Nervous System | Neurological Disorders NCLEX Quiz 54 | Attempts: 1979

2.

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 client’s history. Which preexisting condition would contraindicate the use of pyridostigmine?

Ulcerative colitis
Blood dyscrasia
Intestinal obstruction
Spinal cord injury

Correct Answer

A. Intestinal obstruction

Explanation

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.Options A. B. and D: Ulcerative colitis. blood dyscrasia. and spinal cord injury don’t contraindicate use of the drug.

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3.

A female client is admitted to the facility for investigation of balance and coordination problems. including possible Ménière’s disease. When assessing this client. the nurse expects to note:

Vertigo. tinnitus. and hearing loss.
Vertigo. vomiting. and nystagmus
Vertigo. pain. and hearing impairment.
Vertigo. blurred vision. and fever.

Correct Answer

A. Vertigo. tinnitus. and hearing loss.

Explanation

Ménière’s disease. an inner ear disease. is characterized by the symptom triad of vertigo. tinnitus. and hearing loss. The combination of vertigo. vomiting. and nystagmus suggests labyrinthitis. Ménière’s disease rarely causes pain. blurred vision. or fever.

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4.

A male client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy. the nurse should provide which client instruction?

“Lie in bed with your head elevated. and refrain from blowing your nose for 24 hours.”
“Try to ambulate independently after about 24 hours.”
“Shampoo your hair every day for ten (10) days to help prevent ear infection.”
“Don’t fly in an airplane. climb to high altitudes. make sudden movements. or expose yourself to loud sounds for 30 days.”

Correct Answer

A. “Don’t fly in an airplane. climb to high altitudes. make sudden movements. or expose yourself to loud sounds for 30 days.”

Explanation

For 30 days after a stapedectomy. the client should avoid air travel. sudden movements that may cause trauma. and exposure to loud sounds and pressure changes (such as from high altitudes).Option A: Immediately after surgery. the client should lie flat with the surgical ear facing upward; nose blowing is permitted but should be done gently and on one side at a time.Option B: The client’s first attempt at postoperative ambulation should be supervised to prevent falls caused by vertigo and light-headedness.Option C: The client must avoid shampooing and swimming to keep the dressing and the ear dry.

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5.

Nurse Marty is monitoring a client for adverse reactions to dantrolene (Dantrium). Which adverse reaction is most common?

Excessive tearing
Urine retention
Muscle weakness
Slurred speech

Correct Answer

A. Muscle weakness

Explanation

The most common adverse reaction to dantrolene is muscle weakness. The drug also may depress liver function or cause idiosyncratic hepatitis.Options A and B: Although excessive tearing and urine retention are adverse reactions associated with dantrolene use; they aren’t as common as muscle weakness.Option D: Muscle weakness is rarely severe enough to cause slurring of speech. drooling. and enuresis.

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6.

The nurse is monitoring a male client for adverse reactions to atropine sulfate (Atropine Care) eyedrops. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction?

Tachycardia
Increased salivation
Hypotension
Apnea

Correct Answer

A. Tachycardia

Explanation

Systemic absorption of atropine sulfate can cause tachycardia. palpitations. flushing. dry skin. ataxia. and confusion. To minimize systemic absorption. the client should apply digital pressure over the punctum at the inner canthus for 2 to 3 minutes after instilling the drops.Options B. C. and D: The drug also may cause dry mouth. It isn’t known to cause hypotension or apnea.

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7.

A male client is admitted with a cervical spine injury sustained during a diving accident. When planning this client’s care. the nurse should assign the highest priority to which nursing diagnosis?

Impaired physical mobility
Ineffective breathing pattern
Disturbed sensory perception (tactile)
Self-care deficit: Dressing/grooming

Correct Answer

A. Ineffective breathing pattern

Explanation

Because a cervical spine injury can cause respiratory distress. the nurse should take immediate action to maintain a patent airway and provide adequate oxygenation.Options A. C. and D: The other options may be appropriate for a client with a spinal cord injury — particularly during the course of recovery — but don’t take precedence over a diagnosis of Ineffective breathing pattern.

