Text Mode Text version of the exam

1) SITUATION: A 65 year old woman was admitted for Parkinsons Disease.

The charge nurse is going to make an initial assessment. One day, the patient
complained of difficulty in walking. Your response would be
A.
B.
C.
D.

You will need a cane for support

Walk erect with eyes on horizon
Ill get you a wheelchair
Dont force yourself to walk
2) Nurse Carol is assessing a client with Parkinsons disease. The nurse
recognize bradykinesia when the client exhibits:

A.
B.
C.
D.

Intentional tremor
Paralysis of limbs
Muscle spasm
Lack of spontaneous movement
3) Which of the following diseases is associated with decreased levels of
dopamine due to destruction of pigmented neuronal cells in the substantia
nigra in the basal ganglia of the brain?

A.
B.
C.
D.

Parkinsons disease
Multiple sclerosis
Huntingtons disease
Creutzfeldt-Jakobs disease
4) SITUATION: A 65 year old woman was admitted for Parkinsons Disease.
The charge nurse is going to make an initial assessment. The patient was
prescribed with levodopa. What is the action of this drug?

A.
B.
C.
D.

Increase dopamine availability

Activates dopaminergic receptors in the basal ganglia
Decrease acetylcholine availability
Release dopamine and other catecholamine from neurological
storage sites
5) A shuffling gait is typically associated with the patient who has:

A.
B.
C.
D.

Parkinsons disease
Multiple sclerosis
Raynauds disease
Myasthenia gravis

6) SITUATION: A 65 year old woman was admitted for Parkinsons Disease.

The charge nurse is going to make an initial assessment. Which of the
following is a characteristic of a patient with advanced Parkinsons disease?
A.
B.
C.
D.

Disturbed vision
Forgetfulness
Mask like facial expression
Muscle atrophy
7) SITUATION: A 65 year old woman was admitted for Parkinsons Disease.
The charge nurse is going to make an initial assessment. You are discussing
with the dietician what food to avoid with patients taking levodopa?

A.
B.
C.
D.

Vitamin C rich food

Vitamin E rich food
Thiamine rich food
Vitamin B6 rich food
8) All of these nursing activities are included in the care plan for a 78-year-old
man with Parkinsons disease who has been referred to your home health
agency. Which ones will you delegate to a nursing assistant (NA)? (Choose all
that apply).

A.
B.

Check for orthostatic changes in pulse and bloods pressure.

Monitor for improvement in tremor after levodopa (L-dopa) is
given.
C.
Remind the patient to allow adequate time for meals.
D.
Monitor for abnormal involuntary jerky movements of
extremities.
E.
Assist the patient with prescribed strengthening exercises.
F.
Adapt the patients preferred activities to his level of function.
9) Which of the following is the most common cause of dementia among
elderly persons?
A.
B.
C.
D.

A.

Parkinsons disease
Multiple sclerosis
Amyotrophic lateral sclerosis
Alzheimers disease
10) The nurse should instruct the patient with Parkinsons disease to avoid
which of the following?
Walking in an indoor shopping mall

B.
C.
D.

Sitting on the deck on a cool summer evening

Walking to the car on a cold winter day
Sitting on the beach in the sun on a summer day
11) A patient with Parkinsons disease has a nursing diagnosis of Impaired
Physical Mobility related to neuromuscular impairment. You observe a nursing
assistant performing all of these actions. For which action must you
intervene?

A.

The NA assists the patient to ambulate to the bathroom and

back to bed.
B.
The NA reminds the patient not to look at his feet when he is
walking.
C.
The NA performs the patients complete bath and oral care.
D.
The NA sets up the patients tray and encourages patient to
feed himself.
12) Which of the following diseases 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?
A.
B.
C.
D.

Multiple sclerosis
Parkinsons disease
Huntingtons disease
Creutzfeldt-Jakobs disease
13) The nurse is teaching a client with Parkinsons disease ways to prevent
curvatures of the spine associated with the disease. To prevent spinal flexion,
the nurse should tell the client to:

A.
B.
C.
D.

Periodically lie prone without a neck pillow

Sleep only in dorsal recumbent position
Rest in supine position with his head elevated
Sleep on either side but keep his back straight
14) SITUATION: A 65 year old woman was admitted for Parkinsons Disease.
The charge nurse is going to make an initial assessment. The onset of
Parkinsons disease is between 50-60 years old. This disorder is caused by

A.
B.
C.
D.

Injurious chemical substances

Hereditary factors
Death of brain cells due to old age
Impairment of dopamine producing cells in the brain

15) A nurse is assigned to care to a client with Parkinsons disease. What

interventions are important if the nurse wants to improve nutrition and promote
effective swallowing of the client?
A.
B.
C.
D.

Eat solid food

Give liquids with meals
Feed the client
Sit in an upright position to eat
16) The nurse is assessing a patient and notes a Brudzinskis sign and
Kernigs sign. These are two classic signs of which of the following disorders?

A.
B.
C.
D.

Cerebrovascular accident (CVA)

Meningitis
Seizure disorder
Parkinsons disease
17) A nurse is caring for a client with Parkinsons disease who has been taking
carbidopa/levodopa (Sinemet) for a year. Which of the following adverse
reactions will the nurse monitor the client for?

A.
B.
C.
D.

Dykinesia
Glaucoma
Hypotension
Respiratory depression
18) Levodopa is ordered for a client with Parkinsons disease. Before starting
the medication, the nurse should know that:

A.
B.

Levodopa is inadequately absorbed if given with meals.

Levodopa may cause the side effects of orthostatic
hypotension
C.
Levodopa must be monitored by weekly laboratory tests.
D.
Levodopa causes an initial euphoria followed by depression.
19) A client has been placed on levodopa to treat Parkinsons disease. Which
of the following is a common side effects of levodopa that the nurse should
include in the clients teaching plan?
A.
B.
C.
D.

Pancytopenia
Peptic ulcer
Postural hypotension
Weight loss

20) Mr. Perkson has a parkinsons disease and he finds the resting tremor he
is experiencing in his right hand very frustrating. The nurse advises him to:
A.
B.
C.
D.

Take a warm bath

Hold an object
Practice deep breathing
Take diazepam as needed

Answers and Rationales

1.

2.
3.
4.

5.

6.

7.

A. You will need a cane for support .Telling the client to

walk erect neglects the clients complain of difficulty walking.
Wheelchair is as much as possible not used to still enhance the
clients motor function using a cane. Telling the client not to force
himself walk is non therapeutic. The client wants to talk and we
should help her walk using devices such as cane to provide support
and prevent injuries.
D. Lack of spontaneous movement . Bradykinesia is
slowing down from the initiation and execution of movement.
A. Parkinsons disease. In some patients, Parkinsons
disease can be controlled; however, it cannot be cured.
A. Increase dopamine availability. Levodopa is an altered
form of dopamine. It is metabolized by the body and then converted
into dopamine for brains use thus increasing dopamine availability.
Dopamine is not given directly because of its inability to cross the
BBB.
A. Parkinsons disease . A shuffling gait from the
musculoskeletal rigidity of the patient with Parkinsons disease is
common. Patients experiencing a stroke usually exhibit loss of
voluntary control over motor movements associated with
generalized weakness; a shuffling gait is usually not observed in
stroke patient.
C. Mask like facial expression. Parkinsons disease does not
affect the cognitive ability of a person. It is a disorder due to the
depletion of the neurotransmitter dopamine which is needed for
inhibitory control of muscular contractions. Client will exhibit mask
like facial expression, Cog wheel rigidity, Bradykinesia, Shuffling gait
etc. Muscle atrophy does not occur in parkinsons disease nor visual
disturbances.
D. Vitamin B6 rich food . Vitamin b6 or pyridoxine is avoided
in patients taking levodopa because levodopa increases vitamin b6
availability leading to toxicity.

8.

