinson's disease. PD clients have characteristic slow speech but that does not cause illegible writing. Cogwheel rigidity makes it difficult to walk and balance. Although depression is common in PD, this does not directly lead to denying affectionate feelings.

Question 12

The health care provider is considering the use of sumatriptan for a client with migraine headaches. Which of the following information obtained by the nurse is most important to report to the health care provider?
A)The client has at least 1-2 cups of coffee daily.
B)The client has had migraine headaches for 30 years.
C)The client has a history of a recent acute myocardial infarction.
D)The client has been taking topiramate for 2 months.

Accepted Answer

The triptans cause coronary artery vasoconstriction and should be avoided in clients with coronary artery disease. The other information will be reported to the health care provider, but none of it is an indication that sumatriptan would be an inappropriate treatment.

Question 13

The nurse is caring for a client with Parkinson's disease who has decreased tongue mobility and an inability to move the facial muscles. Which of the following nursing diagnoses is of highest priority?
A)Activity intolerance related to immobility
B)Toileting self-care deficit related to impaired mobility
C)Ineffective health management related to difficulty managing complex treatment regimen
D)Imbalanced nutrition: less than body requirements related to insufficient dietary intake

Accepted Answer

The data about the client indicate that poor nutrition will be a concern because of decreased swallowing. The other diagnoses also may be appropriate for a client with Parkinson's disease, but the data do not indicate they are current problems for this client.

Quiz 61: Nursing Management Chronic Neurological Problems

The nurse is caring for a client with myasthenia gravis who has had a thymectomy and receives the usual dose of pyridostigmine. An hour later, the client has nausea and severe abdominal cramps. Which of the following actions should the nurse take first?

The nurse is caring for a client with Parkinson's disease who is admitted to the hospital for treatment of an acute infection. Which of the following nursing interventions will be included in the plan of care? (Select all that apply.)

The nurse is caring for a client with a history of cluster headache who awakens during the night with a severe stabbing headache. Which of the following actions should the nurse take first?

The nurse is assessing a client with myasthenia gravis. Which of the following parameters is most important for the nurse to assess?

Which of the following information about a client who is being treated with carbidopa/levodopa for Parkinson's disease is most important for the nurse to report to the health care provider?

A client tells the nurse about using acetaminophen several times every day for recurrent bilateral headaches. Which of the following actions should the nurse take first?

The nurse is teaching a client with Parkinson's disease preventive measures to reduce the risk of a fall. Which of the following instructions should the nurse include in the teaching session?

The nurse is preparing to admit a client who has been treated for status epilepticus in the emergency department. Which of the following equipment should the nurse have available in the room? (Select all that apply.)

Which of the following prescribed interventions will the nurse implement first for a hospitalized client who is experiencing continuous tonic-clonic seizures?

The nurse witnesses a client with a seizure disorder as the client suddenly jerks the arms and legs, falls to the floor, and regains consciousness immediately. Which of the following actions is priority for the nurse to take initially?

The partner of a client with Parkinson's disease (PD) is upset and asks the nurse why he is no longer able to read the affectionate notes that the client writes for him. Which of the following information is the basis for the nurse's response?

The health care provider is considering the use of sumatriptan for a client with migraine headaches. Which of the following information obtained by the nurse is most important to report to the health care provider?

The nurse is caring for a client with Parkinson's disease who has decreased tongue mobility and an inability to move the facial muscles. Which of the following nursing diagnoses is of highest priority?