Medical-Surgical Nursing Assessment and Management of Clinical Problems 9e Chapter 59

Chapter 59: Nursing Management: Chronic Neurologic Problems
Test Bank
MULTIPLE CHOICE
1. The nurse determines that teaching about management of migraine headaches has been
effective when the patient says which of the following?
a. I can take the (Topamax) as soon as a headache starts.
b. A glass of wine might help me relax and prevent a headache.
c. I will lie down someplace dark and quiet when the headaches begin.
d. I should avoid taking aspirin and sumatriptan (Imitrex) at the same time.
ANS: C
It is recommended that the patient with a migraine rest in a dark, quiet area. Topiramate
(Topamax) is used to prevent migraines and must be taken for several months to determine
effectiveness. Aspirin or other nonsteroidal antiinflammatory medications can be taken with
the triptans. Alcohol may precipitate migraine headaches.
DIF: Cognitive Level: Apply (application) REF: 1416 | 1419

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
2. The nurse will assess a 67-year-old patient who is experiencing a cluster headache for
a. nuchal rigidity.
b. unilateral ptosis.
c. projectile vomiting.
d. throbbing, bilateral facial pain.
ANS: B
Unilateral eye edema, tearing, and ptosis are characteristic of cluster headaches. Nuchal
rigidity suggests meningeal irritation, such as occurs with meningitis. Although nausea and
vomiting may occur with migraine headaches, projectile vomiting is more consistent with
increased intracranial pressure (ICP). Unilateral sharp, stabbing pain, rather than throbbing
pain, is characteristic of cluster headaches.
DIF: Cognitive Level: Understand (comprehension) REF: 1414

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
3. While the nurse is transporting a patient on a stretcher to the radiology department, the patient
begins having a tonic-clonic seizure. Which action should the nurse take?
a. Insert an oral airway during the seizure to maintain a patent airway.
b. Restrain the patients arms and legs to prevent injury during the seizure.
c. Time and observe and record the details of the seizure and postictal state.
d. Avoid touching the patient to prevent further nervous system stimulation.
ANS: C
Because the diagnosis and treatment of seizures frequently are based on the description of the
seizure, recording the length and details of the seizure is important. Insertion of an oral airway
and restraining the patient during the seizure are contraindicated. The nurse may need to move
the patient to decrease the risk of injury during the seizure.
DIF: Cognitive Level: Apply (application) REF: 1422
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. A high school teacher who has just been diagnosed with epilepsy after having a generalized
tonic-clonic seizure tells the nurse, I cannot teach anymore, it will be too upsetting if I have a
seizure at work. Which response by the nurse is best?
a. You might benefit from some psychologic counseling.
b. Epilepsy usually can be well controlled with medications.
c. You will want to contact the Epilepsy Foundation for assistance.
d. The Department of Vocational Rehabilitation can help with work retraining.
ANS: B
The nurse should inform the patient that most patients with seizure disorders are controlled
with medication. The other information may be necessary if the seizures persist after treatment
with antiseizure medications is implemented.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
5. A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the nurse take
when evaluating for adverse effects of the medication?
a.Inspect the oral mucosa.
b.Listen to the lung sounds.
c.Auscultate the bowel tones.
d.Check pupil reaction to light.
ANS: A
Phenytoin can cause gingival hyperplasia, but does not affect bowel tones, lung sounds, or
pupil reaction to light.

6. A patient reports feeling numbness and tingling of the left arm before experiencing a tonic-
clonic seizure. The nurse determines that this history is consistent with what type of seizure?
a. Focal
b. Atonic
c. Absence
d. Myoclonic
ANS: A
The initial symptoms of a focal seizure involve clinical manifestations that are localized to a
particular part of the body or brain. Symptoms of an absence seizure are staring and a brief
loss of consciousness. In an atonic seizure, the patient loses muscle tone and (typically) falls
to the ground. Myoclonic seizures are characterized by a sudden jerk of the body or
extremities.

7. When obtaining a health history and physical assessment for a 36-year-old female patient with
possible multiple sclerosis (MS), the nurse should
a. assess for the presence of chest pain.
b. inquire about urinary tract problems.
c. inspect the skin for rashes or discoloration.
d. ask the patient about any increase in libido.
ANS: B
Urinary tract problems with incontinence or retention are common symptoms of MS. Chest
pain and skin rashes are not symptoms of MS. A decrease in libido is common with MS.