A. Check for orthostatic changes in pulse and bloods

pressure. , C. Remind the patient to allow adequate time for
meals. , E. Assist the patient with prescribed strengthening
exercises. NA education and scope of practice includes taking
pulse and blood pressure measurements. In addition, NAs can
reinforce previous teaching or skills taught by the RN or other
disciplines, such as speech or physical therapists. Evaluation of
patient response to medication and development and individualizing
the plan of care require RN-level education and scope of practice.
Focus: Delegation
9.
D. Alzheimers disease. Alzheimer;s disease, sometimes
known as senile dementia of the Alzheimers type or primary
degenerative dementia, is an insidious; progressive, irreversible, and
degenerative disease of the brain whose etiology is still unknown.
Parkinsons disease is a neurologic disorder caused by lesions in the
extrapyramidial system and manifested by tremors, muscle rigidity,
hypokinesis, dysphagia, and dysphonia. Multiple sclerosis, a
progressive, degenerative disease involving demyelination of the
nerve fibers, usually begins in young adulthood and is marked by
periods of remission and exacerbation. Amyotrophic lateral sclerosis,
a disease marked by progressive degeneration of the neurons,
eventually results in atrophy of all the muscles; including those
necessary for respiration.
10.
D. Sitting on the beach in the sun on a summer day . The
patient with Parkinsons disease may be hypersensitive to heat,
which increases the risk of hyperthermia, and he should be
instructed to avoid sun exposure during hot weather.
11.
C. The NA performs the patients complete bath and
oral care. The nursing assistant should assist the patient with
morning care as needed, but the goal is to keep this patient as
independent and mobile as possible. Assisting the patient to
ambulate, reminding the patient not to look at his feet (to prevent
falls), and encouraging the patient to feed himself are all
appropriate to goal of maintaining independence. Focus:
Delegation/supervision
12.
A. Multiple sclerosis . The cause of MS is not known and the
disease affects twice as many women as men.
13.
A. Periodically lie prone without a neck
pillow. Periodically lying in a prone position without a pillow will
help prevent the flexion of the spine that occurs with Parkinsons
disease. Answers B and C flex the spine; therefore, they are

incorrect. Answer D is not realistic because of position changes

during sleep; therefore, it is incorrect.
14.
D. Impairment of dopamine producing cells in the
brain. Dopamine producing cells in the basal ganglia mysteriously
deteriorates due to unknown cause.
15.
D. Sit in an upright position to eat . Client with Parkinsons
disease are at a high risk for aspiration and undernutrition. Sitting
upright promotes more effective swallowing.
16.
B. Meningitis. A positive response to one or both tests
indicates meningeal irritation that is present with meningitis.
Brudzinskis and Kernigs signs dont occur in CVA, seizure disorder,
or Parkinsons disease.
17.
C. Hypotension . Hypotension, dizziness and lethargy are side
effects of anti parkinson drugs like levodopa and carbidopa.
18.
B. Levodopa may cause the side effects of orthostatic
hypotension. Levodopa is the metabolic precursor of dopamine. It
reduces sympathetic outflow by limiting vasoconstriction, which may
result in orthostatic hypotension.
19.
C. Postural hypotension
20.
B. Hold an object . The resting or non-intentional tremor may
be controlled with purposeful movement such as holding an object.
A warm bath, deep breathing and diazepam will promote relaxation
but are not specific interventions for tremor
Text Mode Text version of the exam
1) A nurse is putting together a presentation on meningitis. Which of the
following microorganisms has noted been linked to meningitis in humans?
A.
B.
C.
D.

S. pneumonia
H. influenza
N. meningitis
Cl. difficile
2) The mother brings a child to the health care clinic because of severe
headache and vomiting. During the assessment of the health care nurse, the
temperature of the child is 40 degree Celsius, and the nurse notes the
presence of nuchal rigidity. The nurse is suspecting that the child might be
suffering from bacterial meningitis. The nurse continues to assess the child for
the presence of Kernigs sign. Which finding would indicate the presence of
this sign?

A.
B.
C.
D.

Flexion of the hips when the neck is flexed from a lying position
Calf pain when the foot is dorsiflexed
Inability of the child to extend the legs fully when lying supine
Pain when the chin is pulled down to the chest
3) Richard Barnes was diagnosed with pneumococcal meningitis. What
response by the patient indicates that he understands the precautions
necessary with this diagnosis?

A.

Im so depressed because I cant have any visitors for a

week.
B.
Thank goodness, Ill only be in isolation for 24 hours.
C.
The nurse told me that my urine and stool are also sources of
meningitis bacteria.
D.
The doctor is a good friend of mine and wont keep me in
isolation.
4) A child is admitted to the pediatric unit with a diagnosis of suspected
meningococcal meningitis. Which of the following nursing measures should
the nurse do FIRST?
A.
B.
C.
D.

Institute seizure precautions

Assess neurologic status
Place in respiratory isolation
Assess vital signs
5) A 4-month-old with meningococcal meningitis has just been admitted to the
pediatric unit. Which nursing intervention has the highest priority?

A.
B.
C.
D.

Instituting droplet precautions

Administering acetaminophen (Tylenol)
Obtaining history information from the parents
Orienting the parents to the pediatric unit
6) A client is admitted and has been diagnosed with bacterial (meningococcal)
meningitis. The infection control registered nurse visits the staff nurse caring
to the client. What statement made by the nurse reflects an understanding of
the management of this client?

A.
B.

speech pattern may be altered

Respiratory isolation is necessary for 24 hours after antibiotics
are started
C.
Perform skin culture on the macular popular rash
D.
Expect abnormal general muscle contractions

7) Patrick, a healthy adolescent has meningitis and is receiving I.V. and oral
fluids. The nurse should monitor this clients fluid intake because fluid
overload may cause:
A.
B.
C.
D.

Cerebral edema
Dehydration
Heart failure
Hypovolemic shock
8) You are mentoring a student nurse in the intensive care unit (ICU) while
caring for a patient with meningococcal meningitis. Which action by the
student requires that you intervene immediately?

A.

The student enters the room without putting on a mask and

gown.
B.
The student instructs the family that visits are restricted to 10
minutes.
C.
The student gives the patient a warm blanket when he says he
feels cold.
D.
The student checks the patients pupil response to light every
30 minutes.
9) Which of these patients in the neurologic ICU will be best to assign to an
RN who has floated from the medical unit?
A.

A 26-year-old patient with a basilar skull structure who has

clear drainage coming out of the nose
B.
A 42-year-old patient admitted several hours ago with a
headache and diagnosed with a ruptured berry aneurysm.
C.
A 46-year-old patient who was admitted 48 hours ago with
bacterial meningitis and has an antibiotic dose due
D.
A 65-year-old patient with a astrocytoma who has just returned
to the unit after having a craniotomy
10) You have just admitted a patient with bacterial meningitis to the medicalsurgical unit. The patient complains of a severe headache with photophobia
and has a temperature of 102.60 F orally. Which collaborative intervention
must be accomplished first?
A.
B.
C.

Administer codeine 15 mg orally for the patients headache.

Infuse ceftriaxone (Rocephin) 2000 mg IV to treat the infection.
Give acetaminophen (Tylenol) 650 mg orally to reduce the
fever.

D.

Give furosemide (Lasix) 40 mg IV to decrease intracranial

pressure.
11) A 5-month-old infant is admitted to the ER with a temperature of 6F and
irritability. The mother states that the child has been listless for the past
several hours and that he had a seizure on the way to the hospital. A lumbar
puncture confirms a diagnosis of bacterial meningitis. The nurse should
assess the infant for:

A.
B.
C.
D.

Periorbital edema
Tenseness of the anterior fontanel
Positive Babinski reflex
Negative scarf sign
12) A client, age 22, is admitted with bacterial meningitis. Which hospital room
would be the best choice for this client?

A.
B.
C.

A private room down the hall from the nurses station

An isolation room three doors from the nurses station
A semiprivate room with a 32-year-old client who has viral
meningitis
D.
A two-bed room with a client who previously had bacterial
meningitis
13) The nurse is assessing a patient and notes a Brudzinskis sign and
Kernigs sign. These are two classic signs of which of the following disorders?
A.
B.
C.
D.

Cerebrovascular accident (CVA)

Meningitis
Seizure disorder
Parkinsons disease
14) The adolescent patient has symptoms of meningitis: nuchal rigidity, fever,
vomiting, and lethargy. The nurse knows to prepare for the following test:

A.
B.
C.
D.

blood culture.
throat and ear culture.
CAT scan.
lumbar puncture.
15) A patients chart indicates a history of meningitis. Which of the following
would you not expect to see with this patient if this condition were acute?

A.
B.

Increased appetite
Vomiting

C.
D.

Fever
Poor tolerance of light
16) Dexamethasone improves mortality in meningococcal meningitis

A.
B.

True
False
17) The client with suspected meningitis is admitted to the unit. The doctor is
performing an assessment to determine meningeal irritation and spinal nerve
root inflammation. A positive Kernigs sign is charted if the nurse notes:

A.
B.
C.
D.

Pain on flexion of the hip and knee

Nuchal rigidity on flexion of the neck
Pain when the head is turned to the left side
Dizziness when changing positions
18) A 4 year old girl is admitted with pneumococcal meningitis. She has just
returned from a holiday to Disneyland, Florida, 2 days before. What are you
going to treat her with:

A.
B.
C.
D.

ceftriaxone
amoxicillin and gentamicin
benzylpenicillin and rifampicin
cefotaxime and vancomycin
19) A client is admitted with a diagnosis of meningitis caused by Neisseria
meningitides. The nurse should institute which type of isolation precautions?

A.
B.
C.
D.

Contact precautions
Droplet precautions
Airborne precautions
Standard precautions
20) Among children aged 2 months to 3 years, the most prevalent form of
meningitis is caused by which microorganism?

A.
B.
C.
D.

Hemophilus influenzae
Morbillivirus
Steptococcus pneumoniae
Neisseria meningitidis

Answers and Rationales

1.
2.

D. Cl. difficile . Cl. difficile has not been linked to meningitis.

C. Inability of the child to extend the legs fully when
lying supine . Kernigs sign is the inability of the child to extend

3.
4.

5.

6.

7.

