Cranial Nerves
Myasthenia Gravis
Stroke
Multiple Sclerosis
Math for Meds
100
Closing off one side of the nose and having the patient identify familiar smells tests this cranial nerve.
What is Cranial Nerve I. Olfactory Nerve.
100
The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by:
A.Taking medications on time to maintain therapeutic blood levels
B.Doing all chores early in the day while less fatigued
C.Doing muscle-strengthening exercises
D.Eating large, well-balanced meals
A.Taking medications on time to maintain therapeutic blood levels
Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low or too high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotional stress
100
A nurse assessing a client who has a new onset of stroke-like symptoms. The nurse assesses the “S” in “FAST”. This stands for which of the following?
What is Speech?
100
Select all the TRUE statements about the pathophysiology of multiple sclerosis: SATA
- A. "The dendrites on the neuron are overstimulated leading to the destruction of the axon."
- B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon."
- C. "This disease affects the insulating structure found on the neuron in the central nervous system."
- D. "The dopaminergic neurons in the part of the brain called substantia nigra have started to die."
- B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon."
- C. "This disease affects the insulating structure found on the neuron in the central nervous system."
100
You need to administer 250 mg of erythromycin (Erythrocin) PO. You have on hand 0.5 g tablets. How many tablet(s) will you give?
Correct answer:
- 1/2 tablet or 0.5 tablet
200
This nerve is responsible for Bell's Palsy.
What is Cranial Nerve VII
200
The nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with a diagnosis of myasthenia gravis?
A. Visual disturbances, including diplopia
B. Ascending paralysis and loss of motor function
C. Cogwheel rigidity and loss of coordination
D. Progressive weakness that is worse at the day s end
D. Progressive weakness that is worse at the days end
The client with myasthenia develops progressive weakness that worsens during the day. Visual disturbances, including diplopia is incorrect because it refers to symptoms of multiple sclerosis. Ascending paralysis and loss of motor function is incorrect because it refers to symptoms of Guillain Barre syndrome. Cogwheel rigidity and loss of coordination is incorrect because it refers to Parkinsons disease.
200
A 68-year-old patient is being admitted with a possible stroke. Which information from the assessment indicates that the nurse should consult with the health care provider before giving the prescribed aspirin?
a. The patient has dysphasia.
b. The patient has atrial fibrillation.
c. The patient reports that symptoms began with a severe headache.
d. The patient has a history of brief episodes of right-sided hemiplegia.
What is C. A sudden onset headache is typical of a subarachnoid hemorrhage, and aspirin is contraindicated. Atrial fibrillation, dysphasia, and transient ischemic attack (TIA) are not contraindications to aspirin use, so the nurse can administer the aspirin
200
True or False: Multiple Sclerosis tends to affect men more than women and occurs during the ages of 50-70 years.
False: MS affects WOMEN more than men and shows up during the ages of 20-40 years.
200
The physician orders alprazolam (Xanax) 0.5 mg PO. You have on hand Xanax 0.25 mg tablets. How many tablet(s) will you give?
Correct answer:
- 2 tablets
300
Facial - taste and facial expression
Test: Smile: Look for symmetry in face.
What is cranial nerve 7?
300
The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirms a diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is:
A.
Prostigmine (neostigmine)
B.
Atropine (atropine sulfate)
C.
Didronel (etidronate)
D.
Tensilon (edrophonium)
A. Prostigmine (neostigmine)
Protigmine is used to treat clients with myasthenia gravis. Atropine (atropine sulfate) is incorrect because it is used to reverse the effects of neostigmine. Didronel (etidronate)is incorrect because the drug is unrelated to the treatment of myasthenia gravis. Tensilon (edrophonium) is incorrect because it is the test for myasthenia gravis.
300
A 73-year-old patient with a stroke experiences facial drooping on the right side and right-sided arm and leg paralysis. When admitting the patient, which clinical manifestation will the nurse expect to find?
a. Impulsive behavior
b. Right-sided neglect
c. Hyperactive left-sided tendon reflexes
d. Difficulty comprehending instructions
What is D. Right-sided paralysis indicates a left-brain stroke, which will lead to difficulty with comprehension and use of language. The left-side reflexes are likely to be intact. Impulsive behavior and neglect are more likely with a right-side stroke.
300
. True or False: Patients with multiple sclerosis have different signs and symptoms because this disease can affect various areas of the peripheral nervous system.
False: Yes, patients with MS have different signs and symptoms because lesions can present at different locations in the CENTRAL NERVOUS SYSTEM....hence the brain and spinal cord (not the peripheral nervous system).
300
You have an IVPB of ranitidine (Zantac) 50 mg in 50 mL D5W to run over 30 minutes. The tubing has a drip factor of 15. How many drops per minute will you set on the IV infusion controller?