8. A 31-year-old woman who has multiple sclerosis (MS) asks the nurse about risks associated
with pregnancy. Which response by the nurse is accurate?
a. MS symptoms may be worse after the pregnancy.
b. Women with MS frequently have premature labor.
c. MS is associated with an increased risk for congenital defects.
d. Symptoms of MS are likely to become worse during pregnancy.
ANS: A
During the postpartum period, women with MS are at greater risk for exacerbation of
symptoms. There is no increased risk for congenital defects in infants born of mothers with
MS. Symptoms of MS may improve during pregnancy. Onset of labor is not affected by MS.

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
9. A 49-year-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer
acetate (Copaxone). Which information will the nurse include in patient teaching?
a. Recommendation to drink at least 4 L of fluid daily
b. Need to avoid driving or operating heavy machinery
c. How to draw up and administer injections of the medication
d. Use of contraceptive methods other than oral contraceptives
ANS: C
Copaxone is administered by self-injection. Oral contraceptives are an appropriate choice for
birth control. There is no need to avoid driving or drink large fluid volumes when taking
glatiramer.

10. Which information about a 60-year-old patient with MS indicates that the nurse should
consult with the health care provider before giving the prescribed dose of dalfampridine
(Ampyra)?
a. The patient has relapsing-remitting MS.
b. The patient walks a mile a day for exercise.
c. The patient complains of pain with neck flexion.
d. The patient has an increased serum creatinine level.
ANS: D
Dalfampridine should not be given to patients with impaired renal function. The other
information will not impact whether the dalfampridine should be administered.

11. Which action will the nurse plan to take for a 40-year-old patient with multiple sclerosis (MS)
who has urinary retention caused by a flaccid bladder?
a. Decrease the patients evening fluid intake.
b. Teach the patient how to use the Cred method.
c. Suggest the use of adult incontinence briefs for nighttime only.
d. Assist the patient to the commode every 2 hours during the day.
ANS: B
The Cred method can be used to improve bladder emptying. Decreasing fluid intake will not
improve bladder emptying and may increase risk for urinary tract infection (UTI) and
dehydration. The use of incontinence briefs and frequent toileting will not improve bladder
emptying.
DIF: Cognitive Level: Apply (application) REF: eNCP 59-3

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
12. A 73-year-old patient with Parkinsons disease has a nursing diagnosis of impaired physical
mobility related to bradykinesia. Which action will the nurse include in the plan of care?
a.Instruct the patient in activities that can be done while lying or sitting.
b.Suggest that the patient rock from side to side to initiate leg movement.
c.Have the patient take small steps in a straight line directly in front of the feet.
d.Teach the patient to keep the feet in contact with the floor and slide them forward.
ANS: B
Rocking the body from side to side stimulates balance and improves mobility. The patient will
be encouraged to continue exercising because this will maintain functional abilities.
Maintaining a wide base of support will help with balance. The patient should lift the feet and
avoid a shuffling gait.

13. A 62-year-old patient who has Parkinsons disease is taking bromocriptine (Parlodel). Which
information obtained by the nurse may indicate a need for a decrease in the dose?
a. The patient has a chronic dry cough.
b. The patient has four loose stools in a day.
c. The patient develops a deep vein thrombosis.
d. The patients blood pressure is 92/52 mm Hg.
ANS: D
Hypotension is an adverse effect of bromocriptine, and the nurse should check with the health
care provider before giving the medication. Diarrhea, cough, and deep vein thrombosis are not
associated with bromocriptine use.

14. The nurse advises a patient with myasthenia gravis (MG) to
a. perform physically demanding activities early in the day.
b. anticipate the need for weekly plasmapheresis treatments.
c. do frequent weight-bearing exercise to prevent muscle atrophy.
d. protect the extremities from injury due to poor sensory perception.
ANS: A
Muscles are generally strongest in the morning, and activities involving muscle activity
should be scheduled then. Plasmapheresis is not routinely scheduled, but is used for
myasthenia crisis or for situations in which corticosteroid therapy must be avoided. There is
no decrease in sensation with MG, and muscle atrophy does not occur because although there
is muscle weakness, they are still used.

15. Which medication taken by a patient with restless legs syndrome should the nurse discuss
with the patient?
a. Multivitamin (Stresstabs)
b. Acetaminophen (Tylenol)
c. Ibuprofen (Motrin, Advil)
d. Diphenhydramine (Benadryl)
ANS: D
Antihistamines can aggravate restless legs syndrome. The other medications will not
contribute to restless legs syndrome.