8.

the legs fully when lying supine. This sign is frequently present in
bacterial meningitis. Nuchal rigidity is also present in bacterial
meningitis and occurs when pain prevents the child from touching
the chin to the chest.
B. Thank goodness, Ill only be in isolation for 24
hours. Patient with pneumococcal meningitis require respiratory
isolation for the first 24 hours after treatment is initiated.
C. Place in respiratory isolation . The initial therapeutic
management of acute bacterial meningitis includes isolation
precautions, initiation of antimicrobial therapy and maintenance of
optimum hydration. Nurses should take necessary precautions to
protect themselves and others from possible infection.
A. Instituting droplet precautions. Instituting droplet
precautions is a priority for a newly admitted infant with
meningococcal meningitis. Acetaminophen may be prescribed but
administering it doesnt take priority over instituting droplet
precautions. Obtaining history information and orienting the parents
to the unit dont take priority.
B. Respiratory isolation is necessary for 24 hours after
antibiotics are started . After a minimum of 24 hours of IV
antibiotics, the client is no longer considered communicable.
Evaluation of the nurses knowledge is needed for safe care and
continuity of care.
A. Cerebral edema. Because of the inflammation of the
meninges, the client is vulnerable to developing cerebral edema and
increase intracranial pressure. Fluid overload wont cause
dehydration. It would be unusual for an adolescent to develop heart
failure unless the overhydration is extreme. Hypovolemic shock
would occur with an extreme loss of fluid of blood.
A. The student enters the room without putting on a
mask and gown. Meningococcal meningitis is spread through
contact with respiratory secretions so use of a mask and gown is
required to prevent spread of the infection to staff members or other
patients. The other actions may not be appropriate but they do not
require intervention as rapidly. The presence of a family member at
the bedside may decrease patient confusion and agitation. Patients
with hyperthermia frequently complain of feeling chilled, but
warming the patient is not an appropriate intervention. Checking the
pupil response to light is appropriate, but it is not needed every 30
minutes and is uncomfortable for a patient with photophobia. Focus:
Prioritization

9.

C. A 46-year-old patient who was admitted 48 hours ago

with bacterial meningitis and has an antibiotic dose due. This
patient is the most stable of the patients listed. An RN from the
medical unit would be familiar with administration of IV antibiotics.
The other patients require assessments and care from RNs more
experienced in caring for patients with neurologic diagnoses. Focus:
Assignment.
10.
B. Infuse ceftriaxone (Rocephin) 2000 mg IV to treat the
infection. Untreated bacterial meningitis has a mortality are
approaching 100%, so rapid antibiotic treatment is essential. The
other interventions will help reduce CNS stimulation and irritation,
and should be implemented as soon as possible. Focus: Prioritization
11.
B. Tenseness of the anterior fontanel .Tenseness of the
anterior fontanel indicates an increase in intracranial pressure.
Periorbital edema is incorrect because periorbital edema is not
associated with meningitis. Positive Babinski reflex is incorrect
because a positive Babinski reflex is normal in the infant. Negative
scarf sign is incorrect because it relates to the preterm infant, not
the infant with meningitis.
12.
B. An isolation room three doors from the nurses
station . A client with bacterial meningitis should be kept in
isolation for at least 24 hours after admission and, during the initial
acute phase, should be as close to the nurses station as possible to
allow maximal observation. Placing the client in a room with a client
who has viral meningitis may cause harm to both clients because
the organisms causing viral and bacterial meningitis differ; either
client may contract the others disease. Immunity to bacterial
meningitis cant be acquired; therefore, a client who previously had
bacterial meningitis shouldnt be put at risk by rooming with a client
who has just been diagnosed with this disease.
13.
B. Meningitis. A positive response to one or both tests
indicates meningeal irritation that is present with meningitis.
Brudzinskis and Kernigs signs dont occur in CVA, seizure disorder,
or Parkinsons disease.
14.
D. lumbar puncture. Meningitis is an infection of the
meninges, the outer membrane of the brain. Since it is surrounded
by cerebrospinal fluid, a lumbar puncture will help to identify the
organism involved.
15.
A. Increased appetite. Loss of appetite would be expected.
16.
B. False

17.
A. Pain on flexion of the hip and knee . Kernigs sign is
positive if pain occurs on flexion of the hip and knee. The Brudzinski
reflex is positive if pain occurs on flexion of the head and neck onto
the chest.
18.
D. cefotaxime and vancomycin. The USA has a high rate of
penicillin resistant pneumococi and first line treatment should
include vancomycin until sensitivities are known.
19.
B. Droplet precautions . This client requires droplet
precautions because the organism can be transmitted through
airborne droplets when the client coughs, sneezes, or doesnt cover
his mouth. Airborne precautions would be instituted for a client
infected with tuberculosis. Standard precautions would be instituted
for a client when contact with body substances is likely. Contact
precautions would be instituted for a client infected with an
organism that is transmitted through skin-to-skin contact.
20.
A. Hemophilus influenzae . Hemophilus meningitis is
unusual over the age of 5 years. In developing countries, the peak
incidence is in children less than 6 months of age. Morbillivirus is the
etiology of measles. Streptococcus pneumoniae and Neisseria
meningitidis may cause meningitis, but age distribution is not
specific in young children
1) The diagnostic work-up of a client hospitalized with complaints of
progressive weakness and fatigue confirms a diagnosis of myasthenia gravis.
The medication used to treat myasthenia gravis is:
A.
B.
C.
D.

A.

Prostigmine (neostigmine)
Atropine (atropine sulfate)
Didronel (etidronate)
Tensilon (edrophonium)
2) Karina a client with myasthenia gravis is to receive immunosuppressive
therapy. The nurse understands that this therapy is effective because it:

Promotes the removal of antibodies that impair the

transmission of impulses
B.
Stimulates the production of acetylcholine at the
neuromuscular junction.
C.
Decreases the production of autoantibodies that attack the
acetylcholine receptors.
D.
Inhibits the breakdown of acetylcholine at the neuromuscular
junction.

3) Myasthenia gravis is due to ____ receptors being blocked and destroyed by

antibodies.
A.
B.
C.
D.

Epinephrine
Nicotinic
Acetylcholine
Transient
4) A client with myasthenia gravis has been receiving Neostigmine
(Prostigmin). This drug acts by:

A.
B.
C.
D.

Stimulating the cerebral cortex

Blocking the action of cholinesterase
Replacing deficient neurotransmitters
Accelerating transmission along neural swaths
5) The most significant initial nursing observations that need to be made about
a client with myasthenia include:

A.
B.
C.
D.

Ability to chew and speak distinctly

Degree of anxiety about her diagnosis
Ability to smile an to close her eyelids
Respiratory exchange and ability to swallow
6) In making a diagnosis of myasthenia gravis Edrophonium HCI (Tensilon) is
used. The nurse knows that this drug will cause a temporary increase in:

A.
B.
C.
D.

Muscle strength
Symptoms
Blood pressure
Consciousness
7) Helen, a client with myasthenia gravis, begins to experience increased
difficulty in swallowing. To prevent aspiration of food, the nursing action that
would be most effective would be to:

A.
B.
C.
D.

Change her diet order from soft foods to clear liquids

Place an emergency tracheostomy set in her room
Assess her respiratory status before and after meals
Coordinate her meal schedule with the peak effect of her
medication, Mestinon
8) Myasthenia gravis reflects a deficiency in communication by
_______________ because receptors for this neurotransmitter have been
destroyed.

A.
B.
C.
D.

acetylcholine
norepinephrine
GABA
dopamine
9) While reviewing a clients chart, the nurse notices that the female client has
myasthenia gravis. Which of the following statements about neuromuscular
blocking agents is true for a client with this condition?

A.

The client may be less sensitive to the effects of a

neuromuscular blocking agent.
B.
Succinylcholine shouldnt be used; pancuronium may be used
in a lower dosage.
C.
Pancuronium shouldnt be used; succinylcholine may be used
in a lower dosage.
D.
Pancuronium and succinylcholine both require cautious
administration.
10) Which of the following is not an autoimmune disease?
A.
B.
C.
D.

Graves disease
Myasthenia gravis
Insulin-dependent diabetes mellitus
Alzheimers disease
11) A client with myasthenia gravis ask the nurse why the disease has
occurred. The nurse bases the reply on the knowledge that there is:

A.
B.
C.
D.

A genetic in the production acetylcholine

A reduced amount of neurotransmitter acetylcholine
A decreased number of functioning acetylcholine receptor sites
An inhibition of the enzyme ACHE leaving the end plates folded
12) The nurse is teaching the female client with myasthenia gravis about the
prevention of myasthenic and cholinergic crises. The nurse tells the client that
this is most effectively done by:

A.
B.
C.
D.

Eating large, well-balanced meals

Doing muscle-strengthening exercises
Doing all chores early in the day while less fatigued
Taking medications on time to maintain therapeutic blood
levels

13) The nurse is caring for a client admitted with suspected myasthenia
gravis. Which finding is usually associated with a diagnosis of myasthenia
gravis?
A.
B.
C.
D.

