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MS2 quiz #8 Chapter 21&22: Neurologic
System Introduction, Neurologic Disorders|
Questions and Answers, with Rationales|
Updated 2025
Why is a patient with amyotrophic lateral sclerosis (ALS) uniquely prone to depression? a. Nutritional intake is poor. b. Intellectual capacity is not affected. c. Mobility is limited. d. Communication is altered. ANS: Intellectual capacity is not affected. Because of their unimpaired intellect, patients with ALS are able to assess their deterioration, which increases their risk for depression. Altered mobility, nutrition, and communication are common to many disorders. What should the nurse implement before giving an enteral feeding to a patient? a. Palpate the abdomen to check for residual feeding. b. Warm the feeding. c. Elevate the head of the bed 30 degrees. d. Ask the patient to tip his head forward.
ANS: Elevate the head of the bed 30 degrees. The head of the bed should be elevated 30 degrees to prevent aspiration. A nurse is careful about limb position in caring for an unconscious patient who sustained a head injury 10 days ago. What is the nurse trying to prevent? a. Flexion deformities b. Atrophy c. Paralysis d. Pathologic fracture ANS: Flexion deformities An unconscious patient should be positioned in anatomic alignment to prevent flexion deformities. Passive range of motion and frequent position changes are essential to maintain the limbs in a functional position.
- What diagnostic test might be contraindicate for a patient who has a pacemaker? a. Computed tomography (CT) b. Electromyography (EMG) c. Magnetic resonance imaging (MRI) d. Electroencephalography (EEG)
ANS: Flexed hips when the neck is flexed by the nurse Inflamed meninges will stimulate hip flexion to reduce meningeal discomfort. Which assessment on a patient on mannitol therapy for cerebral edema indicates the medication is effective in decreasing ICP? a. Increased BP b. Increased urinary output c. Decreased pulse d. Widening pulse pressure ANS: Increased urinary output Mannitol is a hyperosmolar diuretic that draws fluid from brain tissue into the bloodstream, which is then excreted by the kidneys. Decreasing pulse and widening pulse pressure indicate increased ICP. What should a nurse instruct a patient after a lumbar puncture to prevent a headache? a. Lie flat. b. Lie on left side. c. Stay in semi-Fowler position. d. Ambulate in the room with assistance.
ANS: Lie flat Lying flat for a prescribed period will allow the loss of cerebrospinal fluid during the procedure to replenish. Which describes the Babinski reflex? a. Downward curl of the toes b. Big toe bending upward c. Spreading out of the toes d. Pain in the big toe ANS: Downward curl of the toes Normal cortical function causes the toes to curl downward. Abnormal findings would be the toes turning up and spreading. An older adult patient is experiencing extreme stress related to an admission to the hospital. What should the nurse expect the patient to demonstrate? a. Decreased heart rate b. Decreased blood pressure (BP) c. Irregular respiration d. Dilation of the pupils
c. Puree all foods and drink through a straw. d. Offer a diet high in carbohydrates and fat and low in protein. ANS: Thicken liquids to make them easier to swallow. Thickened feedings are easier to swallow. Several small, protein-rich meals are preferable to large ones. A pureed diet is unappealing. Neurotransmitter(s) include: (Select all that apply.) a. gamma aminobutyric acid. b. acetylcholine. c. serotonin. d. glucose. e. histamine. f. epinephrine. ANS: A, B, C, E, F The CNS is composed of systems of different types of neurons that secrete separate neurotransmitters. Gamma aminobutyric acid, acetylcholine, serotonin, histamine, and epinephrine are examples. Glucose is a sugar that is the body's main source of energy.
What action should the nurse implement when a patient falls to the floor in a generalized seizure? a. Cradle the head to prevent injury. b. Insert an object between the teeth to prevent the patient from biting the tongue. c. Manually restrain the limbs. d. Keep the patient on his or her back to prevent aspiration. ANS: Cradle the head to prevent injury Cradling the head and turning it to the side prevents injury and aspiration; restraint of limbs and insertion of an object into a patient's mouth often result in injury. A patient with generalized convulsive disorder has a nursing diagnosis of "Deficient knowledge, related to lack of information about the side effects of phenytoin (Dilantin)." Which goal and outcome criteria would be most appropriate? a. Absence of gastrointestinal (GI) complaint; takes medication with food b. Stimulation of gingiva; brushes teeth vigorously to encourage gingival growth c. Maintenance of normal pattern of elimination; limits fluids and eats foods that reduce diarrhea d. Maintenance of normal sleep pattern; reduces stimuli and takes warm baths to induce drowsiness
c. Semicomatose d. Somnolent ANS: Semicomatose A stuporous patient who reacts to pain is semicomatose. The patient with no reaction to pain is comatose. What is the most reliable indicator of neurologic status? a. Blood pressure b. Pulse rate c. Temperature d. Level of consciousness ANS: Level of consciousness The ability to respond readily and correctly to person, place, and time is good evidence of intact sensorium. Why are beta blockers used cautiously in patients with respiratory conditions? a. They mask the signs and symptoms of acute hypoglycemia. b. They cause extensive vasodilation and cardiac overload. c. They may produce severe bronchoconstriction. d. They increase hypertensive episodes.
