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MED SURG ATI ADVANCED FINAL EXAM
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MED SURG ATI ADVANCED FINAL EXAM
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MED SURG ATI ADVANCED FINAL EXAM
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MED SURG ATI ADVANCED FINAL EXAMA 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. - 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 - 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 - 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. - 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." -
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? -
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. - 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. -
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." -
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. - 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 - 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. - ANSWER: 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.
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." - ANSWER: 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.
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 - ANSWER: 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.
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. - ANSWER: D.
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