Nokea
A ___ is a diagnostic procedure used to identify lesions by observing the flow of radiopaque dye through the subarachnoid space.
Correct Answer: myelogram
Rationale: Preparation for this procedure is the same as for lumbar puncture.
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The nurse is aware that the characteristic gait of the person with Parkinson disease is a propulsive gait, which causes the patient to walk in which manner?
- A. stagger and need support of a walker.
- B. shuffle with arms flexed.
- C. fall over to one side when walking.
- D. take small steps balanced on the toes.
Correct Answer: B
Rationale: The propulsive gait causes the patient to shuffle with his arms flexed and with a loss of postural reflexes.
Which technique is necessary for safely feeding a patient with hemiplegia?
- A. Mixing liquids and solid foods together
- B. Taking the patient's dentures out to prevent choking
- C. Checking the affected side of mouth for food accumulation
- D. Offering small bites of food
- E. Elevating the patient to no more than 30 degrees
- F. Adding a thickening agent to liquids
Correct Answer: C,D,F
Rationale: Important nursing measures include avoiding foods that cause choking, checking the affected side of the mouth for accumulation of food and resultant poor hygiene, not mixing liquids and solid foods, and encouraging the patient to take small bites.
Which food should the person who experiences migraine headaches avoid?
- A. Yogurt
- B. Caffeine
- C. Beef
- D. Pears
- E. Marinated foods
- F. Milk
Correct Answer: A,B,E
Rationale: Some foods may cause or worsen headaches. Foods that may provoke headaches include vinegar, chocolate, yogurt, alcohol, fermented or marinated foods, ripened cheese, cured sandwich meat, caffeine, and pork.
For which reason is the patient with suspected Guillain-Barre Syndrome (GBS) hospitalized immediately?
- A. The infection needs to be treated with IV antibiotics to prevent paralysis.
- B. The brain may swell quickly causing seizures.
- C. The disease can rapidly progress into respiratory failure.
- D. IV hydration is needed to prevent possible fatal hypotension.
Correct Answer: C
Rationale: Hospitalization is necessary for GBS patients because the disease progresses very quickly and respiratory failure may occur.
A patient with a spinal cord injury at T1 complains of stuffiness of the nose and a headache. The nurse notes a flushing of the neck and 'goose flesh.' Which action will be the initial nursing intervention based on these signs?
- A. Place patient in flat position and check temperature.
- B. Administer oxygen and check oxygen saturation.
- C. Place on side and check for leg swelling.
- D. Sit upright and check blood pressure.
Correct Answer: D
Rationale: These are indicators of autonomic dysreflexia or hyperreflexia. It is a medical emergency. The patient should be placed in an upright position to decrease blood pressure and the blood pressure should be checked. Assessments for impaction, full bladder, or a urine infection can help to evaluate this condition.