Nursing 406 - Adult Health Care » Spring 2020 » Chapter 69 Quiz
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Question #1
A nurse is teaching a client with multiple sclerosis (MS). When teaching the client how to reduce fatigue, the nurse should tell the client to:
A.
rest in an air-conditioned room.
B.
avoid naps during the day.
C.
increase the dose of muscle relaxants.
D.
take a hot bath.
Question #2
The primary arthropod vector in North America that transmits encephalitis is the
A.
horse.
B.
flea.
C.
tick.
D.
mosquito.
Question #3
Medical management of arthropod-borne virus (arboviral) encephalitis is aimed at
A.
preventing renal insufficiency
B.
controlling seizures and increased intracranial pressure.
C.
preventing muscular atrophy.
D.
maintaining hemodynamic stability and adequate cardiac output
Question #4
Which drug should be available to counteract the effect of edrophonium chloride?
A.
Pyridostigmine bromide
B.
Prednisone
C.
Atropine
D.
Azathioprine
Question #5
A client with fungal encephalitis receiving IV amphotericin B reports fever, chills, and body aches. What action by the nurse is appropriate?
A.
Stop the infusion immediately.
B.
Administer diphenhydramine and acetaminophen per orders.
C.
Notify the physician and prepare for a lumbar puncture to obtain CSF cultures.
D.
Assess laboratory values for renal insufficiency.
Question #6
A client who recently experienced a stroke tells the nurse that he has double vision. Which nursing intervention is most appropriate?
A.
Turn out the lights in the room.
B.
Encourage the client to close his eyes.
C.
Instill artificial tears.
D.
Alternatively patch one eye every 2 hours.
Question #7
A client is undergoing testing to confirm a diagnosis of myasthenia gravis. The nurse explains that a diagnosis is made if muscle function improves after the client receives an IV injection of a medication. What is the medication the nurse tells the client he'll receive during this test?
A.
Edrophonium (Tensilon)
B.
Cyclosporine (Sandimmune)
C.
Immunoglobulin G (Iveegam EN)
D.
Azathioprine (Imuran)
Question #8
The nurse is taking health history from a client admitted to rule out Guillain-Barre syndrome. An important question to ask related to the diagnosis is which of the following?
A.
Have you developed any new allergies in the last year?"
B.
Have you experienced any viral infections in the last month?"
C.
Have you had difficulty with urination in the last 6 weeks?"
D.
Have you experienced any ptosis in the last few weeks?"
Question #9
A client is diagnosed with meningococcal meningitis. The 22-year-old client shares an apartment with one other person. What would the nurse expect as appropriate care for the client's roommate?
A.
Admission to the nearest hospital for observation
B.
Bedrest at home for 72 hours
C.
Treatment with antimicrobial prophylaxis as soon as possible
D.
treatment unless the roommate begins to show symptoms
Question #10
The nurse is planning care of a client admitted to the neurologic rehabilitation unit following a cerebrovascular accident. Which nursing intervention would be of highest priority?
A.
Assess client for ability to ambulate independently.
B.
Include client in planning of care and setting of goals.
C.
Provide instruction on blood-thinning medication.
D.
Praise client when using adaptive equipment.
Question #11
Which is the primary medical management of arthropod-borne virus (arboviral) encephalitis?
A.
Maintaining hemodynamic stability and adequate cardiac output
B.
Controlling seizures and increased intracranial pressure
C.
Preventing renal insufficiency
D.
Preventing muscular atrophy
Question #12
Which nursing intervention is appropriate for a client with double vision in the right eye due to MS?
A.
Apply an eye patch to the right eye.
B.
Administer eye drops as needed.
C.
Place needed items on the right side.
D.
Exercise the right eye twice a day.
Question #13
The nurse is volunteering for a Red Cross blood drive and is taking the history of potential donors. Which volunteer would the nurse know will not be allowed to donate blood?
A.
A donor who is taking medication for benign prostatic hyperplasia
B.