Visual disturbances, including diplopia

Ascending paralysis and loss of motor function
Cogwheel rigidity and loss of coordination
Progressive weakness that is worse at the days end
14) Helen is diagnosed with myasthenia gravis and pyridostigmine bromide
(Mestinon) therapy is started. The Mestinon dosage is frequently changed
during the first week. While the dosage is being adjusted, the nurses priority
intervention is to:

A.
B.
C.
D.

Administer the medication exactly on time

Administer the medication with food or mild
Evaluate the clients muscle strength hourly after medication
Evaluate the clients emotional side effects between doses
15) The initial nursing goal for a client with myasthenia gravis during the
diagnostic phase of her hospitalization would be to:

A.
B.
C.
D.

Develop a teaching plan

Facilitate psychologic adjustment
Maintain the present muscle strength
Prepare for the appearance of myasthenic crisis
16) A female client has experienced an episode of myasthenic crisis. The
nurse would assess whether the client has precipitating factors such as:

A.
B.
C.
D.

Getting too little exercise

Taking excess medication
Omitting doses of medication
Increasing intake of fatty foods
17) Jane, a 20- year old college student is admiited to the hospital with a
tentative diagnosis of myasthenia gravis. She is scheduled to have a series of
diagnostic studies for myasthenia gravis, including a Tensilon test. In
preparing her for this procedure, the nurse explains that her response to the
medication will confirm the diagnosis if Tensilon produces:

A.
B.
C.

Brief exaggeration of symptoms

Prolonged symptomatic improvement
Rapid but brief symptomatic improvement

D.

Symptomatic improvement of just the ptosis

18) Toy with a tentative diagnosis of myasthenia gravis is admitted for
diagnostic make up. Myasthenia gravis can confirmed by:

A.
B.
C.
D.

Kernigs sign
Brudzinskis sign
A positive sweat chloride test
A positive edrophonium (Tensilon) test
19) A physician diagnoses a client with myasthenia gravis, prescribing
pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. Before administering
this anticholinesterase agent, the nurse reviews the clients history. Which
preexisting condition would contraindicate the use of pyridostigmine?

A.
B.
C.
D.

Ulcerative colitis
Blood dyscrasia
Intestinal obstruction
Spinal cord injury
20) The nursing assistant reports to you, the RN, that the patient with
myasthenia gravis (MG) has an elevated temperature (102.20 F), heart rate of
120/minute, rise in blood pressure (158/94), and was incontinent off urine and
stool. What is your best first action at this time?

A.
B.
C.
D.

Administer an acetaminophen suppository.

Notify the physician immediately.
Recheck vital signs in 1 hour.
Reschedule patients physical therapy.

Answers and Rationales

1.

A. Prostigmine (neostigmine). Protigmine is used to treat

clients with myasthenia gravis. Atropine (atropine sulfate) is
incorrect because it is used to reverse the effects of neostigmine.
Didronel (etidronate)is incorrect because the drug is unrelated to the
treatment of myasthenia gravis. Tensilon (edrophonium) is incorrect
because it is the test for myasthenia gravis.
2.
C. Decreases the production of autoantibodies that
attack the acetylcholine receptors. Steroids decrease the bodys
immune response thus decreasing the production of antibodies that
attack the acetylcholine receptors at the neuromuscular junction
3.
C. Acetylcholine
4.
B. Blocking the action of cholinesterase

5.

D. Respiratory exchange and ability to swallow . Muscle

weakness can lead to respiratory failure that will require emergency
intervention and inability to swallow may lead to aspiration
6.
A. Muscle strength. Tensilon, an anticholinesterase drug,
causes temporary relief of symptoms of myasthenia gravis in client
who have the disease and is therefore an effective diagnostic aid.
7.
D. Coordinate her meal schedule with the peak effect of
her medication, Mestinon. Dysphagia should be minimized
during peak effect of Mestinon, thereby decreasing the probability of
aspiration. Mestinon can increase her muscle strength including her
ability to swallow.
8.
A. acetylcholine
9.
D. Pancuronium and succinylcholine both require
cautious administration. The nurse must cautiously administer
pancuronium, succinylcholine, and any other neuromuscular
blocking agent to a client with myasthenia gravis. Such a client isnt
less sensitive to the effects of a neuromuscular blocking agent.
Either succinylcholine or pancuronium can be administered in the
usual adult dosage to a client with myasthenia gravis.
10.
D. Alzheimers disease
11.
C. A decreased number of functioning acetylcholine
receptor sites
12.
D. Taking medications on time to maintain therapeutic
blood levels. Clients with myasthenia gravis are taught to space
out activities over the day to conserve energy and restore muscle
strength. Taking medications correctly to maintain blood levels that
are not too low or too high is important. Muscle-strengthening
exercises are not helpful and can fatigue the client. Overeating is a
cause of exacerbation of symptoms, as is exposure to heat, crowds,
erratic sleep habits, and emotional stress.
13.
D. Progressive weakness that is worse at the days
end . The client with myasthenia develops progressive weakness
that worsens during the day. Visual disturbances, including diplopia
is incorrect because it refers to symptoms of multiple sclerosis.
Ascending paralysis and loss of motor function is incorrect because
it refers to symptoms of Guillain Barre syndrome. Cogwheel rigidity
and loss of coordination is incorrect because it refers to Parkinsons
disease.
14.
C. Evaluate the clients muscle strength hourly after
medication. Peak response occurs 1 hour after administration and
lasts up to 8 hours; the response will influence dosage levels.

15.
C. Maintain the present muscle strength. Until diagnosis
is confirmed, primary goal should be to maintain adequate activity
and prevent muscle atrophy
16.
C. Omitting doses of medication. Myasthenic crisis often is
caused by undermedication and responds to the administration of
cholinergic medications, such as neostigmine (Prostigmin) and
pyridostigmine (Mestinon). Cholinergic crisis (the opposite problem)
is caused by excess medication and responds to withholding of
medications. Too little exercise and fatty food intake are incorrect.
Overexertion and overeating possibly could trigger myasthenic
crisis.
17.
C. Rapid but brief symptomatic improvement . Tensilon
acts systemically to increase muscle strength; with a peak effect in
30 seconds, It lasts several minutes.
18.
D. A positive edrophonium (Tensilon) test
19.
C. Intestinal obstruction . Anticholinesterase agents such as
pyridostigmine are contraindicated in a client with a mechanical
obstruction of the intestines or urinary tract, peritonitis, or
hypersensitivity to anticholinesterase agents. Ulcerative colitis,
blood dyscrasia, and spinal cord injury dont contraindicate use of
the drug.
20.
B. Notify the physician immediately.The changes that the
nursing assistant is reporting are characteristics of myasthenia
crisis, which often follows some type of infection. The patient is at
risk for inadequate respiratory function. In addition to notifying the
physician, the nurse should carefully monitor the patients
respiratory status. The patient may need incubation and mechanical
ventilation. The nurse would notify the physician before giving the
suppository because there may be orders for cultures before giving
acetaminophen. This patients vital signs need to be re-checked
sooner than 1 hour. Rescheduling the physical therapy can
be delegated to the unit clerk and is not urgent. Focus: Prioritization
1) Which of the following signs of increased intracranial pressure (ICP) would
appear first after head trauma?
A.
B.
C.
D.

Bradycardia.
Large amounts of very dilute urine.
Restlessness and confusion.
Widened pulse pressure.

2) The nurse is positioning the female client with increased intracranial

pressure. Which of the following positions would the nurse avoid?
A.
B.
C.
D.

Head mildline
Head turned to the side
Neck in neutral position
Head of bed elevated 30 to 45 degrees
3) Whether Mr Snyders tumor is benign or malignant, it will eventually cause
increased intracranial pressure. Signs and symptoms of increasing intracranial
pressure may include all of the following except:

A.
B.
C.
D.

Headache, nausea, and vomiting

Papilledema, dizziness, mental status changes
Obvious motor deficits
increased pulse rate, drop in blood pressure
4) For a male client with suspected increased intracranial pressure (ICP), a
most appropriate respiratory goal is to:

A.
B.
C.
D.

Prevent respiratory alkalosis.

Lower arterial pH.
Promote carbon dioxide elimination.
Maintain partial pressure of arterial oxygen (PaO2) above 80
mm Hg
5) The nurse is teaching family members of a patient with a concussion about
the early signs of increased intracranial pressure (ICP). Which of the following
would she cite as an early sign of increased ICP?

A.
B.
C.
D.

Decreased systolic blood pressure

Headache and vomiting
Inability to wake the patient with noxious stimuli
Dilated pupils that dont react to light
6) Later signs of increased intracranial pressure (ICP) later include which of
the following?

A.
B.
C.
D.

Projectile vomiting
Increased pulse rate
Decreased blood pressure
Narrowed pulse pressure

7) A client with a head injury is being monitored for increased intracranial

pressure (ICP). His blood pressure is 90/60 mmHG and the ICP is 18 mmHg;
therefore his cerebral perfusion pressure (CPP) is:
A.
B.
C.
D.

52 mm Hg
88 mm Hg
48 mm Hg
68 mm Hg
8) Which of the following types of drugs might be given to control increased
intracranial pressure (ICP)?

