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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter69:ManagementofPatientswithNeurologicInfections, AutoimmuneDisorders,andNeuropathies  1.

ApatientwithpossiblebacterialmeningitisisadmittedtotheICU.Whatassessmentfindingwouldthe nurseexpectforapatientwiththisdiagnosis?

A)

Painuponankledorsiflexionofthefoot

B)

Neckflexionproducesflexionofkneesandhips

C)

Inabilitytostandwitheyesclosedandarmsextendedwithoutswaying

D)

Numbnessandtinglinginthelowerextremities

Ans:

B Feedback: ClinicalmanifestationsofbacterialmeningitisincludeapositiveBrudzinskissign.Neckflexion producingflexionofkneesandhipscorrelateswithapositiveBrudzinskissign.PositiveHomanssign (painupondorsiflexionofthefoot)andnegativeRombergssign(inabilitytostandwitheyesclosedand armsextended)arenotexpectedassessmentfindingsforthepatientwithbacterialmeningitis.Peripheral neuropathymanifestsasnumbnessandtinglinginthelowerextremities.Again,thiswouldnotbean initialassessmenttoruleoutbacterialmeningitis.

2.

Thenurseisplanningdischargeeducationforapatientwithtrigeminalneuralgia.Thenurseknowsto includeinformationaboutfactorsthatprecipitateanattack.Whatwouldthenursebecorrectinteaching thepatienttoavoid?

A)

Washinghisface

B)

Exposinghisskintosunlight

C)

Usingartificialtears

D)

Drinkinglargeamountsoffluids

Ans:

A Feedback: Washingthefaceshouldbeavoidedifpossiblebecausethisactivitycantriggeranattackofpainina patientwithtrigeminalneuralgia.Usingartificialtearswouldbeanappropriatebehavior.Exposingthe skintosunlightwouldnotbeharmfultothispatient.Temperatureextremesinbeveragesshouldbe

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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avoided. 3.

Thenurseiscaringforapatientwithmultiplesclerosis(MS).Thepatienttellsthenursethehardest thingtodealwithisthefatigue.Whenteachingthepatienthowtoreducefatigue,whatactionshouldthe nursesuggest?

A)

Takingahotbathatleastoncedaily

B)

Restinginanair-conditionedroomwheneverpossible

C)

Increasingthedoseofmusclerelaxants

D) Ans:

Avoidingnapsduringtheday

B Feedback: FatigueisacommonsymptomofpatientswithMS.Loweringthebodytemperaturebyrestinginanairconditionedroommayrelievefatigue;however,extremecoldshouldbeavoided.Ahotbathorshower canincreasebodytemperature,producingfatigue.Musclerelaxants,prescribedtoreducespasticity,can causedrowsinessandfatigue.Planningforfrequentrestperiodsandnapscanrelievefatigue.Other measurestoreducefatigueinthepatientwithMSincludetreatingdepression,usingoccupational therapytolearnenergyconservationtechniques,andreducingspasticity.

4.

ApatientwithGuillain-Barrsyndromehasexperiencedasharpdeclineinvitalcapacity.Whatisthe nursesmostappropriateaction?

A)

Administerbronchodilatorsasordered.

B)

Remindthepatientoftheimportanceofdeepbreathingandcoughingexercises.

C)

Preparetoassistwithintubation.

D)

Administersupplementaryoxygenbynasalcannula.

Ans:

C Feedback: ForthepatientwithGuillain-Barrsyndrome,mechanicalventilationisrequiredifthevitalcapacityfalls, makingspontaneousbreathingimpossibleandtissueoxygenationinadequate.Eachoftheotherlisted actionsislikelyinsufficienttomeetthepatientsoxygenationneeds.

5.

ApatientdiagnosedwithBellspalsyisbeingcaredforonanoutpatientbasis.Duringhealtheducation, thenurseshouldpromotewhichofthefollowingactions?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Applyingaprotectiveeyeshieldatnight

B)

Chewingontheaffectedsidetopreventunilateralneglect

C)

Avoidingtheuseofanalgesicswheneverpossible

D)

Avoidingbrushingtheteeth

Ans:

A

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Feedback: Cornealirritationandulcerationmayoccuriftheeyeisunprotected.Whileparalysislasts,theinvolved eyemustbeprotected.Thepatientshouldbeencouragedtoeatontheunaffectedside,dueto swallowingdifficulties.Analgesicsareusedtocontrolthefacialpain.Thepatientshouldcontinueto provideself-careincludingoralhygiene. 6.