A donor with a history of hypertension with a blood pressure of 140/90 mm Hg
C.
A donor who moved to the United States from Canada
D.
A donor who was in college in England for 1 year
Question #14
A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide (Mestinon) on time. The nurse gets busy and does not administer the medication until after breakfast. What outcome will the patient have related to this late dose?
A.
The patient will require a double dose prior to lunch.
B.
There should not be a problem, since the medication was only delayed by about 2 hours.
C.
The muscles will become fatigued and the patient will not be able to chew food or swallow pills.
D.
The patient will go into cardiac arrest.
Question #15
The nurse is caring for a patient in the emergency department with an onset of pain related to trigeminal neuralgia. What subjective data stated by the patient does the nurse determine triggered the paroxysms of pain?
A.
I was putting my shoes on.”
B.
I was sitting at home watching television.”
C.
I was brushing my teeth.”
D.
I was taking a bath.”
Question #16
When providing discharge teaching for a client with multiple sclerosis (MS), the nurse should include which instruction?
A.
Limit your fruit and vegetable intake."
B.
Avoid taking daytime naps."
C.
Restrict fluid intake to 1,500 ml/day."
D.
Avoid hot baths and showers."
Question #17
Bell palsy is a disorder of which cranial nerve?
A.
Vagus (X)
B.
Facial (VII)
C.
Vestibulocochlear (VIII)
D.
Trigeminal (V)
Question #18
A nurse is providing education to a client with newly diagnosed multiple sclerosis (MS). Which of the following will the nurse include?
A.
Avoid physical activity.
B.
Avoid analgesic medication.
C.
Take moderate amounts of alcohol
D.
Avoid hot temperatures.
Question #19
The nurse is performing an initial nursing assessment on a client with possible Guillain-Barre syndrome. Which of the following findings would be most consistent with this diagnosis?
A.
Muscle weakness and hyporeflexia of the lower extremities
B.
Hyporeflexia and skin rash
C.
Ptosis and muscle weakness of upper extremities
D.
Fever and cough
Question #20
While performing an initial nursing assessment on a client admitted with suspected tic douloureux (trigeminal neuralgia), for which of the following would the nurse expect to observe?
A.
Hyporeflexia and weakness of the lower extremities
B.
Facial pain in the areas of the fifth cranial nerve
C.
Ptosis and diplopia
D.
Fatigue and depression
Question #21
The nurse is assessing a client with meningitis. Which of the following signs would the nurse expect to observe?
A.
Hyporeflexia in the lower extremities
B.
Ptosis and diplopia
C.
Numbness and vomiting
D.
Headache and nuchal rigidity
Question #22
A client has been hospitalized for diagnostic testing. The client has just been diagnosed with multiple sclerosis, which the physician explains is an autoimmune disorder. How would the nurse explain an autoimmune disease to the client?
A.
A disorder in which the body does not have enough immunoglobulins
B.
A disorder in which histocompatible cells attack the immunoglobulins
C.
A disorder in which the body has too many immunoglobulins
D.
A disorder in which killer T cells and autoantibodies attack or destroy natural cells—those cells that are “self”
Question #23
Which of the following is the medication of choice in the treatment of herpes simplex virus (HSV)?
A.
Dexamethasone (Decadron)
B.
Phenytoin (Dilantin)
C.
Acyclovir (Zovirax)
D.
Vancomycin
Question #24
Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of demyelination in the brain and spinal cord?
A.
Huntington disease
B.
Creutzfeldt-Jakob disease
C.
Multiple sclerosis
D.
Parkinson disease
Question #25
A patient suspected of having Guillain-Barré syndrome has had a lumbar puncture for cerebrospinal fluid (CSF) evaluation. When reviewing the laboratory results, what does the nurse find that is diagnostic for this disease?
A.
Elevated protein levels in the CSF
B.
White blood cells in the CSF
C.
Red blood cells present in the CSF
D.