16. A 64-year-old patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with
pneumonia. Which nursing action will be included in the plan of care?
a. Assist with active range of motion (ROM).
b. Observe for agitation and paranoia.
c. Give muscle relaxants as needed to reduce spasms.
d. Use simple words and phrases to explain procedures.
ANS: A
ALS causes progressive muscle weakness, but assisting the patient to perform active ROM
will help maintain strength as long as possible. Psychotic manifestations such as agitation and
paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the
patients ability to understand procedures will not be impaired. Muscle relaxants will further
increase muscle weakness and depress respirations.

17. A 40-year-old patient is diagnosed with early Huntingtons disease (HD). When teaching the
patient, spouse, and children about this disorder, the nurse will provide information about the
a. use of levodopa-carbidopa (Sinemet) to help reduce HD symptoms.
b. prophylactic antibiotics to decrease the risk for aspiration pneumonia.
c. option of genetic testing for the patients children to determine their own HD risks.
d. lifestyle changes of improved nutrition and exercise that delay disease
progression.
ANS: C
Genetic testing is available to determine whether an asymptomatic individual has the HD
gene. The patient and family should be informed of the benefits and problems associated with
genetic testing. Sinemet will increase symptoms of HD because HD involves an increase in
dopamine. Antibiotic therapy will not reduce the risk for aspiration. There are no effective
treatments or lifestyle changes that delay the progression of symptoms in HD.

18. When a 74-year-old patient is seen in the health clinic with new development of a stooped
posture, shuffling gait, and pill rollingtype tremor, the nurse will anticipate teaching the
patient about
a. oral corticosteroids.
b. antiparkinsonian drugs.
c. magnetic resonance imaging (MRI).
d. electroencephalogram (EEG) testing.
ANS: B
The diagnosis of Parkinsons is made when two of the three characteristic manifestations of
tremor, rigidity, and bradykinesia are present. The confirmation of the diagnosis is made on
the basis of improvement when antiparkinsonian drugs are administered. This patient has
symptoms of tremor and bradykinesia. The next anticipated step will be treatment with
medications. MRI and EEG are not useful in diagnosing Parkinsons disease, and
corticosteroid therapy is not used to treat it.

19. A 22-year-old patient seen at the health clinic with a severe migraine headache tells the nurse
about having other similar headaches recently. Which initial action should the nurse take?
a. Teach about the use of triptan drugs.
b. Refer the patient for stress counseling.
c. Ask the patient to keep a headache diary.
d. Suggest the use of muscle-relaxation techniques.
ANS: C
The initial nursing action should be further assessment of the precipitating causes of the
headaches, quality, and location of pain, etc. Stress reduction, muscle relaxation, and the
triptan drugs may be helpful, but more assessment is needed first.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
20. A hospitalized patient complains of a bilateral headache, 4/10 on the pain scale, that radiates
from the base of the skull. Which prescribed PRN medications should the nurse administer
initially?
a. Lorazepam (Ativan)
b. Acetaminophen (Tylenol)
c. Morphine sulfate (Roxanol)
d. Butalbital and aspirin (Fiorinal)
ANS: B
The patients symptoms are consistent with a tension headache, and initial therapy usually
involves a nonopioid analgesic such as acetaminophen, which is sometimes combined with a
sedative or muscle relaxant. Lorazepam may be used in conjunction with acetaminophen but
would not be appropriate as the initial monotherapy. Morphine sulfate and butalbital and
aspirin would be more appropriate for a headache that did not respond to a nonopioid
analgesic.

21. A 46-year-old patient tells the nurse about using acetaminophen (Tylenol) several times every
day for recurrent bilateral headaches. Which action will the nurse plan to take first?
a. Discuss the need to stop taking the acetaminophen.
b. Suggest the use of biofeedback for headache control.
c. Describe the use of botulism toxin (Botox) for headaches.
d. Teach the patient about magnetic resonance imaging (MRI).
ANS: A
The headache description suggests that the patient is experiencing medication overuse
headache. The initial action will be withdrawal of the medication. The other actions may be
needed if the headaches persist.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
22. The health care provider is considering the use of sumatriptan (Imitrex) for a 54-year-old male
patient with migraine headaches. Which information obtained by the nurse is most important
to report to the health care provider?
a. The patient drinks 1 to 2 cups of coffee daily.
b. The patient had a recent acute myocardial infarction.
c. The patient has had migraine headaches for 30 years.
d. The patient has taken topiramate (Topamax) for 2 months.
ANS: B
The triptans cause coronary artery vasoconstriction and should be avoided in patients with
coronary artery disease. The other information will be reported to the health care provider, but
none of it indicates that sumatriptan would be an inappropriate treatment.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
23. The nurse observes a patient ambulating in the hospital hall when the patients arms and legs
suddenly jerk and the patient falls to the floor. The nurse will first
a. assess the patient for a possible head injury.
b. give the scheduled dose of divalproex (Depakote).
c. document the timing and description of the seizure.
d. notify the patients health care provider about the seizure.
ANS: A
The patient who has had a myoclonic seizure and fall is at risk for head injury and should first
be evaluated and treated for this possible complication. Documentation of the seizure,
notification of the seizure, and administration of antiseizure medications are also appropriate
actions, but the initial action should be assessment for injury.