A.
B.
C.
D.

Barbiturates
Carbonic anhydrase inhibitors
Anticholinergics
Histamine receptor blockers
9) A female client admitted to an acute care facility after a car accident
develops signs and symptoms of increased intracranial pressure (ICP). The
client is intubated and placed on mechanical ventilation to help reduce ICP. To
prevent a further rise in ICP caused by suctioning, the nurse anticipates
administering which drug endotracheally before suctioning?

A.
B.
C.
D.

Phenytoin (Dilantin)
Mannitol (Osmitrol)
Lidocaine (Xylocaine)
Furosemide (Lasix)
10) A nurse in the emergency department is observing a 4-year-old child for
signs of increased intracranial pressure after a fall from a bicycle, resulting in
head trauma. Which of the following signs or symptoms would be cause for
concern?

A.
B.
C.
D.

Bulging anterior fontanel.

Repeated vomiting.
Signs of sleepiness at 10 PM.
Inability to read short words from a distance of 18 inches.
11) A female client admitted to an acute care facility after a car accident
develops signs and symptoms of increased intracranial pressure (ICP). The
client is intubated and placed on mechanical ventilation to help reduce ICP. To
prevent a further rise in ICP caused by suctioning, the nurse anticipates
administering which drug endotracheally before suctioning?

A.
B.
C.
D.

Phenytoin (Dilantin)
Mannitol (Osmitrol)
Lidocaine (Xylocaine)
Furosemide (Lasix)
12) A male client is brought to the emergency department due to motor vehicle
accident. While monitoring the client, the nurse suspects increasing
intracranial pressure when:

A.

Client is oriented when aroused from sleep, and goes back to

sleep immediately.
B.
Blood pressure is decreased from 160/90 to 110/70.
C.
Client refuses dinner because of anorexia.
D.
Pulse is increased from 88-96 with occasional skipped beat.
13) Kate with severe head injury is being monitored by the nurse for
increasing intracranial pressure (ICP). Which finding should be most indicative
sign of increasing intracranial pressure?
A.
B.
C.
D.

Intermittent tachycardia
Polydipsia
Tachypnea
Increased restlessness

Answers and Rationales

1.

C. Restlessness and confusion. The earliest sign of

increased ICP is a change in mental status. Bradycardia and widened
pulse pressure occur later. The patient may void a lot of very dilute
urine if his posterior pituitary is damaged.
2.
B. Head turned to the side. The head of the client with
increased intracranial pressure should be positioned so the head is
in a neutral midline position. The nurse should avoid flexing or
extending the clients neck or turning the head side to side. The
head of the bed should be raised to 30 to 45 degrees. Use of proper
positions promotes venous drainage from the cranium to keep
intracranial pressure down.
3.
D. increased pulse rate, drop in blood pressure . As ICP
increases, the pulse rate decreases and the BP rise. However, as ICP
continues to rise, vital signs may vary considerably.
4.
C. Promote carbon dioxide elimination. The goal of
treatment is to prevent acidemia by eliminating carbon dioxide. That
is because an acid environment in the brain causes cerebral vessels
to dilate and therefore increases ICP. Preventing respiratory alkalosis

and lowering arterial pH may bring about acidosis, an undesirable

condition in this case. It isnt necessary to maintain a PaO2 as high
as 80 mm Hg; 60 mm Hg will adequately oxygenate most clients.
5.
B. Headache and vomiting . Headache and projectile
vomiting are early signs of increased ICP. Decreased systolic blood
pressure, unconsciousness, and dilated pupils that dont reac to light
are considered late signs.
6.
A. Projectile vomiting . Projectile vomiting may occur with
increased pressure on the reflex center in the medulla.
7.
A. 52 mm Hg . CPP is derived by subtracting the ICP from the
mean arterial pressure (MAP). For adequate cerebral perfusion to
take place, the minimum goal is 70 mmHg. The MAP is derived using
the following formula:

MAP = ((diastolic blood pressure x 2) + systolic blood

pressure) / 3

MAP = ((60 x2) + 90) / 3

MAP = 70 mmHg

To find the CPP, subtract the clients ICP from the MAP; in
this case , 70 mmHg 18 mmHg = 52 mmHg.
8.
A. Barbiturates . Barbiturates may be used to induce a coma
in a patient with increased ICP. This decreases cortical activity and
cerebral metabolism, reduces cerebral blood volume, decreases
cerebral edema, and reduces the brains need for glucose and
oxygen. Carbonic anhydrase inhibitors are used to decrease ocular
pressure or to decrease the serum pH in a patient with metabolic
alkalosis. Anticholinergics have many uses including reducing GI
spasms. Histamine receptor blockers are used to decrease stomach
acidity.
9.
C. Lidocaine (Xylocaine) . Administering lidocaine via an
endotracheal tube may minimize elevations in ICP caused by
suctioning. Although mannitol and furosemide may be given to
reduce ICP, theyre administered parenterally, not endotracheally.
Phenytoin doesnt reduce ICP directly but may be used to abolish
seizures, which can increase ICP. However, phenytoin isnt
administered endotracheally.
10.
B. Repeated vomiting. Increased pressure caused by
bleeding or swelling within the skull can damage delicate brain
tissue and may become life threatening. Repeated vomiting can be
an early sign of pressure as the vomit center within the medulla is
stimulated. The anterior fontanel is closed in a 4-year-old child.

Evidence of sleepiness at 10 PM is normal for a four year old. The

average 4-year-old child cannot read yet, so this too is normal.
11.
C. Lidocaine (Xylocaine) . Administering lidocaine via an
endotracheal tube may minimize elevations in ICP caused by
suctioning. Although mannitol and furosemide may be given to
reduce ICP, theyre administered parenterally, not endotracheally.
Phenytoin doesnt reduce ICP directly but may be used to abolish
seizures, which can increase ICP. However, phenytoin isnt
administered endotracheally.
12.
A. Client is oriented when aroused from sleep, and goes
back to sleep immediately.This suggests that the level of
consciousness is decreasing.
13.
D. Increased restlessness . Restlessness indicates a lack of
oxygen to the brain stem which impairs the reticular activating
system.
1) Which patient should be assigned to the traveling nurse, new to neurologic
nursing care, who has been on the neurologic unit for 1 week?
A.
B.
C.

A 34-year-old patient newly diagnosed with multiple sclerosis

(MS)

A 68-year-old patient with chronic amyotrophic lateral sclerosis

(ALS)

A 56-year-old patient with Guillain-Barre syndrome (GBS) in

respiratory distress
D.
A 25-year-old patient admitted with CA level spinal cord injury
(SCI)
2) A female client with Guillain-Barr 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.

You may have difficulty believing this, but the paralysis

caused by this disease is temporary.
B.
Youll have to accept the fact that youre permanently
paralyzed. However, you wont have any sensory loss.
C.
It must be hard to accept the permanency of your paralysis.
D.
Youll first regain use of your legs and then your arms.
3) A client with Guillain-Barr syndrome has been on a ventilator for three
weeks, and can communicate only with eye blinks because of quadriplegia.
The intensive care nursing staff sometimes have no time for this tedious

communication process. The clients family comes infrequently since they run
a family-owned restaurant that does not close until visiting hours are over.
How should the nurse respond to the familys request for exemption from
visiting hours?
A.

Arrange for a volunteer to stay with the client during the day to
provide for socialization needs and to facilitate communication with
staff.
B.
Explain to the family that consistency in enforcing rules is
important to prevent complaints from the families of other clients.
C.
Suggest that the family visit in shifts during the normal visiting
hours, since the client needs to sleep at night.
D.
Make an exception to visiting regulations because of the longterm nature of the clients recovery and the need for family support.
4) A male client is hospitalized with Guillain-Barre Syndrome. Which
assessment finding is the most significant?
A.
B.
C.
D.

Even, unlabored respirations

Soft, non distended abdomen
Urine output of 50 ml/hr
Warm skin
5) Female client is admitted to the hospital with a diagnosis of Guillain-Barre
syndrome. The nurse inquires during the nursing admission interview if the
client has history of:

A.
B.
C.
D.

Seizures or trauma to the brain

Meningitis during the last 5 years
Back injury or trauma to the spinal cord
Respiratory or gastrointestinal infection during the previous
month.
6) A female client with Guillian-Barre syndrome has ascending paralysis and is
intubated and receiving mechanical ventilation. Which of the following
strategies would the nurse incorporate in the plan of care to help the client
cope with this illness?

A.

Giving client full control over care decisions and restricting

visitors
B.
Providing positive feedback and encouraging active range of
motion

C.

Providing information, giving positive feedback, and

encouraging relaxation
D.
Providing intravaneously administered sedatives, reducing
distractions and limiting visitors
7) A 40n year old male patient is complaining of chronic progressive and
mental deterioration is admitted to the unit. The nurse recognizes that these
characteristics indicate a disease that results in degeneration of the basal
ganglia and cerebral cortex. The disease is called:
A.
B.
C.
D.

