Chapter 58 Chronic Neurologic Problems Lewis: Medical-
Surgical Nursing, 10th Edition EXAM 2024-2025
QUESTIONS AND CORRECT ANSWER
Which assessment is *most* important for the nurse to make regarding a patient with
myasthenia gravis?
a. Pupil size
c. Respiratory effort
b. Grip strength
d. Level of consciousness - answer>>>c. Respiratory effort
Because respiratory insufficiency may be life threatening, it will be most important to monitor
respiratory function.
After a *thymectomy*, a 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 patient's bowel sounds.
b. Notify the patient's health care provider.
c. Administer the prescribed PRN antiemetic drug.
d. Give the scheduled dose of prednisone (Deltasone). - answer>>>b. Notify the patient's health
care provider.
The patient's 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*.
A hospitalized patient with a history of cluster headache awakens during the night with a severe
stabbing headache. Which action should the nurse take first?
a. Put a moist hot pack on the patient's neck.
b. Start the prescribed PRN O2 at 6 L/min.
,c. Give the ordered PRN acetaminophen (Tylenol).
d. Notify the patient's health care provider immediately. - answer>>>b. Start the prescribed
PRN O2 at 6 L/min.
*Acute treatment* for *cluster headache* is administration of *100% O2 at 6 to 8 L/min*.
If the patient obtains relief with the O2, 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.
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. - answer>>>b. Suggest
that the patient exercise regularly during the day.
*Nondrug interventions* such as getting regular exercise are initially suggested to improve
sleep quality in patients with *RLS*.
Which information about a 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 tonic-clonic seizures.
b. Patient experiences an aura before seizures.
c. Patient has minor elevations in the liver function tests.
, d. Patient's most recent blood pressure is 156/92 mm Hg. - answer>>>c. Patient has minor
elevations in the liver function tests.
Many *older patients* (especially with *compromised liver function*) may *not be able to
metabolize phenytoin*.
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 Parkinson's disease who has developed cogwheel rigidity of the arms -
answer>>>a. Patient with myasthenia gravis who is reporting increased muscle weakness
Because increased muscle weakness may indicate the onset of a myasthenic crisis, the nurse
should assess this patient first.
A 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 patient's 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 - answer>>>a, c, d
a. Side-rail pads
c. Oxygen mask
d. Suction tubing
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