24. Which prescribed intervention will the nurse implement first for a patient in the emergency
department who is experiencing continuous tonic-clonic seizures?
a. Give phenytoin (Dilantin) 100 mg IV.
b. Monitor level of consciousness (LOC).
c. Obtain computed tomography (CT) scan.
d. Administer lorazepam (Ativan) 4 mg IV.
ANS: D
To prevent ongoing seizures, the nurse should administer rapidly acting antiseizure
medications such as the benzodiazepines. A CT scan is appropriate, but prevention of any
seizure activity during the CT scan is necessary. Phenytoin will also be administered, but it is
not rapidly acting. Patients who are experiencing tonic-clonic seizures are nonresponsive,
although the nurse should assess LOC after the seizure.

25. The home health registered nurse (RN) is planning care for a patient with a seizure disorder
related to a recent head injury. Which nursing action can be delegated to a licensed
practical/vocational nurse (LPN/LVN)?
a. Make referrals to appropriate community agencies.
b. Place medications in the home medication organizer.
c. Teach the patient and family how to manage seizures.
d. Assess for use of medications that may precipitate seizures.
ANS: B
LPN/LVN education includes administration of medications. The other activities require RN
education and scope of practice.

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
26. A 76-year-old patient is being treated with carbidopa/levodopa (Sinemet) for Parkinsons
disease. Which information is most important for the nurse to report to the health care
provider?
a. Shuffling gait
b. Tremor at rest
c. Cogwheel rigidity of limbs
d. Uncontrolled head movement
ANS: D
Dyskinesia is an adverse effect of the Sinemet, indicating a need for a change in medication or
decrease in dose. The other findings are typical with Parkinsons disease.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
27. Which nursing diagnosis is of highest priority for a patient with Parkinsons disease who is
unable to move the facial muscles?
a. Activity intolerance
b. Self-care deficit: toileting
c. Ineffective self-health management
d. Imbalanced nutrition: less than body requirements
ANS: D
The data about the patient indicate that poor nutrition will be a concern because of decreased
swallowing. The other diagnoses may also be appropriate for a patient with Parkinsons
disease, but the data do not indicate that they are current problems for this patient.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Analysis
28. Which assessment is most important for the nurse to make regarding a patient with
myasthenia gravis?
a.Pupil size
b.Grip strength
c.Respiratory effort
d.Level of consciousness
ANS: C
Because respiratory insufficiency may be life threatening, it will be most important to monitor
respiratory function. The other data also will be assessed but are not as critical.
DIF: Cognitive Level: Apply (application) REF: 1438-1439

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
29. Following a thymectomy, a 62-year-old male patient with myasthenia gravis receives the usual
dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe
abdominal cramps. Which action should the nurse take first?
a. Auscultate the patients bowel sounds.
b. Notify the patients health care provider.
c. Administer the prescribed PRN antiemetic drug.
d. Give the scheduled dose of prednisone (Deltasone).
ANS: B
The patients history and symptoms indicate a possible cholinergic crisis. The health care
provider should be notified immediately, and it is likely that atropine will be prescribed. The
other actions will be appropriate if the patient is not experiencing a cholinergic crisis.

30. A hospitalized 31-year-old patient with a history of cluster headache awakens during the night
with a severe stabbing headache. Which action should the nurse take first?
a. Start the ordered PRN oxygen at 6 L/min.
b. Put a moist hot pack on the patients neck.
c. Give the ordered PRN acetaminophen (Tylenol).
d. Notify the patients health care provider immediately.
ANS: A
Acute treatment for cluster headache is administration of 100% oxygen at 6 to 8 L/min. If the
patient obtains relief with the oxygen, there is no immediate need to notify the health care
provider. Cluster headaches last only 60 to 90 minutes, so oral pain medications have minimal
effect. Hot packs are helpful for tension headaches but are not as likely to reduce pain
associated with a cluster headache.