Glucose in the CSF
Question #26
A 45-year-old client is admitted to the facility with excruciating paroxysmal facial pain. He reports that the episodes occur most often after feeling cold drafts and drinking cold beverages. Based on these findings, the nurse determines that the client is most likely suffering from which neurologic disorder?
A.
Angina pectoris
B.
Trigeminal neuralgia
C.
Migraine headache
D.
Bell's palsy
Question #27
Which is the most common cause of acute encephalitis in the United States?
A.
Lyme Disease
B.
Herpes simplex virus (HSV)
C.
Human immunodeficiency virus (HIV
D.
Western equine bacteria
Question #28
The nurse is assessing a newly admitted client with a diagnosis of meningitis. On assessment, the nurse expects to find which of the following?
A.
Positive Romberg sign
B.
Hyper-alertness
C.
Negative Brudzinski's sign
D.
Positive Kernig's sign
Question #29
The nurse is performing an initial assessment on a client with suspected Bell's palsy. Which of the following findings would the nurse be most focused on related to this medical diagnosis?
A.
Hyporeflexia and weakness of the lower extremities
B.
Fatigue and depression
C.
Ptosis and diplopia
D.
Facial distortion and pain
Question #30
A client with Guillain-Barre syndrome cannot swallow and has a paralytic ileus; the nurse is administering parenteral nutrition intraveneously. The nurse is careful to assess which of the following related to intake of nutrients?
A.
Respiratory status
B.
Urinary output and capillary refill
C.
Condition of skin
D.
Gag reflex and bowel sounds
Question #31
Which of the following tests confirms the diagnosis of myasthenia gravis (MG)?
A.
Tensilon test
B.
Electromyogram (EMG)
C.
Serum studies
D.
Computed tomography (CT) scan
Question #32
A client is brought to the emergency department in a confused state, with slurred speech, characteristics of a headache, and right facial droop. The vital signs reveal a blood pressure of 170/88 mm Hg, pulse of 92 beats/minute, and respirations at 24 breaths/minute. On which bodily system does the nurse focus the nursing assessment?
A.
Respiratory system
B.
Neurovascular system
C.
Endocrine system
D.
Cardiovascular system
Question #33
The nurse is caring for a client with Guillain-Barré syndrome. Which assessment finding would indicate the need for oral suctioning?
A.
Decreased pulse rate, respirations of 20 breaths/minute
B.
Increased pulse rate, adventitious breath sounds
C.
Decreased pulse rate, abdominal breathing
D.
Increased pulse rate, respirations of 16 breaths/minute
Question #34
Myasthenia gravis occurs when antibodies attack which receptor sites?
A.
Gamma-aminobutyric acid
B.
Acetylcholine
C.
Dopamine
D.
Serotonin
Question #35
A client has been brought to the ED with altered LOC, high fever, and a purpura rash on the lower extremities. The family states the client was reporting neck stiffness earlier in the day. What action should the nurse do first?
A.
Ensure the family receives prophylaxis antibiotic treatment.
B.
Apply a cooling blanket.
C.
Initiate isolation precautions.
D.
Administer prescribed antibiotics.
Question #36
A client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond?
A.
It must be hard to accept the permanency of your paralysis."
B.
You'll be permanently paralyzed; however, you won't have any sensory loss."
C.
The paralysis caused by this disease is temporary."
D.
You'll first regain use of your legs and then your arms."
Question #37
The client with herpes simplex virus (HSV) encephalitis is receiving acyclovir. The nurse monitors blood chemistry test results and urinary output for
A.
signs of improvement in the patient's condition.
B.
renal complications related to acyclovir therapy.
C.
signs and symptoms of cardiac insufficiency.
D.
signs of relapse.
Question #38
Which drug should be available to counteract the effect of edrophonium chloride?
A.
Atropine
B.
Pyridostigmine bromide
C.
Prednisone
D.
Azathioprine
Question #39
A client with myasthenia gravis is admitted with an exacerbation. The nurse is educating the client about plasmapherisis and explains this in which of the following statements?
A.
Immune globulin is given intravenously.
B.
Antibodies are removed from the plasma.
C.
Mestinon therapy is initiated.
D.
The thymus gland is removed.
Question #40
The most common cause of cholinergic crisis includes which of the following?
A.
Compliance with medication
B.
Overmedication
C.
Undermedication
D.
Infection
Question #41
A client's spouse relates how the client reported a severe headache, and shortly after was unable to talk or move their right arm and leg. The spouse indicates the client has hypertension. What should be the focus of management during this phase?
A.
reporting changes to the physician
B.
preventing further neurologic damage
C.
destabilizing client's condition
D.
assessing vital signs frequently
Question #42
The initial symptoms of variant Creutzfeldt-Jakob disease (vCJD) include
A.
sensory disturbance, limb pain, and behavioral changes.
B.
muscle rigidity, memory impairment, and cognitive impairment.
C.
akathisia and dysphagia.
D.
diplopia and bradykinesia.
Question #43
The nurse has been educating a client newly diagnosed with MS. Which statement by the client indicates an understanding of the education?
A.
exercises should be completed quickly to reduce fatigue.”
B.
I will stretch daily as directed by the physical therapist.”
C.
I should participate in non–weight-bearing exercises.”
D.
I will take hot tub baths to decrease spasms.”
Question #44
The nurse is assisting with administering a Tensilon test to a patient with ptosis. If the test is positive for myasthenia gravis, what outcome does the nurse know will occur?
A.
Eight hours after administration, the acetylcholinesterase begins to regenerate the available acetylcholine and will relieve symptoms.
B.
The patient will have recovery of symptoms for at least 24 hours after the administration of the Tensilon.
C.
Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes.
D.
After administration of the medication, there will be no change in the status of the ptosis or facial weakness.
Question #45
Which condition is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain?
A.
Multiple sclerosis
B.
Huntington disease
C.
Creutzfeldt-Jakob disease
D.
Parkinson disease
Question #46
The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe?
A.
Diplopia and ptosis
B.
Numbness
C.
Loss of proprioception
D.
Patchy blindness
Question #47
Which basic of client care, occurring during the acute phase, is most helpful in promoting the rehabilitation of a client following a debilitating cerebrovascular accident?
A.
Use of adaptive equipment
B.
Prevention of joint contractures
C.
Promoting ability to critically think
D.
Creating a positive environment
Question #48
Which condition is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain?
A.
Creutzfeldt-Jakob disease
B.
Parkinson disease
C.
Multiple sclerosis
D.
Huntington disease
Question #49
A client has been diagnosed with a frontal lobe brain abscess. Which nursing intervention is appropriate?
A.
Ensure that client takes nothing by mouth.
B.
Initiate seizure precautions.
C.
Assess visual acuity.
D.
Assess for facial weakness.
Question #50
The diagnosis of multiple sclerosis is based on which test?
A.
Evoked potential studies
B.
Magnetic resonance imaging (MRI)
C.
Cerebrospinal fluid (CSF) electrophoresis
D.
Neuropsychological testing
Question #51
The parents of a client intubated due to the progression of Guillain-Barré syndrome ask whether their child will die. What is the best response by the nurse?
A.
Once Guillain-Barré syndrome progresses to the diaphragm, survival decreases significantly.”
B.
It’s too early to give a prognosis.”
C.
Don’t worry; your child will be fine.”
D.
There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive.”
Question #52
A patient has been diagnosed with meningococcal meningitis at a community living home. When should prophylactic therapy begin for those who have had close contact with the patient?
A.
Therapy is not necessary prophylactically and should only be used if the person develops symptoms.
B.
Within 72 hours after exposure
C.
Within 48 hours after exposure
D.
Within 24 hours after exposure
Question #53
During a Tensilon test to determine if a patient has myasthenia gravis, the patient complains of cramping and becomes diaphoretic. Vital signs are BP 130/78, HR 42, and respiration 18. What intervention should the nurse prepare to do?
A.
Administer atropine to control the side effects of edrophonium.
B.