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8.

A male client has a history of painful. continuous muscle spasms. He has taken several skeletal muscle relaxants without experiencing relief. His physician prescribes diazepam (Valium). two (2) mg P.O. twice daily. In addition to being used to relieve painful muscle spasms. Diazepam also is recommended for:

Long-term treatment of epilepsy.
Postoperative pain management of laminectomy clients.
Postoperative pain management of diskectomy clients
Treatment of spasticity associated with spinal cord lesions.

Correct Answer

A. Treatment of spasticity associated with spinal cord lesions.

Explanation

In addition to relieving painful muscle spasms. Diazepam also is recommended for treatment of spasticity associated with spinal cord lesions. Diazepam’s use is limited by its central nervous system effects and the tolerance that develops with prolonged use.Option A: The parenteral form of diazepam can treat status epilepticus. but the drug’s sedating properties make it an unsuitable choice for long-term management of epilepsy.Options B and C: Diazepam isn’t an analgesic agent.

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9.

A female client who was found unconscious at home is brought to the hospital by a rescue squaD. In the intensive care unit. the nurse checks the client’s oculocephalic (doll’s eye) response by:

Introducing ice water into the external auditory canal.
Touching the cornea with a wisp of cotton.
Turning the client’s head suddenly while holding the eyelids open.
Shining a bright light into the pupil.

Correct Answer

A. Turning the client’s head suddenly while holding the eyelids open.

Explanation

To elicit the oculocephalic response. which detects cranial nerve compression. the nurse turns the client’s head suddenly while holding the eyelids open. Normally. the eyes move from side to side when the head is turned; in an abnormal response. the eyes remain fixed.Option A: The nurse introduces ice water into the external auditory canal when testing the oculovestibular response; normally. the client’s eyes deviate to the side of ice water introduction.Option B: The nurse touches the client’s cornea with a wisp of cotton to elicit the corneal reflex response. which reveals brain stem function; blinking is the normal response.Option D: Shining a bright light into the client’s pupil helps evaluate brain stem and cranial nerve III functions; normally. the pupil responds by constricting.

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10.

While reviewing a client’s 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?

The client may be less sensitive to the effects of a neuromuscular blocking agent.
Succinylcholine shouldn’t be used; pancuronium may be used in a lower dosage.
Pancuronium shouldn’t be used; succinylcholine may be used in a lower dosage.
Pancuronium and succinylcholine both require cautious administration.

Correct Answer

A. Pancuronium and succinylcholine both require cautious administration.

Explanation

The nurse must cautiously administer pancuronium. succinylcholine. and any other neuromuscular blocking agent to a client with myasthenia gravis.Option A: Such a client isn’t less sensitive to the effects of a neuromuscular blocking agent.Options B and C: Either succinylcholine or pancuronium can be administered in the usual adult dosage to a client with myasthenia gravis.

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Nervous System | Neurological Disorders NCLEX Quiz 54

A client. age 22. is admitted with bacterial meningitis. Which hospital room would be the best choice for this client?

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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 client’s history. Which preexisting condition would contraindicate the use of pyridostigmine?

A female client is admitted to the facility for investigation of balance and coordination problems. including possible Ménière’s disease. When assessing this client. the nurse expects to note:

A male client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy. the nurse should provide which client instruction?

Nurse Marty is monitoring a client for adverse reactions to dantrolene (Dantrium). Which adverse reaction is most common?

The nurse is monitoring a male client for adverse reactions to atropine sulfate (Atropine Care) eyedrops. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction?

A male client is admitted with a cervical spine injury sustained during a diving accident. When planning this client’s care. the nurse should assign the highest priority to which nursing diagnosis?

A female client who was found unconscious at home is brought to the hospital by a rescue squaD. In the intensive care unit. the nurse checks the client’s oculocephalic (doll’s eye) response by:

While reviewing a client’s 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?