A.
B.
C.
D.

multiple sclerosis
myasthenia gravis
Huntingtons disease
Guillain-Barre syndrome
8) A male client with Guillain-Barr syndrome develops respiratory acidosis as
a result of reduced alveolar ventilation. Which combination of arterial blood
gas (ABG) values confirms respiratory acidosis?
pH,
pH,
pH,
pH,

5.0; PaCO2 30 mm Hg
7.40; PaCO2 35 mm Hg
7.35; PaCO2 40 mm Hg
7.25; PaCO2 50 mm Hg

Answers and Rationales

1.

B. A 68-year-old patient with chronic amyotrophic

lateral sclerosis (ALS) . The traveling is relatively new to
neurologic nursing and should be assigned patients whose
conditions are stable and not complex. The newly diagnosed patient
will need to be transferred to the ICU. The patient with C4 SCI is at
risk for respiratory arrest. All three of these patients should be
assigned to nurses experienced in neurologic nursing care. Focus:
Assignment
2.
A. You may have difficulty believing this, but the
paralysis caused by this disease is temporary. The nurse
should inform the client that the paralysis that accompanies GuillainBarr syndrome is only temporary. Return of motor function begins
proximally and extends distally in the legs.
3.
D. Make an exception to visiting regulations because of
the long-term nature of the clients recovery and the need
for family support.The need for family support is vital to prevent
discouragement and depression. A volunteer will not take the place
of family. The need for family support is vital to prevent

4.
5.

6.

7.

8.

discouragement and depression, even at the risk of offending the

families of other patients. Loss of a breadwinner during the lengthy
recovery process may add financial problems for the family. GuillainBarr syndrome is characterized by the onset of ascending
paralysis, which may include respiratory muscles. Persons with
Guillain-Barr syndrome may remain ventilator-dependent for
weeks, but have full consciousness. The prognosis for recovery from
Guillain-Barr syndrome is good, but is very much dependent upon
the level of supportive care during the acute stage.
A. Even, unlabored respirations
D. Respiratory or gastrointestinal infection during the
previous month. Guillain-Barr syndrome is a clinical syndrome of
unknown origin that involves cranial and peripheral nerves. Many
clients report a history of respiratory or gastrointestinal infection in
the 1 to 4 weeks before the onset of neurological deficits.
Occasionally, the syndrome can be triggered by vaccination or
surgery.
C. Providing information, giving positive feedback, and
encouraging relaxation. The client with Guillain-Barr syndrome
experiences fear and anxiety from the ascending paralysis and
sudden onset of the disorder. The nurse can alleviate these fears by
providing accurate information about the clients condition, giving
expert care and positive feedback to the client, and encouraging
relaxation and distraction. The family can become involved with
selected care activities and provide diversion for the client as well.
C. Huntingtons disease. Huntingtons disease is a
hereditary disease in which degeneration of the basal ganglia and
cerebral cortex causes chronic progressive chorea (muscle
twitching) and mental deterioration, ending in dementia.
Huntingtons disease usually strikes people ages 25 to 55.
D. pH, 7.25; PaCO2 50 mm Hg. In respiratory acidosis, ABG
analysis reveals an arterial pH below 7.35 and partial pressure of
arterial carbon dioxide (PaCO2) above 45 mm Hg. Therefore, the
combination of a pH value of 7.25 and a PaCO2 value of 50 mm Hg
confirms respiratory acidosis. A pH value of 5.0 with a PaCO2 value
of 30 mm Hg indicates respiratory alkalosis.
1) Oral steroids may help reduce the symptoms of a Bells Palsy.

A.

True

B.

False
2) A male client with Bells palsy asks the nurse what has caused this problem.
The nurses response is based on an understanding that the cause is:

A.

Unknown, but possibly includes ischemia, viral infection, or an

autoimmune problem
B.
Unknown, but possibly includes long-term tissue malnutrition
and cellular hypoxia
C.
Primary genetic in origin, triggered by exposure to meningitis
D.
Primarily genetic in origin, triggered by exposure to
neurotoxins
3) Bells palsy is a form of facial paralysis caused by a dysfunction of the 8th
cranial nerve.
A.
B.

True
False
4) Failure of the eye to close properly can occur, which may result in damage
to the cornea.

A.
B.

True
False
5) When the nurse performs a neurologic assessment on Anne Jones, her
pupils are dilated and dont respond to light.

A.
B.
C.
D.

glaucoma
damage to the third cranial nerve
damage to the lumbar spine
Bells palsy
6) The nurse is aware that Bells palsy affects which cranial nerve?

A.
B.
C.
D.

2nd CN (Optic)
3rd CN (Occulomotor)
4th CN (Trochlear)
7th CN (Facial)
7) Which of the following diseases has not been directly linked with Bells
palsy?

A.
B.
C.
D.

AIDS
Diabetes
Lyme disease
Alzheimers disease

8) Bells palsy can be associated with arm and leg weakness and difficulty
finding the right words.
A.
B.

True
False
9) The nurse has given the male client with Bells palsy instructions on
preserving muscle tone in the face and preventing denervation. The nurse
determines that the client needs additional information if the client states that
he or she will:

A.
B.
C.
D.

Exposure to cold and drafts

Massage the face with a gentle upward motion
Perform facial exercises
Wrinkle the forehead, blow out the cheeks, and whistle
10) Bells palsy is a disorder of which cranial nerve?

A.
B.
C.
D.

Facial (VII)
Trigeminal (V)
Vestibulocochlear (VIII)
Vagus (X)

Answers and Rationales

1.
2.

3.
4.
5.

6.

A. True . Oral steroids can improve outcome but need to be

given early after the onset of symptoms.
A. Unknown, but possibly includes ischemia, viral
infection, or an autoimmune problem . Bells palsy is a onesided facial paralysis from compression of the facial nerve. The
exact cause is unknown, but may include vascular ischemia,
infection, exposure to viruses such as herpes zoster or herpes
simplex, autoimmune disease, or a combination of these factors.
B. False. Bells palsy results from a dysfunction of the 7th or
facial cranial nerve.
A. True . To try and avoid corneal damage the lid can be taped
shut at night and eye drops used to lubricate the eye.
B. damage to the third cranial nerve . The third cranial
nerve (oculomotor) is responsible for pupil constriction. When there
is damage to the nerve, the pupils remain dilated and dont respond
to light. Glaucoma, lumbar spine injury, and Bells palsy wont affect
pupil constriction.
D. 7th CN (Facial) . Bells palsy is the paralysis of the motor
component of the 7th caranial nerve, resulting in facial sag, inability

to close the eyelid or the mouth, drooling, flat nasolabial fold and
loss of taste on the affected side of the face.
7.
D. Alzheimers disease
8.
B. False . These signs indicate a stroke and if present the
patient needs urgent medical attention.
9.
A. Exposure to cold and drafts . Prevention of muscle
atrophy with Bells palsy is accomplished with facial massage, facial
exercises, and electrical stimulation of the nerves. Exposure to cold
or drafts is avoided. Local application of heat to the face may
improve blood flow and provide comfort.
10.
A. Facial (VII) . Bells palsy is characterized by facial
dysfunction, weakness, and paralysis. Trigeminal neuralgia is a
disorder of the trigeminal nerve and causes facial pain.Menieres
syndrome is a disorder of the vestibulocochlear nerve. Guillain-Barre
syndrome is a disorder of the vagus nerve.
1) The client with Alzheimers disease is being assisted with activities of daily
living when the nurse notes that the client uses her toothbrush to brush her
hair. The nurse is aware that the client is exhibiting:
A.
B.
C.
D.

Agnosia
Apraxia
Anomia
Aphasia
2) A client with Alzheimers disease is awaiting placement in a skilled nursing
facility. Which long-term plans would be most therapeutic for the client?

A.
B.
C.

Placing mirrors in several locations in the home

Placing a picture of herself in her bedroom
Placing simple signs to indicate the location of the bedroom,
bathroom, and so on
D.
Alternating healthcare workers to prevent boredom
3) The client with dementia is experiencing confusion late in the afternoon and
before bedtime. The nurse is aware that the client is experiencing what is
known as:
A.
B.
C.
D.

Chronic fatigue syndrome

Normal aging
Sundowning
Delusions

4) Which age group has the highest rate of Alzheimers cases reported?
A.
B.
C.
D.

85 and older
74 to 84
65 to 74
55 to 65
5) A 75 year old client is admitted to the hospital with the diagnosis of
dementia of the Alzheimers type and depression. The symptom that is
unrelated to depression would be?

A.
B.
C.
D.

Apathetic response to the environment

I dont know answer to questions
Shallow of labile effect
Neglect of personal hygiene
6) The client with confusion says to the nurse, I havent had anything to eat
all day long. When are they going to bring breakfast? The nurse saw the
client in the day room eating breakfast with other clients 30 minutes before
this conversation. Which response would be best for the nurse to make?

A.
B.

You know you had breakfast 30 minutes ago.

I am so sorry that they didnt get you breakfast. Ill report it to
the charge nurse.
C.
Ill get you some juice and toast. Would you like something
else?
D.
You will have to wait a while; lunch will be here in a little
while.
7) The nurse is caring for a client with stage III Alzheimers disease. A
characteristic of this stage is:
A.
B.
C.
D.