A)

ThenurseisworkingwithapatientwhoisnewlydiagnosedwithMS.Whatbasicinformationshould thenurseprovidetothepatient? MSisaprogressivedemyelinatingdiseaseofthenervoussystem.

B)

MSusuallyoccursmorefrequentlyinmen.

C)

MStypicallyhasanacuteonset.

D)

MSissometimescausedbyabacterialinfection.

Ans:

A Feedback: MSisachronic,degenerative,progressivediseaseofthecentralnervoussystem,characterizedbythe occurrenceofsmallpatchesofdemyelinationinthebrainandspinalcord.ThecauseofMSisnot known,andthediseaseaffectstwiceasmanywomenasmen.

7.

ThenurseiscreatingaplanofcareforapatientwhohasarecentdiagnosisofMS.Whichofthe followingshouldthenurseincludeinthepatientscareplan?

A)

Encouragepatienttovoideveryhour.

B)

Orderalow-residuediet.

C)

ProvidetotalassistancewithallADLs.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Instructthepatientondailymusclestretching.

Ans:

D

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Feedback: ApatientdiagnosedwithMSshouldbeencouragedtoincreasethefiberinhisorherdietandvoid30 minutesafterdrinkingtohelptrainthebladder.Thepatientshouldparticipateindailymusclestretching tohelpalleviateandrelaxmusclespasms. 8.

Apatientwithmetastaticcancerhasdevelopedtrigeminalneuralgiaandistakingcarbamazepine (Tegretol)forpainrelief.Whatprincipleappliestotheadministrationofthismedication?

A)

Tegretolisnotknowntohaveseriousadverseeffects.

B)

Thepatientshouldbemonitoredforbonemarrowdepression.

C)

Sideeffectsofthemedicationincluderenaldysfunction.

D)

Themedicationshouldbefirsttakeninthemaximumdosageformtobeeffective.

Ans:

B Feedback: Theanticonvulsantagentscarbamazepine(Tegretol)andphenytoin(Dilantin)relievepaininmost patientsdiagnosedwithtrigeminalneuralgiabyreducingthetransmissionofimpulsesatcertainnerve terminals.Sideeffectsincludenausea,dizziness,drowsiness,andaplasticanemia.Carbamazepine shouldbegraduallyincreaseduntilpainreliefisobtained.

9.

Amalepatientpresentstothecliniccomplainingofaheadache.Thenursenotesthatthepatientis guardinghisneckandtellsthenursethathehasstiffnessintheneckarea.Thenursesuspectsthepatient mayhavemeningitis.Whatisanotherwell-recognizedsignofthisinfection?

A)

NegativeBrudzinskissign

B)

PositiveKernigssign

C)

Hyperpatellarreflex

D)

Sluggishpupilreaction

Ans:

B

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Feedback: Meningealirritationresultsinanumberofwell-recognizedsignscommonlyseeninmeningitis,suchas apositiveKernigssign,apositiveBrudzinskissign,andphotophobia.Hyperpatellarreflexanda sluggishpupilreactionarenotcommonlyrecognizedsignsofmeningitis. 10. ThenurseisdevelopingaplanofcareforapatientnewlydiagnosedwithBellspalsy.Thenursesplanof careshouldaddresswhatcharacteristicmanifestationofthisdisease? A)

Tinnitus

B)

Facialparalysis

C)

Painatthebaseofthetongue

D)

Diplopia

Ans:

B Feedback: Bellspalsyischaracterizedbyfacialdysfunction,weakness,andparalysis.Itdoesnotresultindiplopia, painatthebaseofthetongue,ortinnitus.

11.

ThenursecaringforapatientdiagnosedwithGuillain-Barrsyndromeisplanningcarewithregardtothe clinicalmanifestationsassociatedthissyndrome.Thenursescommunicationwiththepatientshould reflectthepossibilityofwhatsignorsymptomofthedisease?

A)

Intermittenthearingloss

B)

Tinnitus

C)

Tongueenlargement

D)

Vocalparalysis

Ans:

D Feedback: Guillain-Barrsyndromeisadisorderofthevagusnerve.Clinicalmanifestationsincludevocalparalysis, dysphagia,andvoicechanges(temporaryorpermanenthoarseness).Hearingdeficits,tinnitus,and tongueenlargementarenotassociatedwiththedisease.

12. Thenurseispreparingtoprovidecareforapatientdiagnosedwithmyastheniagravis.Thenurseshould knowthatthesignsandsymptomsofthediseasearetheresultofwhat?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Geneticdysfunction

B)

Upperandlowermotorneuronlesions

C)

Decreasedconductionofimpulsesinanuppermotorneuronlesion

D)

Alowermotorneuronlesion

Ans:

D

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Feedback: Myastheniagravisischaracterizedbyaweaknessofmuscles,especiallyinthefaceandthroat,causedby alowerneuronlesionatthemyoneuraljunction.Itisnotageneticdisorder.Acombinedupperand lowerneuronlesiongenerallyoccursasaresultofspinalinjuries.Alesioninvolvingcranialnervesand theiraxonsinthespinalcordwouldcausedecreasedconductionofimpulsesatanuppermotorneuron. 13. ApatientwithsuspectedCreutzfeldt-Jakobdisease(CJD)isbeingadmittedtotheunit.Thenursewould expectwhatdiagnostictesttobeorderedforthispatient? A)

Cerebralangiography

B)

ABGanalysis

C)

CT

D)

EEG

Ans:

D Feedback: TheEEGrevealsacharacteristicpatternoverthedurationofCJD.ACTscanmaybeusedtoruleout disordersthatmaymimicthesymptomsofCJD.ABGswouldnotbenecessaryuntilthelaterstagesof CJD;theywouldnotbeutilizedasadiagnostictest.CerebralangiographyisnotusedtodiagnoseCJD.

14. Toalleviatepainassociatedwithtrigeminalneuralgia,apatientistakingTegretol(carbamazepine). Whathealtheducationshouldthenurseprovidetothepatientbeforeinitiatingthistreatment? A)

Concurrentuseofcalciumsupplementsiscontraindicated.

B)

Bloodlevelsofthedrugmustbemonitored.

C)

Thedrugislikelytocausehyperactivityandagitation.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Tegretolcancausetinnitusduringthefirstfewdaysoftreatment.

Ans:

B

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Feedback: SideeffectsofTegretolincludenausea,dizziness,drowsiness,andaplasticanemia.Thepatientmust alsobemonitoredforbonemarrowdepressionduringlong-termtherapy.Skindiscoloration,insomnia, andtinnitusarenotsideeffectsofTegretol. 15. Apatientwithherpessimplexvirusencephalitis(HSV)hasbeenadmittedtotheICU.Whatmedication wouldthenurseexpectthephysiciantoorderforthetreatmentofthisdiseaseprocess? A)

Cyclosporine(Neoral)

B)

Acyclovir(Zovirax)

C)

Cyclobenzaprine(Flexeril)

D)

Ampicillin(Prinicpen)

Ans:

B Feedback: Acyclovir(Zovirax)organciclovir(Cytovene),antiviralagents,arethemedicationsofchoiceinthe treatmentofHSV.ThemodeofactionistheinhibitionofviralDNAreplication.Topreventrelapse, treatmentwouldcontinueforupto3weeks.Cyclosporineisanimmunosuppressantandantirheumatic. Cyclobenzaprineisacentrallyactingskeletalmusclerelaxant.Ampicillin,anantibiotic,isineffective againstviruses.

16. Amiddle-agedwomanhassoughtcarefromherprimarycareproviderandundergonediagnostictesting thathasresultedinadiagnosisofMS.Whatsignorsymptomismostlikelytohavepromptedthe womantoseekcare? A)

Cognitivedeclines

B)

Personalitychanges

C)

Contractures

D)

Difficultyincoordination

Ans:

D

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

1303

Feedback: TheprimarysymptomsofMSmostcommonlyreportedarefatigue,depression,weakness,numbness, difficultyincoordination,lossofbalance,spasticity,andpain.Cognitivechangesandcontractures usuallyoccurlaterinthedisease. 17. Anurseisplanningthecareofa28-year-oldwomanhospitalizedwithadiagnosisofmyastheniagravis. Whatapproachwouldbemostappropriateforthecareandschedulingofdiagnosticproceduresforthis patient? A)

Allatonetime,toprovidealongerrestperiod

B)

Beforemeals,tostimulateherappetite

C)

Inthemorning,withfrequentrestperiods

D)

Beforebedtime,topromoterest

Ans:

C Feedback: Proceduresshouldbespacedtoallowforrestinbetween.Proceduresshouldbeavoidedbeforemeals,or thepatientmaybetooexhaustedtoeat.Proceduresshouldbeavoidednearbedtimeifpossible.