Administer diphenhydramine (Benadryl) for the allergic reaction.
C.
Place the patient in the supine position
D.
Call the rapid response team because the patient is preparing to arrest.
Question #54
A client with respiratory complications of multiple sclerosis (MS) is admitted to the medical-surgical unit. Which equipment is most important for the nurse to keep at the client's bedside?
A.
Padded tongue blade
B.
Sphygmomanometer
C.
Suction machine with catheters
D.
Nasal cannula and oxygen
Question #55
A client with fungal encephalitis receiving amphotericin B reports fever, chills, and body aches. The nurse knows that these symptoms
A.
indicate the need for immediate blood and cerebral spinal fluid (CSF) cultures.
B.
are primarily associated with infection with Coccidioides immitis and Aspergillus.
C.
may be controlled by the administration of diphenhydramine and acetaminophen approximately 30 minutes before administration of the amphotericin.
D.
indicate renal toxicity and a worsening condition.
Question #56
The diagnosis of multiple sclerosis is based on which test?
A.
Neuropsychological testing
B.
Magnetic resonance imaging
C.
CSF electrophoresis
D.
Evoked potential studies
Question #57
The nurse is assessing a client with meningitis. Which of the following signs would the nurse expect to observe?
A.
Headache and nuchal rigidity
B.
Hyporeflexia in the lower extremities
C.
Numbness and vomiting
D.
Ptosis and diplopia
Question #58
You are the nurse caring for a client with Guillain-Barré syndrome (GBS). The client also has an ascending paralysis. Knowing the complications of the disorder, what should you keep always ready at the bedside?
A.
Nebulizer and thermometer
B.
Incentive spirometer
C.
Blood pressure apparatus
D.
Intubation tray and suction apparatus
Question #59
Which of the following is the first-line therapy for myasthenia gravis (MG)?
A.
Lioresal (Baclofen)
B.
Deltasone (Prednisone)
C.
Azathioprine (Imuran)
D.
Pyridostigmine bromide (Mestinon)
Question #60
Guillain-Barré syndrome is an autoimmune attack on the peripheral myelin sheath. Which of the following is an action of myelin?
A.
Speeds nerve impulse transmission
B.
Acts as chemical messenger
C.
Represents building block of nervous system
D.
Carries message to the next nerve cell
Question #61
While caring for clients who have suffered neurologic deficits from causes such as cerebrovascular accident and closed head injury, an important nursing goal that motivate nurses to offer the best care possible is preventing:
A.
falls.
B.
choking.
C.
complications.
D.
infection.
Question #62
Which is a component of the nursing management of the client with variant Creutzfeldt-Jakob disease (vCJD)?
A.
Preparing for organ donation
B.
Initiating isolation procedures
C.
Administering amphotericin B
D.
Providing palliative care
Question #63
A health care provider asks a nurse to assess a patient being evaluated for aseptic meningitis for a positive Brudzinski sign. Which of the following actions should the nurse take?
A.
Support the patient's neck through normal range of motion and evaluate stiffness.
B.
Flex the patient's thigh on his abdomen and assess the extension of the leg.
C.
Assess the patient's sensitivity to light.
D.
Help the patient flex his neck and observe for flexion of the hips and knees
Question #64
A client is hospitalized with Guillain-Barré syndrome. Which nursing assessment finding is most significant?
A.
Urine output of 40 ml/hour
B.
Soft, nondistended abdomen
C.
Warm, dry skin
D.
Even, unlabored respirations
Question #65
Which well-recognized sign of meningitis is exhibited when the client’s neck is flexed and flexion of the knees and hips is produced?
A.
Positive Brudzinski sign
B.
Nuchal rigidity
C.
Photophobia
D.
Positive Kerning sign
Question #66
A client is suspected to have bacterial meningitis. What is the priority nursing intervention?
A.
Administer prescribed antibiotics.
B.
Encourage oral fluid intake.
C.
Prepare the client for a CT scan.
D.
Assess the CSF fluid laboratory test results
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