Correct answer:
- 25 gtts/minute
Formula:
Rationale:
- Use the IV flow rate formula for gtts/minute above.
- Multiply 50 mL (total volume) to 15 gtts (drop factor) to get 750 gtts.
- Divide 750 gtts with 30 minutes (time in minutes) to get 25 gtts/minute.
Computation:
400
Eye Movement
Test: Have patient look down and towards the nose.
What is Cranial Nerve 4?
400
The doctor is not sure if the patient is having a Myastenic Crisis or Cholinergic Crisis. What medication can he use to determine which one the patient is having?
What is Tensolin?
400
During the change of shift report a nurse is told that a patient has an occluded left posterior cerebral artery. The nurse will anticipate that the patient may have
a. dysphasia.
b. confusion.
c. visual deficits.
d. poor judgment.
What is C. Visual disturbances are expected with posterior cerebral artery occlusion. Aphasia occurs with middle cerebral artery involvement. Cognitive deficits and changes in judgment are more typical of anterior cerebral artery occlusion.
400
A patient is suspected of having multiple sclerosis. The neurologist orders various test. The patient's MRI results are back and show lesions on the cerebellum and optic nerve. What signs and symptoms below would correlate with this MRI finding in a patient with multiple sclerosis?
- A. Blurry vision
- B. Pain when moving eyes
- C. Dysarthria
- D. Balance and coordination issues
- E. "Pill rolling" of fingers and hands
- G. Heat intolerance
- H. Dark spots in vision
- I. Ptosis
What are: A, B C, D, and H.
If lesions are present on the optic nerves, optic neuritis can occurs which can lead to blurry vision, pain when moving the eyes, and dark spots in the vision. If cerebellar lesions are found, this can affect movement, speech, and some cognitive abilities. This would present as dysarthria (issues articulating words), and balance/coordination issues. "Pill rolling" of the fingers and hands is found in Parkinson's disease. Ptosis is common in myasthenia gravis, and heat intolerance in thyroid issues.
400
A patient has a bottle of warfarin (Coumadin) 5 mg tablets at home. After his most recent international normalized ratio (INR), the doctor calls and tells him to take 7.5 mg/day. How many tablets (scored) should the patient take?
Correct answer:
- 1.5 tablet
Formula:
Rationale:
- Use the standard formula above.
- First, multiply the desired dose (7.5 mg) to the vehicle (1 tablet) to get 7.5mg.
- Then, divide 7.5 mg by the drug on hand (5 mg) to get 1.5 tablets.
Computation:
500
Vestibulocochlear: Hearing and balance
Test: Snap fingers beside pts ears, have them stand on one foot
What is cranial nerve VIII
500
The most significant initial nursing observations that need to be made about a client with myasthenia include:
A. Ability to chew and speak distinctly
B. Degree of anxiety about her diagnosis
C. Ability to smile an to close her eyelids
D. Respiratory exchange and ability to swallow
A. Ability to chew and speak distinctly
Muscle weakness can lead to respiratory failure that will require emergency intervention and inability to swallow may lead to aspiration.
500
A 56-year-old patient arrives in the emergency department with hemiparesis and dysarthria that started 2 hours previously, and health records show a history of several transient ischemic attacks (TIAs). The nurse anticipates preparing the patient for
a. surgical endarterectomy.
b. transluminal angioplasty.
c. intravenous heparin administration.
d. tissue plasminogen activator (tPA) infusion.
What is D. The patient's history and clinical manifestations suggest an acute ischemic stroke and a patient who is seen within 4.5 hours of stroke onset is likely to receive tPA (after screening with a CT scan). Heparin administration in the emergency phase is not indicated. Emergent carotid transluminal angioplasty or endarterectomy is not indicated for the patient who is having an acute ischemic stroke.
500
Which finding below represents a positive Romberg Sign in a patient with multiple sclerosis?
- A. The patient report dark spots in the visual fields during the confrontation visual field test.
- B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth.
- C. The patient's sign and symptoms increase when expose to hot temperatures.
- D. The patient reports an electric shock feeling when the head and neck are moved downward.
What is: B. This is an example of a positive Romberg's Sign.
500
You are caring for a patient at home who must take magnesium hydroxide/aluminum hydroxide (Maalox) 30 mL PO. How will you instruct the patient to measure the dose using ordinary household measuring devices?
Correct answer:
- 2 tbsp.
Rationale:
- One tablespoon is equal to 15 mL.
- Convert 30 mL to tablespoons by multiplying it by one tablespoon.
- Then, divide 30 by 15 mL to get the final answer of 2 tbsp.
Computation:
