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Chapter 58: Chronic Neurologic Problems Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. The nurse determines that teaching about management of migraine headaches has been

effective when the patient says which of the following? “I can take the (Topamax) as soon as a headache starts.” “A glass of wine might help me relax and prevent a headache.” “I will lie down someplace dark and quiet when the headaches begin.” “I should avoid taking aspirin and sumatriptan (Imitrex) at the same time.”

a. b. c. d.

ANS: C

It is recommended that the patient with a migraine rest in a dark, quiet area. Topiramate (Topamax) is used to prevent migraines and must be taken for several months to determine effectiveness. Aspirin or other nonsteroidal antiinflammatory medications can be taken with the triptans. Alcohol may precipitate migraine headaches. DIF: Cognitive Level: Apply (application) REF: 1373 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 2. The nurse expects the assessment of a patient who is experiencing a cluster headache to

include a. nuchal rigidity. b. unilateral ptosis.

c. projectile vomiting. d. throbbing, bilateral facial pain.

ANS: B

Unilateral eye edema, tearing, and ptosis are characteristic of cluster headaches. Nuchal rigidity suggests meningeal irritation, such as occurs with meningitis. Although nausea and vomiting may occur with migraine headaches, projectile vomiting is more consistent with increased intracranial pressure. Unilateral sharp, stabbing pain, rather than throbbing pain, is characteristic of cluster headaches. DIF: Cognitive Level: Understand (comprehension) REF: 1371 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 3. While the nurse is transporting a patient on a stretcher to the radiology department, the patient

begins having a tonic-clonic seizure. Which action should the nurse take? Insert an oral airway during the seizure to maintain a patent airway. Restrain the patient’s arms and legs to prevent injury during the seizure. Time and observe and record the details of the seizure and postictal state. Avoid touching the patient to prevent further nervous system stimulation.

a. b. c. d.

ANS: C

Because the diagnosis and treatment of seizures frequently are based on the description of the seizure, recording the length and details of the seizure is important. Insertion of an oral airway and restraining the patient during the seizure are contraindicated. The nurse may need to move the patient to decrease the risk of injury during the seizure. DIF: Cognitive Level: Apply (application) REF: 1381 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

4. A high school teacher who has been diagnosed with epilepsy after having a generalized tonic-

clonic seizure tells the nurse, “I cannot teach any more. It will be too upsetting if I have a seizure at work.” Which response by the nurse specifically addresses the patient’s concern? a. “You might benefit from some psychologic counseling.” b. “Epilepsy usually can be well controlled with medications.” c. “You will want to contact the Epilepsy Foundation for assistance.” d. “The Department of Vocational Rehabilitation can help with work retraining.” ANS: B

The nurse should inform the patient that most patients with seizure disorders are controlled with medication. The other information may be necessary if the seizures persist after treatment with antiseizure medications is implemented. DIF: Cognitive Level: Apply (application) REF: 1381 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 5. A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the nurse take

when evaluating for adverse effects of the medication? c. Auscultate the bowel sounds. d. Check pupil reaction to light.

a. Inspect the oral mucosa. b. Listen to the lung sounds. ANS: A

Phenytoin can cause gingival hyperplasia, but does not affect bowel sounds, lung sounds, or pupil reaction to light. DIF: Cognitive Level: Apply (application) REF: 1379 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 6. A patient reports feeling numbness and tingling of the left arm before experiencing a seizure.

The nurse determines that this history is consistent with what type of seizure? c. Absence d. Myoclonic

a. Focal b. Atonic ANS: A

The initial symptoms of a focal seizure involve clinical manifestations that are localized to a particular part of the body or brain. Symptoms of an absence seizure are staring and a brief loss of consciousness. In an atonic seizure, the patient loses muscle tone and (typically) falls to the ground. Myoclonic seizures are characterized by a sudden jerk of the body or extremities. DIF: Cognitive Level: Understand (comprehension) REF: 1376 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 7. When obtaining a health history and physical assessment for a 36-yr-old female patient with

possible multiple sclerosis (MS), the nurse should assess for the presence of chest pain. inquire about urinary tract problems. inspect the skin for rashes or discoloration. ask the patient about any increase in libido.

a. b. c. d.

ANS: B

Urinary tract problems with incontinence or retention are common symptoms of MS. Chest pain and skin rashes are not symptoms of MS. A decrease in libido is common with MS. DIF: Cognitive Level: Apply (application) REF: 1384 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 8. A woman who has multiple sclerosis (MS) asks the nurse about risks associated with

pregnancy. Which response by the nurse is accurate? “MS symptoms may be worse after the pregnancy.” “Women with MS frequently have premature labor.” “MS is associated with an increased risk for congenital defects.” “Symptoms of MS are likely to become worse during pregnancy.”

a. b. c. d.

ANS: A

During the postpartum period, women with MS are at greater risk for exacerbation of symptoms. There is no increased risk for congenital defects in infants born of mothers with MS. Symptoms of MS may improve during pregnancy. Onset of labor is not affected by MS. DIF: Cognitive Level: Understand (comprehension) REF: 1384 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance 9. A 33-yr-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate

(Copaxone). Which information will the nurse include in patient teaching? Recommendation to drink at least 4 L of fluid daily Need to avoid driving or operating heavy machinery How to draw up and administer injections of the medication Use of contraceptive methods other than oral contraceptives

a. b. c. d.

ANS: C

Copaxone is administered by self-injection. Oral contraceptives are an appropriate choice for birth control. There is no need to avoid driving or drink large fluid volumes when taking glatiramer. DIF: Cognitive Level: Apply (application) REF: 1385 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 10. Which information about a 60-yr-old patient with multiple sclerosis indicates that the nurse

should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a. The patient walks a mile each day for exercise. b. The patient complains of pain with neck flexion. c. The patient has an increased serum creatinine level. d. The patient has the relapsing-remitting form of MS. ANS: C

Dalfampridine should not be given to patients with impaired renal function. The other information will not impact whether the dalfampridine should be administered. DIF: Cognitive Level: Apply (application) REF: 1386 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

11. Which action will the nurse plan to take for a patient with multiple sclerosis who has urinary

retention caused by a flaccid bladder? Encourage a decreased evening intake of fluid. Teach the patient how to use the Credé method. Suggest the use of adult incontinence briefs for nighttime only. Assist the patient to the commode every 2 hours during the day.

a. b. c. d.

ANS: B

The Credé method can be used to improve bladder emptying. Decreasing fluid intake will not improve bladder emptying and may increase risk for urinary tract infection and dehydration. The use of incontinence briefs and frequent toileting will not improve bladder emptying. DIF: Cognitive Level: Apply (application) REF: 1387 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 12. A patient with Parkinson’s disease has bradykinesia. Which action will the nurse include in

the plan of care? Instruct the patient in activities that can be done while lying or sitting. Suggest that the patient rock from side to side to initiate leg movement. Have the patient take small steps in a straight line directly in front of the feet. Teach the patient to keep the feet in contact with the floor and slide them forward.

a. b. c. d.

ANS: B

Rocking the body from side to side stimulates balance and improves mobility. The patient will be encouraged to continue exercising because this will maintain functional abilities. Maintaining a wide base of support will help with balance. The patient should lift the feet and avoid a shuffling gait. DIF: Cognitive Level: Apply (application) REF: 1392 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 13. A 62-yr-old patient who has Parkinson’s disease is taking bromocriptine (Parlodel). Which

information obtained by the nurse may indicate a need for a decrease in the dosage? The patient has a chronic dry cough. The patient has four loose stools in a day. The patient develops a deep vein thrombosis. The patient’s blood pressure is 92/52 mm Hg.

a. b. c. d.

ANS: D

Hypotension is an adverse effect of bromocriptine, and the nurse should check with the health care provider before giving the medication. Diarrhea, cough, and deep vein thrombosis are not associated with bromocriptine use. DIF: Cognitive Level: Apply (application) REF: 1390 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 14. The nurse advises a patient with myasthenia gravis (MG) to a. perform physically demanding activities early in the day. b. anticipate the need for weekly plasmapheresis treatments. c. do frequent weight-bearing exercise to prevent muscle atrophy. d. protect the extremities from injury due to poor sensory perception.

ANS: A

Muscles are generally strongest in the morning, and activities involving muscle activity should be scheduled then. Plasmapheresis is not routinely scheduled but is used for myasthenia crisis or for situations in which corticosteroid therapy must be avoided. There is no decrease in sensation with MG, and muscle atrophy does not occur because although there is muscle weakness, they are still used. DIF: Cognitive Level: Apply (application) REF: 1393 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 15. Which medication taken by a patient with restless legs syndrome should the nurse discuss

with the patient? a. Ibuprofen b. Multivitamin

c. Acetaminophen d. Diphenhydramine

ANS: D

Antihistamines can aggravate restless legs syndrome. The other medications will not contribute to restless legs syndrome. DIF: Cognitive Level: Apply (application) REF: 1383 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 16. A patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which

nursing action will be included in the plan of care? Observe for agitation and paranoia. Assist with active range of motion (ROM). Give muscle relaxants as needed to reduce spasms. Use simple words and phrases to explain procedures.

a. b. c. d.

ANS: B

ALS causes progressive muscle weakness, but assisting the patient to perform active ROM will help maintain strength as long as possible. Psychotic manifestations such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient’s ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations. DIF: Cognitive Level: Apply (application) REF: 1395 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 17. A 40-yr-old patient is diagnosed with early Huntington’s disease (HD). When teaching the

patient, spouse, and adult children about this disorder, the nurse will provide information about the a. use of levodopa-carbidopa (Sinemet) to help reduce HD symptoms. b. prophylactic antibiotics to decrease the risk for aspiration pneumonia. c. option of genetic testing for the patient’s children to determine their own HD risks. d. lifestyle changes of improved nutrition and exercise that delay disease progression. ANS: C

Genetic testing is available to determine whether an asymptomatic individual has the HD gene. The patient and family should be informed of the benefits and problems associated with genetic testing. Sinemet will increase symptoms of HD because HD involves an increase in dopamine. Antibiotic therapy will not reduce the risk for aspiration. There are no effective treatments or lifestyle changes that delay the progression of symptoms in HD. DIF: Cognitive Level: Apply (application) REF: 1396 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 18. When a 74-yr-old patient is seen in the health clinic with new development of a stooped

posture, shuffling gait, and pill rolling–type tremor, the nurse will anticipate teaching the patient about a. oral corticosteroids. b. antiparkinsonian drugs. c. magnetic resonance imaging (MRI). d. electroencephalogram (EEG) testing. ANS: B

The clinical diagnosis of Parkinson’s is made when tremor, rigidity, and akinesia, and postural instability are present. The confirmation of the diagnosis is made on the basis of improvement when antiparkinsonian drugs are administered. MRI and EEG are not useful in diagnosing Parkinson’s disease, and corticosteroid therapy is not used to treat it. DIF: Cognitive Level: Apply (application) REF: 1389 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 19. A 22-yr-old patient seen at the health clinic with a severe migraine headache tells the nurse

about having similar headaches recently. Which initial action should the nurse take? Teach about the use of triptan drugs. Refer the patient for stress counseling. Ask the patient to keep a headache diary. Suggest the use of muscle-relaxation techniques.

a. b. c. d.

ANS: C

The initial nursing action should be further assessment of the precipitating causes of the headaches, quality, and location of pain. Stress reduction, muscle relaxation, and the triptan drugs may be helpful, but more assessment is needed first. DIF: Cognitive Level: Analyze (analysis) REF: 1373 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 20. A hospitalized patient complains of a bilateral headache (4/10 on the pain scale) that radiates

from the base of the skull. Which prescribed PRN medications should the nurse administer initially? a. Lorazepam (Ativan) c. Morphine sulfate (MS Contin) b. Acetaminophen (Tylenol) d. Butalbital and aspirin (Fiorinal) ANS: B

The patient’s symptoms are consistent with a tension headache, and initial therapy usually involves a nonopioid analgesic such as acetaminophen, which is sometimes combined with a sedative or muscle relaxant. Lorazepam may be used in conjunction with acetaminophen but would not be appropriate as the initial monotherapy. Morphine sulfate and butalbital and aspirin would be more appropriate for a headache that did not respond to a nonopioid analgesic. DIF: Cognitive Level: Analyze (analysis) REF: 1372 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 21. A patient tells the nurse about using acetaminophen (Tylenol) several times every day for

recurrent bilateral headaches. Which action will the nurse plan to take first? Discuss the need to stop taking the acetaminophen. Suggest the use of biofeedback for headache control. Describe the use of botulism toxin (Botox) for headaches. Teach the patient about magnetic resonance imaging (MRI).

a. b. c. d.

ANS: A

The headache description suggests that the patient is experiencing medication overuse headache. The initial action will be withdrawal of the medication. The other actions may be needed if the headaches persist. DIF: Cognitive Level: Analyze (analysis) REF: 1372 OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 22. The health care provider is considering the use of sumatriptan (Imitrex) for a 54-yr-old male

patient with migraine headaches. Which information obtained by the nurse is most important to report to the health care provider? a. The patient drinks 1 to 2 cups of coffee daily. b. The patient had a recent acute myocardial infarction. c. The patient has had migraine headaches for 30 years. d. The patient has taken topiramate (Topamax) for 2 months. ANS: B

The triptans cause coronary artery vasoconstriction and should be avoided in patients with coronary artery disease. The other information will be reported to the health care provider, but none of it indicates that sumatriptan would be an inappropriate treatment. DIF: Cognitive Level: Analyze (analysis) REF: 1372 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 23. The nurse observes a patient ambulating in the hospital hall when the patient’s arms and legs

suddenly jerk and the patient falls to the floor. The nurse will first assess the patient for a possible injury. give the scheduled divalproex (Depakote). document the timing and description of the seizure. notify the patient’s health care provider about the seizure.

a. b. c. d.

ANS: A

The patient who has had a myoclonic seizure and fall is at risk for head injury and should first be evaluated and treated for this possible complication. Documentation of the seizure, notification of the health care provider, and administration of antiseizure medications are also appropriate actions, but the initial action should be assessment for injury. DIF: Cognitive Level: Analyze (analysis) REF: 1376 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 24. Which prescribed intervention will the nurse implement first for a patient in the emergency

department who is experiencing continuous tonic-clonic seizures? Give phenytoin (Dilantin) 100 mg IV. Monitor level of consciousness (LOC). Administer lorazepam (Ativan) 4 mg IV. Obtain computed tomography (CT) scan.

a. b. c. d.

ANS: C

To prevent ongoing seizures, the nurse should administer rapidly acting antiseizure medications such as the benzodiazepines. A CT scan is appropriate, but prevention of any seizure activity during the CT scan is necessary. Phenytoin will also be administered, but it is not rapidly acting. Patients who are experiencing tonic-clonic seizures are nonresponsive, although the nurse should assess LOC after the seizure. DIF: Cognitive Level: Analyze (analysis) REF: 1378 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 25. The home health registered nurse (RN) is planning care for a patient w...