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Strategies Review of Key Quizzes
_____________Quiz____________? The nurse is caring for a group of patients on a medical unit. After receiving report, which patient should the nurse see first? A. A 42-year-old patient with multiple sclerosis who was admitted with sepsis B. A 72-year-old patient with Parkinson's disease who has aspiration pneumonia C. A 38-year-old patient with myasthenia gravis who declined prescribed medications D. A 45-year-old patient with amyotrophic lateral sclerosis who refuses enteral feedings -
Answer ✓✓
C. A 38-year-old patient with myasthenia gravis who declined prescribed medications Patients with myasthenia gravis who discontinue pyridostigmine (Mestinon) will develop a myasthenic crisis. Myasthenia crisis results in severe muscle weakness and can lead to a respiratory arrest. _____________Quiz____________? The nurse observes a 74-year-old man with Parkinson's disease rocking side to side while sitting in the chair. Which action by the nurse is most appropriate? A. Provide the patient with diversional activities. B. Document the activity in the patient's health record. C. Take the patient's blood pressure sitting and standing.
D. Ask if the patient is feeling either anxious or depressed. -
Answer ✓✓
B. Document the activity in the patient's health record. Patients with Parkinson's disease are instructed to rock from side to side to stimulate balance mechanisms and decrease akinesia. _____________Quiz____________? The nurse provides dietary instructions to the in-home caregiver of a 45-year-old man who has Huntington's disease. The nurse is most concerned if the caregiver makes which statement? A. "Depression is common and may cause a decrease in appetite." B. "If swallowing becomes difficult, a feeding tube may be needed." C. "Calories should be restricted to prevent unnecessary weight gain." D. "Muscles in the face are affected, and chewing may become impossible." -
Answer ✓✓
C. "Calories should be restricted to prevent unnecessary weight gain." Patients with Huntington's disease may require 4000 to 5000 calories per day to maintain body weight. Weight loss occurs in patients with Huntington's disease because of choreic movements, difficulty swallowing, depression, and mental deterioration. _____________Quiz____________? Which measure should the nurse prioritize when providing care for a patient with a diagnosis of multiple sclerosis (MS)? A. Vigilant infection control and adherence to standard precautions B. Careful monitoring of neurologic assessment and frequent reorientation C. Maintenance of a calorie count and hourly assessment of intake and output D. Assessment of blood pressure and monitoring for signs of orthostatic hypotension -
A. Acute confusion B. Bowel incontinence C. Activity intolerance D. Disturbed sleep pattern -
Answer ✓✓
C. Activity intolerance The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG, and although sleep disturbance is likely, activity intolerance is usually of primary concern. _____________Quiz____________? When establishing a diagnosis of MS, the nurse should teach the patient about what diagnostic studies (select all that apply)? A. EEG B. CT scan C. Carotid duplex scan D. Evoked response testing E. Cerebrospinal fluid analysis -
Answer ✓✓
B. CT scan Correct D. Evoked response testing Correct E. Cerebrospinal fluid analysis Correct There is no definitive diagnostic test for MS. CT scan, evoked response testing, cerebrospinal fluid analysis, and MRI along with history and physical examination are used to establish a diagnosis for MS. EEG and carotid duplex scan are not used for diagnosing MS
_____________Quiz____________? A 48-year-old man was just diagnosed with Huntington's disease. His 20-year-old son is upset about his father's diagnosis. How can the nurse best help this young man? A. Provide emotional and psychologic support. B. Encourage him to get diagnostic genetic testing done. C. Tell him the cognitive deterioration will be treated with counseling. D. Tell him the chorea and psychiatric disorders can be treated with haloperidol (Haldol). -
Answer ✓✓
A. Provide emotional and psychologic support. The patient's son will first need emotional and psychologic support. He should be taught about diagnostic genetic testing for himself but should decide for himself with a genetic counselor if and when he wants this done. The treatment plan for his father will be determined depending on his father's needs. _____________Quiz____________? A 65 year old woman was just diagnosed with PD. The priority nursing intervention is? A. searching the internet for educational videos B. evaluating the home for environmental safety C. promoting physical exercise and a well-balanced diet D. designing an exercise program to strengthen and stretch specific muscles -
Answer ✓✓
C. promoting physical exercise and a well-balanced diet _____________Quiz____________? Social effects of a chronic neurologic disease include (select all that apply)
B. limit activities and take morning and afternoon naps C. Identify where assistive devices can be obtained at reasonable prices D. space activities throughout the day with opportunities for rest. -
Answer ✓✓
