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Advanced Med Surg Final Exam TestBank
A patient with myasthenia gravis is admitted to the hospital with respiratory insufficiency and severe
weakness. When is a diagnosis of cholinergic crisis made?
a. The patient's respiration is impaired because of muscle weakness.
b. Administration of edrophonium (Tensilon) increases muscle weakness.
c. Administration of edrophonium (Tensilon) results in improved muscle contractility.
d. EMG reveals decreased response to repeated stimulation of muscles. - verified answer b.
The reduction of the acetylcholine (ACh) effect in myasthenia gravis (MG) is treated with
anticholinesterase drugs, which prolong the action of ACh at the neuromuscular synapse, but too
much of these drugs will cause a cholinergic crisis with symptoms very similar to those of MG. To
determine whether the patient's manifestations are due to a deficiency of ACh or to too much
anticholinesterase drug, the anticholinesterase drug edrophonium chloride (Tensilon) is
administered. If the patient is in cholinergic crisis, the patient's symptoms will worsen; if the patient
is in a myasthenic crisis, the patient will improve.
During care of a patient in myasthenic crisis, maintenance of what is the nurse's first priority for the
patient?
a. Mobility
b. Nutrition
c. Respiratory function
d. Verbal communication - verified answer c.
The patient in myasthenic crisis has severe weakness and fatigability of all skeletal muscles, affecting
the patient's ability to breathe, swallow, talk, and move. However, the priority of nursing care is
monitoring and maintaining adequate ventilation.
When providing care for a patient with ALS, the nurse recognizes what as one of the most distressing
problems experienced by the patient?
a. Painful spasticity of the face and extremities
b. Retention of cognitive function with total degeneration of motor function
,c. Uncontrollable writhing and twisting movements of the face, limbs, and body
d. Knowledge that there is a 50% chance the disease has been passed to any offspring - verified
answer b.
In ALS there is gradual degeneration of motor neurons with extreme muscle wasting from lack of
stimulation and use. However, cognitive function is not impaired and patients feel trapped in a dying
body. Chorea manifested by writhing, involuntary movements is characteristic of HD. As an
autosomal dominant genetic disease, HD also has a 50% chance of being passed to each offspring.
In providing care for patients with chronic, progressive neurologic disease, what is the major goal of
treatment that the nurse works toward?
a. Meet the patient's personal care needs.
b. Return the patient to normal neurologic function.
c. Maximize neurologic functioning for as long as possible.
d. Prevent the development of additional chronic diseases. - verified answer c.
Many chronic neurologic diseases involve progressive deterioration in physical or mental capabilities
and have no cure, with devastating results for patients and families. Health care providers can only
attempt to alleviate physical symptoms, prevent complications, and assist patients in maximizing
function and self-care abilities for as long as possible.
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." - verified answer 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.
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? - verified answer 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.
,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. - verified answer 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.
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 patient's 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. - verified answer 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.
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." - verified answer 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.
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. - verified answer A.
Phenytoin can cause gingival hyperplasia, but does not affect bowel tones, lung sounds, or pupil
reaction to light.
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 - verified answer 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.
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. - verified answer B.
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