A.
B.
C.
D.

Memory loss
Failing to recognize familiar objects
Wandering at night
Failing to communicate
8) The primary nursing intervention in working with a client with moderate
stage dementia is ensuring that the client:
receives adequate nutrition and hydration
will reminisce to decrease isolation
remains in a safe and secure environment
independently performs self care

9) During the evaluation of the quality of home care for a client with
Alzheimers disease, the priority for the nurse is to reinforce which statement
by a family member?
A.
B.

At least 2 full meals a day is eaten.

We go to a group discussion every week at our community
center.
C.
We have safety bars installed in the bathroom and have 24
hour alarms on the doors.
D.
The medication is not a problem to have it taken 3 times a day.
10) Signs of Alzheimers include which of these symptoms?
A.
B.
C.
D.

Loss of memory
Increase in irritability
Restlessness
All of the above
11) Which neurotransmitter has been implicated in the development of
Alzheimers disease?

A.
B.
C.
D.

Acetylcholine
Dopamine
Epinephrine
Serotonin
12) Alzheimers is an INSIDIOUS disease. This means:

A.
B.
C.
D.
E.

that it is terminal
that is can be cured
that it sneaks up on a person over time
that it only affects the elderly
none of the above
13) Edward, a 66 year old client with slight memory impairment and poor
concentration is diagnosed with primary degenerative dementia of the
Alzheimers type. Early signs of this dementia include subtle personality
changes and withdrawal from social interactions. To assess for progression to
the middle stage of Alzheimers disease, the nurse should observe the client
for:

A.
B.
C.

Occasional irritable outbursts.

Impaired communication.
Lack of spontaneity.

D.

Inability to perform self-care activities.

14) Which of the following is not directly related with Alzheimers disease?

A.
B.
C.
D.

Senile plaques
Diabetes mellitus
Tangles
Dementia
15) Alzheimers is the most common form of which of these?

A.
B.
C.
D.

Malnutrition
Dementia
Fatigue
Psychosis
16) Which nursing intervention is most appropriate for a client with Alzheimers
disease who has frequent episodes emotional lability?

A.
B.
C.
D.

Attempt humor to alter the client mood.

Explore reasons for the clients altered mood.
Reduce environmental stimuli to redirect the clients attention.
Use logic to point out reality aspects.
17) Which of the following is the most common cause of dementia among
elderly persons?

A.
B.
C.
D.

Parkinsons disease
Multiple sclerosis
Amyotrophic lateral sclerosis (Lou Gerhigs disease)
Alzheimers disease
18) Rosana is in the second stage of Alzheimers disease who appears to be
in pain. Which question by Nurse Jenny would best elicit information about the
pain?

A.
B.
C.
D.

Where is your pain located?

Do you hurt? (pause) Do you hurt?
Can you describe your pain?
Where do you hurt?
19) Rosana is in the second stage of Alzheimers disease who appears to be
in pain. Which question by Nurse Jenny would best elicit information about the
pain?

A.
B.

Where is your pain located?

Do you hurt? (pause) Do you hurt?

C.
D.

Can you describe your pain?

Where do you hurt?
20) How is Alzheimers diagnosed?

A.
B.
C.
D.

Mental-status tests
Blood tests
Neurological tests
All of the above
21) The usual span of years that Alzheimers may progress in the patient is:

A.
B.
C.
D.
E.

three to five years

two to twenty years
fifty to sixty years
6 months to one year
eight to ten years
22) Scientists believe that _________________ develop in the brain of an
Alzheimers patient, and may be a cause of the disease.

A.
B.
C.
D.

cholesterols
tumors
ruptured blood vessels
plaques and tangles
23) To encourage adequate nutritional intake for a female client with
Alzheimers disease, the nurse should:

A.
B.
C.
D.

stay with the client and encourage him to eat.

help the client fill out his menu.
give the client privacy during meals.
fill out the menu for the client.
24) A 93 year-old female with a history of Alzheimers Disease gets admitted
to an Alzheimers unit. The patient has exhibited signs of increased confusion
and limited stability with gait. Moreover, the patient is refusing to use a w/c.
Which of the following is the most appropriate course of action for the nurse?

A.
B.

Recommend
Recommend
room.
C.
Recommend
D.
Recommend
safety.

the patient remain in her room at all times.

family members bring pictures to the patients
a speech therapy consult to the doctor.
the patient attempt to walk pushing the w/c for

25) The doctor has prescribed Exelon (rivastigmine) for the client with
Alzheimers disease. Which side effect is most often associated with this
drug?
A.
B.
C.
D.

Urinary incontinence
Headaches
Confusion
Nausea
26) A patient with Stage One Alzheimers might exhibit these behaviors:

A.
B.
C.
D.
E.

forgetting names
missing appointments
getting lost while driving
all of the above
none of the above
27) Which of the following diseases has not been directly linked with Bells
palsy?

A.
B.
C.
D.

AIDS
Diabetes
Lyme disease
Alzheimers disease
28) The symptom of dementia that involved a more confused state after dark
is called:

A.
B.
C.
D.

dark retreat
sundowning
agitation
dark reaction
29) Which of these is the strongest risk factor for developing the Alzheimers
disease?

A.
B.
C.
D.

Heredity
Age
Exposure to toxins
None of the above
30) The priority of care for a client with Alzheimers disease is

A.
B.
C.

Help client develop coping mechanism

Encourage to learn new hobbies and interest
Provide him stimulating environment

D.

Simplify the environment to eliminate the need to make chores

31) An elderly client with Alzheimers disease becomes agitated and
combative when a nurse approaches to help with morning care. The most
appropriate nursing intervention in this situation would be to:

A.
B.
C.
D.

Tell the client family that it is time to get dressed.

Obtain assistance to restrain the client for safety.
Remain calm and talk quietly to the client.
Call the doctor and request an order for sedation.
32) Thomas Elison is a 79 year old man who is admitted with diagnosis of
dementia. The doctor orders a series of laboratory tests to determine whether
Mr. Elisons dementia is treatable. The nurse understands that the most
common cause of dementia in this population is:

A.
B.
C.
D.

AIDS
Alzheimers disease
Brain tumors
Vascular disease
33) A patient who has been admitted to the medical unit with new-onset
angina also has a diagnosis of Alzheimers disease. Her husband tells you
that he rarely gets a good nights sleep because he needs to be sure she
does not wander during the night. He insists on checking each of the
medications you give her to be sure they are the same as the ones she takes
at home. Based on this information, which nursing diagnosis is most
appropriate for this patient?

A.

Decreased Cardiac Output related to poor myocardial

contractility
B.
Caregiver Role Strain related to continuous need for providing
care
C.
Ineffective Therapeutic Regimen Management related to poor
patient memory
D.
Risk for Falls related to patient wandering behavior during the
night
34) Physiologically, what happens to the brain as Alzheimers progresses?
A.
B.
C.
D.

Tissue swells
Fluid collects
Many cells die
Brain-stem atrophies

35) The nurse is aware that the following ways in vascular dementia different
from Alzheimers disease is:
A.
B.
C.
D.

Vascular dementia has more abrupt onset

The duration of vascular dementia is usually brief
Personality change is common in vascular dementia
The inability to perform motor activities occurs in vascular
dementia
36) A 65 years old client is in the first stage of Alzheimers disease. Nurse
Patricia should plan to focus this clients care on:

A.

Offering nourishing finger foods to help maintain the clients

nutritional status.
B.
Providing emotional support and individual counseling.
C.
Monitoring the client to prevent minor illnesses from turning
into major problems.
D.
Suggesting new activities for the client and family to do
together.
37) A nurse caring to a client with Alzheimers disease overheard a family
member say to the client, if you pee one more time, I wont give you any
more food and drinks. What initial action is best for the nurse to take?
A.

Take no action because it is the family member saying that to

the client
B.
Talk to the family member and explain that what she/he has
said is not appropriate for the client
C.
Give the family member the number for an Elder Abuse Hot
line
D.
Document what the family member has said
38) Alzheimers disease is the secondary diagnosis of a client admitted with
myocardial infarction. Which nursing intervention should appear on this clients
plan of care?
A.

Perform activities of daily living for the client to decease

frustration.
B.
Provide a stimulating environment.
C.
Establish and maintain a routine.
D.
Try to reason with the client as much as possible.
39) As the manager in a long-term-care (LTC) facility, you are in charge of
developing a standard plan of care for residents with Alzheimers disease.

Which of these nursing tasks is best to delegate to the LPN team leaders
working in the facility?
A.

Check for improvement in resident memory after medication

therapy is initiated.
B.
Use the Mini-Mental State Examination to assess residents
every 6 months.
C.
Assist residents to toilet every 2 hours to decrease risk for
urinary intolerance.
D.
Develop individualized activity plans after consulting with
residents and family.
40) The nurse would expect a client with early Alzheimers disease to have
problems with:
A.
B.
C.
D.

Balancing a checkbook.
Self-care measures.
Relating to family members.
Remembering his own name

Answers and Rationales

1.