D. space activities throughout the day with opportunities for rest. _____________Quiz____________? Which chronic neurologic disorder involves a deficiency of the neurotransmitters acetylcholine and aminobutyric acid (GABA) in the basal ganglia and extrapyramidal system? A. myasthenia gravis B. Parkinson's disease C. Huntington's disease D. ALS -
Answer ✓✓
C. Huntington's disease _____________Quiz____________? A 38 year woman has newly diagnosed MS and asks the nurse what is going to happen to her. What is the best response by the nurse? A. "you will have either periods of attacks and remission or progression of nerve damage over time" B. "you need to plan for a continuous loss of movement, sensory functions, and mental capabilities" C. "you will most likely have a steady course of chronic progressive nerve damage that will change your personality" D. " it is common for people with MS to have an acute attack of weakness and then not have any other symptoms for years" -
Answer ✓✓
A. "you will have either periods of attacks and remission or progression of nerve damage over time" _____________Quiz____________? During assessment of a patient admitted to the hospital with an acute excerbation of MS, what should the nurse expect to find? A. tremors, dysphasia, and ptosis B. bowel and bladder incontinence and loss of memory C. motor impairment, visual disturbances, paresthesias D. excessive involuntary movements, hearing loss, ataxia -
Answer ✓✓
C. motor impairment, visual disturbances, paresthesias _____________Quiz____________? The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by A. spinal x-ray findings B. T-cell analysis of the blood C. analysis of cerebrospinal fluid D. history and clinical manifestations -
Answer ✓✓
D. history and clinical manifestations There is no specific diagnostic test for MS. _____________Quiz____________?
D. muscle soreness and pain -
Answer ✓✓
D. muscle soreness and pain _____________Quiz____________? A patient with a tremor is being evaluated for PD. The nurse explains to the patient that PD can be confirmed by A. CT and MRI scans B. relief of symptoms with the administration of dopaminergic agents C. the presence of tremors that increase during voluntary movement D. cerebral angiogram that reveals the presence of cerebral atherosclerosis -
Answer ✓✓
B. relief of symptoms with the administration of dopaminergic agents _____________Quiz____________? which observation of the patient made by the nurse is most indicative of PD? A. large, embellished handwriting B. weakness of one leg resulting in a limp walk C. difficulty rising from a chair and beginning to walk D. onset of muscle spasms occurring with voluntary movement -
Answer ✓✓
C. difficulty rising from a chair and beginning to walk _____________Quiz____________? A patient with PD is started on levodopa. What should the nurse explain about this drug? A. it stimulates dopamine receptors in the basal ganglia
B. it promotes the release of dopamine from brain neurons C. it is a precursor of dopamine that is converted to dopamine in the brain D. it prevents the excessive breakdown of dopamine in the peripheral tissues -
Answer ✓✓
C. it is a precursor of dopamine that is converted to dopamine in the brain _____________Quiz____________? To reduce the risk of falls in a patient with PD, what should the nurse teach the patient to do? A. use an elevated toilet seat B. use a walker or cane for support C. consciously lift toes when stepping D. rock side to side to initiate leg movements -
Answer ✓✓
C. consciously lift toes when stepping _____________Quiz____________? A patient with MG is admitted to the hospital with respiratory insufficiency and severe weakness. when is a diagnosis of cholinergic crisis made? A. the patient's respiration is impaired because of muscle weakness B. administration of endrophonium (Tensilon) increases muscle weakness C. administration of endrophonium (Tensilon) results in improved muscle weakness D. EMG reveals decreased response to repeated stimulation of muscles -
Answer ✓✓
B. administration of endrophonium (Tensilon) increases muscle weakness _____________Quiz____________?
C. maximize neurologic functioning for as long as possible _____________Quiz____________? A health care provider has ordered carbidopa-levodopa (sinemet) four times per day for a client with PD. The client states that he wants "to end it all now that the PD has progressed" what should the nurse do? (select all that apply) A. explain that the new prescription for sinemet will treat his depression B. encourage the client to discuss his feelings as the sinemet is being administrated C. contact the health care provider before administrating the sinemet D. determine if the client is at risk for suicide E. determine of the client is on antidepressants or MAOIs -
Answer ✓✓
C. contact the health care provider before administrating the sinemet D. determine if the client is at risk for suicide E. determine of the client is on antidepressants or MAOIs _____________Quiz____________? Which of the following is an initial sign of PD? A. rigidity B. tremor C. bradykinesia D. akinesia -
Answer ✓✓
B. tremor _____________Quiz____________? The nurse develops a teaching plan for a client newly diagnosed with PD. which of the following topics that the nurse plans to discuss is the most important?