ANS: They may produce severe bronchoconstriction. Nonselective beta blockers, such as Inderal, and larger doses of selective beta antagonists will readily affect the beta-2 receptors of the bronchi, causing bronchoconstriction. Therefore, beta blockers must be used with extreme caution in patients with respiratory conditions such as bronchitis, emphysema, asthma, or allergic rhinitis. Beta blockers affect blood glucose byinducing the hypoglycemic effects of insulin. Vasodilation relieves cardiac overload. Beta blockers induce hypotensive effects. A long-term care resident is taking an anticholinergic agent. The nurse observes the resident to be disoriented and hallucinating. The priority nursing action is to: a. report development of alterations to the charge nurse. b. assess blood glucose. c. provide for resident's safety. d. medicate with antianxiety medication. ANS Provide for resident's safety. Serious psychological side effects of anticholinergic agents include confusion, depression, nightmares, and hallucinations. The priority nursing action at onset of confusion and hallucinations is safety. Once the resident is safe, development of
ANS: Gingival hyperplasia Encouraging good oral hygiene practices is indicated when a patient is on hydantoin therapy because its use contributes to gingival hyperplasia. Postictal state is a characteristic of generalized tonic-clonic seizures. Atonia is not associated with hydantoin therapy. Hydantoin raises the seizure threshold. The nurse is preparing discharge instructions for a patient with a history of diabetes who has just been diagnosed with seizure disorder. The patient has been prescribed hydantoin therapy.What will the patient most likely experiencing? a. Hunger b. Hyperglycemia c. Diarrhea d. Pupil dilation ANS: Hyperglycemia Hydantoins may elevate blood sugar levels. Hunger, diarrhea, and pupil dilation are adverse effects of hydantoin therapy. Constipation and nystagmus are potential adverse effects. Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity?
a. Oculogyric crisis b. Nystagmus c. Strabismus d. Amblyopia ANS: Nystagmus Nystagmus (involuntary rhythmic, uncontrollable movements of one or both eyes) may be a sign of phenytoin toxicity. Oculogyric crisis is an adverse effect of some antipsychotic medications. Strabismus is a visual disorder in which the eyes are misaligned and point in different directions. Amblyopia is a loss of visual acuity in the nondominant eye caused by lack of use of the eye in early childhood. Which body function(s) is/are controlled by the autonomic nervous system? (Select all that apply.) a. Blood pressure b. Skeletal muscle contraction c. GI secretion d. Body temperature e. Urination ANS: A, C, D, E
rather than prevent, injury. Inserting anything into the mouth of someone who is having a seizure can cause injury. Patients taking phenytoin (Dilantin) for control of seizures must be aware of the risk for which adverse effect(s)? (Select all that apply.) a. Blood dyscrasias b. Hyperglycemia c. Urinary retention d. Gingival hyperplasia e. Insomnia f. Sedation ANS: A, B, D, F Phenytoin may cause blood dyscrasias, gingival hyperplasia, and sedation and may elevate blood glucose levels, especially if higher doses are used. Urinary retention and insomnia are not adverse effects of phenytoin. Before the initiation of anticholinergic medications, it is important for the nurse to screen patients for which condition? a. Hypertension b. Infectious diseases
c. Diabetes d. Closed-angle glaucoma ANS: Closed-angle glaucoma The inhibition of cholinergic activity (anticholinergic effects) causes pupil dilation, which increases intraocular pressure in patients with glaucoma. In patients with closed-angle glaucoma, anticholinergic medications can precipitate an acute attack. Anticholinergic agents may produce increased heart rate but not hypertension. Anticholinergic agents do not affect infections or diabetes. The nurse is caring for a patient taking a cholinergic agent. When auscultating lung sounds, the nurse notes inspiratory and expiratory wheezing bilaterally. The best action for the nurse to take would be to: a. provide the next dose of the cholinergic agent immediately. b. assess heart rate and blood pressure. c. reposition the patient. d. withhold the next dose and notify the physician. ANS: Withhold the next dose and notify the physician. Serious respiratory adverse effects of cholinergic agents include bronchospasm and
ANS: Tremors and droolingAnticholinergic drugs will reduce the severity of tremors and drooling in patients with Parkinson's disease. Anticholinergics are most useful when used in combination with levodopa. Anticholinergic drugs do not affect cognitive impairments. Anticholinergics havelittle effect on rigidity or on postural abnormalities. When a patient taking a monoamine oxidase B inhibitor receives his dietary tray, the nurse knows to remove the: a. cheese. b. eggs. c. bread. d. coffee. ANS: cheese Patients taking monoamine oxidase B inhibitors should avoid food and beverages with a high tyramine content, such as cheeses. Eggs, bread, and coffee do not have a high tyramine content. For which condition may carbamazepine (Tegretol) be used? a. Tardive dyskinesia b. Psychotic episodes
c. Trigeminal neuralgia pain d. Sedation ANS: Trigeminal neuralgia pain Carbamazepine has been used successfully to treat pain associated with trigeminal neuralgia and for bipolar disorders when lithium therapy has not been optimal. Carbamazepine does not have antidepressant, antipsychotic, or sedative effects. What is the drug of choice when treating a generalized tonic-clonic seizure? a. Diazepam (Valium) b. Haloperidol (Haldol) c. Valproic acid (Depakene) d. Risperidone (Risperdal) ANS: Valproic acid (Depakene) Anticonvulsant therapy should start with the use of a single agent selected from a group of first-line agents based on the type of seizure. Valproic acid is indicated for generalized tonic-clonic seizures. Diazepam is not the drug of choice for treatment of tonic-clonic seizures. Haloperidol is an antipsychotic medication. Risperidone is an antipsychotic agent.