18. ThenurseiscaringforapatientwhoishospitalizedwithanexacerbationofMS.Toensurethepatients safety,whatnursingactionshouldbeperformed? A)

Ensurethatsuctionapparatusissetupatthebedside.

B)

Padthepatientsbedrails.

C)

Maintainbedrestwheneverpossible.

D)

Provideseveralsmallmealseachday.

Ans:

A Feedback: Becauseofthepatientsriskofaspiration,itisimportanttohaveasuctionapparatusathand.Bedrest shouldbegenerallybeminimized,notmaximized,andthereisnoneedtopadthepatientsbedrailsorto providemultiplesmallmeals.

19. A33-year-oldpatientpresentsattheclinicwithcomplaintsofweakness,incoordination,dizziness,and

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

1304

lossofbalance.ThepatientishospitalizedanddiagnosedwithMS.Whatsignorsymptom,revealed duringtheinitialassessment,istypicalofMS? A)

Diplopia,historyofincreasedfatigue,anddecreasedorabsentdeeptendonreflexes

B)

Flexorspasm,clonus,andnegativeBabinskisreflex

C)

Blurredvision,intentiontremor,andurinaryhesitancy

D)

Hyperactiveabdominalreflexesandhistoryofunsteadygaitandepisodicparesthesiainbothlegs

Ans:

C Feedback: Opticneuritis,leadingtoblurredvision,isacommonearlysignofMS,asisintentiontremor(tremor whenperforminganactivity).Nervedamagecancauseurinaryhesitancy.InMS,deeptendonreflexes areincreasedorhyperactive.ApositiveBabinskisreflexisfoundinMS.Abdominalreflexesareabsent withMS.

20. ThenurseisdevelopingaplanofcareforapatientwithGuillain-Barrsyndrome.Whichofthefollowing interventionsshouldthenurseprioritizeforthispatient? A)

Usingtheincentivespirometerasprescribed

B)

Maintainingthepatientonbedrest

C)

Providingaidstocompensateforlossofvision

D)

Assessingfrequentlyforlossofcognitivefunction

Ans:

A Feedback: Respiratoryfunctioncanbemaximizedwithincentivespirometryandchestphysiotherapy.Nursing interventionstowardenhancingphysicalmobilityshouldbeutilized.Nursinginterventionsareaimedat preventingadeepveinthrombosis.Guillain-Barrsyndromedoesnotaffectcognitivefunctionorvision.

21. A69-year-oldpatientisbroughttotheEDbyambulancebecauseafamilymemberfoundhimlyingon thefloordisorientedandlethargic.Thephysiciansuspectsbacterialmeningitisandadmitsthepatientto theICU.Thenurseknowsthatriskfactorsforanunfavorableoutcomeincludewhat?Selectallthat apply. A)

Bloodpressuregreaterthan140/90mmHg

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Heartrategreaterthan120bpm

C)

Olderage

D)

LowGlasgowComaScale

E)

Lackofpreviousimmunizations

Ans:

B,C,D

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Feedback: Risksforanunfavorableoutcomeofmeningitisincludeolderage,aheartrategreaterthan120 beats/minute,lowGlasgowComaScalescore,cranialnervepalsies,andapositiveGramstain1hour afterpresentationtothehospital.ABPgreaterthan140/90mmHgisindicativeofhypertension,butis notnecessarilyrelatedtopooroutcomesrelatedtomeningitis.Immunizationsarenotnormallyrelevant tothecourseofthedisease. 22. Thecriticalcarenurseiscaringfor25-year-oldmanadmittedtotheICUwithabrainabscess.Whatisa prioritynursingresponsibilityinthecareofthispatient? A)

Maintainingthepatientsfunctionalindependence

B)

Providinghealtheducation

C)

Monitoringneurologicstatusclosely

D)

Promotingmobility

Ans:

C Feedback: Vigilantneurologicmonitoringisakeyaspectofcaringforapatientwhohasabrainabscess.This supersedeseducation,ADLs,andmobility,eventhoughtheseareallvalidandimportantaspectsof nursingcare.

23. ApatientisbeingadmittedtotheneurologicICUwithsuspectedherpessimplexvirusencephalitis. Whatnursingactionbestaddressesthepatientscomplaintsofheadache? A)

Initiatingapatient-controlledanalgesia(PCA)ofmorphinesulfate

B)

Administeringhydromorphone(Dilaudid)IVasneeded

C)

Dimmingthelightsandreducingstimulation

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Distractingthepatientwithactivity

Ans:

C

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Feedback: Comfor...