2.

3.
4.
5.
6.

B. Apraxia . Apraxia is the inability to use objects

appropriately. Agnosia is loss of sensory comprehension, anomia is
the inability to find words, and aphasia is the inability to speak or
understand .
C. Placing simple signs to indicate the location of the
bedroom, bathroom, and so on. Placing simple signs that
indicate the location of rooms where the client sleeps, eats, and
bathes will help the client be more independent. Providing mirrors
and pictures is not recommended with the client who has
Alzheimers disease because mirrors and pictures tend to cause
agitation, and alternating healthcare workers confuses the client.
C. Sundowning . Increased confusion at night is known as
sundowning syndrome. This increased confusion occurs when the
sun begins to set and continues during the night.
A. 85 and older
C. Shallow of labile effect
C. Ill get you some juice and toast. Would you like
something else?. The client who is confused might forget that he
ate earlier. Dont argue with the client. Simply get him something to
eat that will satisfy him until lunch.

7.

B. Failing to recognize familiar objects . In stage III of

Alzheimers disease, the client develops agnosia, or failure to
recognize familiar objects.
8.
C. remains in a safe and secure environment. Safety is a
priority consideration as the clients cognitive ability deteriorates..
receiving adequate nutrition and hydration is appropriate
interventions because the clients cognitive impairment can affect
the clients ability to attend to his nutritional needs, but it is not the
priority Patient is allowed to reminisce but it is not the priority. The
client in the moderate stage of Alzheimers disease will have
difficulty in performing activities independently
9.
C. We have safety bars installed in the bathroom and
have 24 hour alarms on the doors. We have safety bars installed
in the bathroom and have 24 hour alarms on the doors. Ensuring
safety of the client with increasing memory loss is a priority of home
care. Note all options are correct statements. However, safety is
most important to reinforce.
10.
D. All of the above. Alzheimers sufferers also cant learn
new information and tend to repeat themselves.
11.
A. Acetylcholine. A relative deficiency of acetylcholine is
associated with this disorder. The drugs used in the early stages of
Alzheimers disease will act to increase available acetylcholine in the
brain. The remaining neurotransmitters have not been implicated in
Alzheimers disease.
12.
C. that it sneaks up on a person over time
13.
B. Impaired communication. Initially, memory impairment
may be the only cognitive deficit in a client with Alzheimers
disease. During the early stage of this disease, subtle personality
changes may also be present. However, other than occasional
irritable outbursts and lack of spontaneity, the client is usually
cooperative and exhibits socially appropriate behavior. Signs of
advancement to the middle stage of Alzheimers disease include
exacerbated cognitive impairment with obvious personality changes
and impaired communication, such as inappropriate conversation,
actions, and responses. During the late stage, the client cant
perform self-care activities and may become mute.
14.
B. Diabetes mellitus
15.
B. Dementia. It is a collection of symptoms characterized by
decreasing intellectual and social abilities.
16.
C. Reduce environmental stimuli to redirect the clients
attention. The client with Alzheimers disease can have frequent

episode of labile mood, which can best be handled by decreasing a

stimulating environment and redirecting the clients attention. An
over stimulating environment may cause the labile mood, which will
be difficult for the client to understand. The client with Alzheimers
disease loses the cognitive ability to respond to either humor or
logic. The client lacks any insight into his or her own behavior and
therefore will be unaware of any causative factors.
17.
D. Alzheimers disease . Alzheimer;s disease, sometimes
known as senile dementia of the Alzheimers type or primary
degenerative dementia, is an insidious; progressive, irreversible, and
degenerative disease of the brain whose etiology is still unknown.
Parkinsons disease is a neurologic disorder caused by lesions in the
extrapyramidial system and manifested by tremors, muscle rigidity,
hypokinesis, dysphagia, and dysphonia. Multiple sclerosis, a
progressive, degenerative disease involving demyelination of the
nerve fibers, usually begins in young adulthood and is marked by
periods of remission and exacerbation. Amyotrophic lateral sclerosis,
a disease marked by progressive degeneration of the neurons,
eventually results in atrophy of all the muscles; including those
necessary for respiration.
18.
B. Do you hurt? (pause) Do you hurt? . When speaking
to a client with Alzheimers disease, the nurse should use closeended questions.Those that the client can answer with yes or no
19.
B. Do you hurt? (pause) Do you hurt? When speaking
to a client with Alzheimers disease, the nurse should use closeended questions.Those that the client can answer with yes or no
whenever possible and avoid questions that require the client to
make choices. Repeating the question aids comprehension.
20.
D. D. All of the above. No single test identifies Alzheimers.
Lab tests help rule out other disorders that may produce similar
symptoms. Neurological and mental-status tests reveal cognitivefunction deficits.
21.
B. two to twenty years
22.
D. plaques and tangles
23.
A. stay with the client and encourage him to eat. Staying
with the client and encouraging him to feed himself will ensure
adequate food intake. A client with Alzheimers disease can forget
how to eat. Allowing privacy during meals, filling out the menu, or
helping the client to complete the menu doesnt ensure adequate
nutritional intake.

24.
B. Recommend family members bring pictures to the
patients room. Stimulation in the form of pictures may decrease
signs of confusion.
25.
D. Nausea . Nausea and gastrointestinal upset are very
common in clients taking acetlcholinesterase inhibitors such as
Exelon. Other side effects include liver toxicity, dizziness,
unsteadiness, and clumsiness. The client might already be
experiencing urinary incontinence or headaches, but they are not
necessarily associated; and the client with Alzheimers disease is
already confused.
26.
D. all of the above
27.
D. Alzheimers disease
28.
B. sundowning
29.
B. Age . Although some studies have shown an association
between certain modifiable lifestyle factors and a reduced risk for
Alzheimers disease, the National Institutes of Health says that age
is the strongest known risk factor where most people receive the
diagnosis after age 60. An early onset familial form can also occur,
although it is rare.
30.
D. Simplify the environment to eliminate the need to
make chores
31.
C. Remain calm and talk quietly to the client. Maintaining
a calm approach when intervening with an agitated client is
extremely important. Telling the client firmly that it is time to get
dressed may increase his agitation, especially if the nurse touches
him. Restraints are a last resort to ensure client safety and are
inappropriate in this situation. Sedation should be avoided, if
possible, because it will interfere with CNS functioning and may
contribute to the clients confusion.
32.
B. Alzheimers disease . Alzheimers disease is the most
common cause of dementia in the elderly population. AIDS, brain
tumors and vascular disease are all less common causes of
progressive loss of mental function in elderly patients.
33.
B. Caregiver Role Strain related to continuous need for
providing care. The husbands statement about lack of sleep and
anxiety over whether the patient is receiving the correct
medications are behaviors that support this diagnosis. There is no
evidence that the patients cardiac output is decreased. The
husbands statements about how he monitors the patient and his
concern with medication administration indicate that the Risk for

Ineffective Therapeutic Regimen Management and falls are not

priorities at this time. Focus: Prioritization
34.
C. Many cells die . Nerve cells change in certain parts of the
brain, which causes brain cells to die. The loss of cells impairs
thinking and judgment.
35.
A. Vascular dementia has more abrupt onset . Vascular
dementia differs from Alzheimers disease in that it has a more
abrupt onset and runs a highly variable course. Personally change is
common in Alzheimers disease. The duration of delirium is usually
brief. The inability to carry out motor activities is common in
Alzheimers disease.
36.
B. Providing emotional support and individual
counseling. Clients in the first stage of Alzheimers disease are
aware that something is happening to them and may become
overwhelmed and frightened. Therefore, nursing care typically
focuses on providing emotional support and individual counseling.
The other options are appropriate during the second stage of
Alzheimers disease, when the client needs continuous monitoring to
prevent minor illnesses from progressing into major problems and
when maintaining adequate nutrition may become a challenge.
During this stage, offering nourishing finger foods helps clients to
feed themselves and maintain adequate nutrition.
37.
B. Talk to the family member and explain that what
she/he has said is not appropriate for the client . This
response is the most direct and immediate. This is a case of
potential need for advocacy and patients rights.
38.
C. Establish and maintain a routine. Establishing and
maintaining a routine is essential to decreasing extraneous stimuli.
The client should participate in daily care as much as possible.
Attempting to reason with such clients isnt successful, because they
cant participate in abstract thinking.
39.
A. Check for improvement in resident memory after
medication therapy is initiated. LPN education and team leader
responsibilities include checking for the therapeutic and adverse
effects of medications. Changes in the residents memory would be
communicated to the RN supervisor, who is responsible for
overseeing the plan of care for each resident. Assessment for
changes on the Mini-Mental State Examination and developing the
plan of care are RN responsibilities. Assisting residents with personal
care and hygiene would be delegated to nursing assistants working
the LTC facility. Focus: Delegation

40.
A. Balancing a checkbook. In the early stage of Alzheimers
disease, complex tasks (such as balancing a checkbook) would be
the first cognitive deficit to occur. The loss of self-care ability,
problems with relating to family members, and difficulty
remembering ones own name are all areas of cognitive decline that
occur later in the disease process.