A. maintaining a balanced nutritional diet B. enhancing the immune system C. maintaining a safe environment D. engaging in diversional activity -
Answer ✓✓
C. maintaining a safe environment _____________Quiz____________? The nurse observes that the client's upper arm tremors disappear as he unbuttons his shirt. Which statement best guides the nurse's analysis of this observation about the client's tremors? A. the tremors are probably psychological and can be controlled at will B. the tremors sometimes disappear with purposeful and voluntary movements C. the tremors disappear when the client's attention is diverted by some activity D. there is no explanation for observation; it is probably a chance occurrence -
Answer ✓✓
B. the tremors sometimes disappear with purposeful and voluntary movements _____________Quiz____________? At what time of day should the nurse encourage a client with PD to schedule the most demanding physical activities to minimize the effects of hypokinesia? A. early in the morning , when the client's energy level is high B. to coincide with the peak action of drug therapy C. immediately after a rest period D. when family members will be available -
Answer ✓✓
B. to coincide with the peak action of drug therapy
D. alertness -
Answer ✓✓
B. muscle rigidity _____________Quiz____________? A client is being switched from levodopa to carbidopa-levodopa (sinemet). The nurse should monitor for which of the following possible complications during medication changes and dosage adjustment? A. euphoria B. jaundice C. vital sign fluctuation D. signs and symptoms of diabetes -
Answer ✓✓
C. vital sign fluctuation _____________Quiz____________? A new medication regimen is ordered for a client with PD. At which time should the nurse make certain that the medication is taken? A. at bedtime B. all at one time C. two hours before mealtime D. at the time scheduled -
Answer ✓✓
D. at the time scheduled _____________Quiz____________?
A client with PD needs a long time to complete her morning hygiene, but she becomes annoyed when the nurse offers assistance and refuses all help. which action is the nurse's best initial response in this situation? A. tell the client firmly that she needs assistance and help her with her care B. praise the client for her desire to be independent and give her extra time and encouragement C. tell the client that she is being unrealistic about her abilities and must accept the fact that she needs help D. suggest to the client that if she insists on self-care, she should at least modify her routine
Answer ✓✓
B. praise the client for her desire to be independent and give her extra time and encouragement _____________Quiz____________? A client with PD asks the nurse to explain to his nephew " what the doctor said the pallidotomy would do." The nurse's best response includes stating that the main goal for the client after pallidotomy is improved: A. functional ability B. emotional stress C. alertness D. appetite -
Answer ✓✓
A. functional ability _____________Quiz____________? The nurse is teaching a client with bladder dysfunction from MS about bladder training at home. Which instructions should the nurse include in the teaching plan? (select all that apply)
Answer ✓✓
C. relieves muscular spasticity _____________Quiz____________? A client has had MS for 15 years and has received various drug therapies. What is the primary reason why the nurse has found it difficult evaluate the effectiveness of the drugs that the client has used? A. the client exhibits in tolerance to many drugs B. the client experiences spontaneous remissions from time to time C. the client requires multiple drugs simultaneously D. the client endures long periods of exacerbation before the illness responds to a particular drug. -
Answer ✓✓
B. the client experiences spontaneous remissions from time to time _____________Quiz____________? When the nurse talks with a client with MS who has slurred speech, which nursing intervention is contraindicated? A. encouraging the client to speak slowly B. encouraging the client to speak distinctly C. asking the client to repeat indistinguishable words D. asking the client to speak louder when tired -
Answer ✓✓
D. asking the client to speak louder when tired _____________Quiz____________? The right hand of the client with MS trembles severely whenever she attempts a voluntary action. she spills her coffee twice at lunch and cannot get her dress fastened securely. which is the best legal documentation in nurses' notes of the chart for this client assessment?
A. "has an intention tremor of the right hand" B. "right-hand tremor worsens with purposeful acts C. "needs assistance with dressing and eating due to severe trembling and clumsiness" D. "slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup" -
Answer ✓✓
D. "slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup" _____________Quiz____________? A client with MS is experiencing bowel incontinence and is starting a bowel retraining program. which strategy is inappropriate? A. eating a diet high in fiber B. setting a regular time for elimination C. using an elevated toilet seat D. limiting fluid intake to 1,000 mL/day -
Answer ✓✓
D. limiting fluid intake to 1,000 mL/day _____________Quiz____________? Which of the following is an inappropriate outcome to establish with a client who has MS? The client will: A. develop joint mobility B. develop muscle strength C. develop cognition D. develop mood elevation -
Answer ✓✓