31. Which intervention will the nurse include in the plan of care for a patient with primary restless
legs syndrome (RLS) who is having difficulty sleeping?
a. Teach about the use of antihistamines to improve sleep.
b. Suggest that the patient exercise regularly during the day.
c. Make a referral to a massage therapist for deep massage of the legs.
d. Assure the patient that the problem is transient and likely to resolve.
ANS: B
Nondrug interventions such as getting regular exercise are initially suggested to improve sleep
quality in patients with RLS. Antihistamines may aggravate RLS. Massage does not alleviate
RLS symptoms and RLS is likely to progress in most patients.

32. Which information about a 72-year-old patient who has a new prescription for phenytoin
(Dilantin) indicates that the nurse should consult with the health care provider before
administration of the medication?
a. Patient has generalized tonic-clonic seizures.
b. Patient experiences an aura before seizures.
c. Patients most recent blood pressure is 156/92 mm Hg.
d. Patient has minor elevations in the liver function tests.
ANS: D
Many older patients (especially with compromised liver function) may not be able to
metabolize phenytoin. The health care provider may need to choose another antiseizure
medication. Phenytoin is an appropriate medication for patients with tonic-clonic seizures,
with or without an aura. Hypertension is not a contraindication for phenytoin therapy.

33. After change-of-shift report, which patient should the nurse assess first?
a. Patient with myasthenia gravis who is reporting increased muscle weakness
b. Patient with a bilateral headache described as like a band around my head
c. Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin)
d. Patient with Parkinsons disease who has developed cogwheel rigidity of the arms
ANS: A
Because increased muscle weakness may indicate the onset of a myasthenic crisis, the nurse
should assess this patient first. The other patients should also be assessed, but do not appear to
need immediate nursing assessments or actions to prevent life-threatening complications.
DIF: Cognitive Level: Analyze (analysis) REF: 1438-1439

OBJ: Special Questions: Prioritization; Multiple Patients TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
MULTIPLE RESPONSE
1. A 27-year-old patient who has been treated for status epilepticus in the emergency department
will be transferred to the medical nursing unit. Which equipment should the nurse have
available in the patients assigned room (select all that apply)?
a. Side-rail pads
b. Tongue blade
c. Oxygen mask
d. Suction tubing
e. Urinary catheter
f. Nasogastric tube
ANS: A, C, D
The patient is at risk for further seizures, and oxygen and suctioning may be needed after any
seizures to clear the airway and maximize oxygenation. The beds side rails should be padded
to minimize the risk for patient injury during a seizure. Use of tongue blades during a seizure
is contraindicated. Insertion of a nasogastric (NG) tube is not indicated because the airway
problem is not caused by vomiting or abdominal distention. A urinary catheter is not required
unless there is urinary retention.

2. A patient with Parkinsons disease is admitted to the hospital for treatment of pneumonia.
Which nursing interventions will be included in the plan of care (select all that apply)?
a. Use an elevated toilet seat.
b. Cut patients food into small pieces.
c. Provide high-protein foods at each meal.
d. Place an armchair at the patients bedside.
e. Observe for sudden exacerbation of symptoms.
ANS: A, B, D
Because the patient with Parkinsons has difficulty chewing, food should be cut into small
pieces. An armchair should be used when the patient is seated so that the patient can use the
arms to assist with getting up from the chair. An elevated toilet seat will facilitate getting on
and off the toilet. High-protein foods will decrease the effectiveness of L-dopa. Parkinsons is
a steadily progressive disease without acute exacerbations.

SHORT ANSWER
1. A patient who is having an acute exacerbation of multiple sclerosis has a prescription for
methylprednisolone (Solu-Medrol) 160 mg IV. The label on the vial reads:
methylprednisolone 125 mg in 2 mL. How many mL will the nurse administer?
ANS:
2.56
With a concentration of 125 mg/2 mL, the nurse will need to administer 2.56 mL to obtain 160
mg of methylprednisolone.
DIF: Cognitive Level: Understand (comprehension) REF: 1430-1431


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Chapter 59: Nursing Management: Chronic Neurologic Problems

DIF: Cognitive Level: Apply (application) REF: 1416 | 1419

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