Nokea
A patient who has been admitted to the medical unit with new-onset angina also has a diagnosis of Alzheimer's disease. Her husband tells you that he rarely gets a good night's sleep because he needs to be sure she does not wander during the night. He insists on checking each of the medications you give her to be sure they are the same as the ones she takes at home. Based on this information, which nursing diagnosis is most appropriate for this patient?
- A. Decreased Cardiac Output related to poor myocardial contractility
- B. Caregiver Role Strain related to continuous need for providing care
- C. Risk for Falls related to patient wandering behavior during the night
- D. Ineffective Therapeutic Regimen Management related to poor patient memory
Correct Answer: B
Rationale: The caregiver's strain is evident from his description of needing to constantly monitor the patient.
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During muscle strength testing, the patient has active movement against gravity and some resistance to pressure. What score should the nurse give this finding?
- A. 2
- B. 3
- C. 4
- D. 5
Correct Answer: C
Rationale: Grade 4 indicates movement against gravity and moderate resistance.
A previously healthy 26-year-old male is brought to the emergency department due to muscle weakness. He reports mild weakness in his legs that has progressively worsened over a few days to the point that he can barely move his legs. He has some numbness in his legs and his arms feel weak. He has recently recovered from a respiratory infection. 1/5 muscle strength is noted throughout the lower extremities, as well as absent patellar and ankle reflexes. 3 to 4-/5 muscle strength is appreciated throughout his upper extremities. A lumbar puncture is performed, which shows the following: Cell count: 4 cells/mm3, Glucose: 67 mg/dL, Protein: 187 mg/dL Gram stain: no organisms Spirometry is performed, which shows a forced vital capacity of 0.85 L. Which of the following is the best next step in management?
- A. Intravenous (IV) immunoglobulin
- B. Intubation
- C. IV corticosteroids
- D. Immunomodulating agent
Correct Answer: B
Rationale: The patient's presentation of rapidly progressive weakness, areflexia, and elevated cerebrospinal fluid protein with normal cell count (albuminocytologic dissociation) is classic for Guillain-Barre syndrome (GBS). The forced vital capacity of 0.85 L indicates respiratory failure, necessitating immediate intubation to protect the airway and provide mechanical ventilation. Intravenous immunoglobulin and plasma exchange are treatments for GBS but are secondary to securing the airway in this critically ill patient.
In initial stage of Parkinson disease the most typical involuntary movement is the following:
- A. chorea
- B. atetosis
- C. tremor
- D. dystonia
Correct Answer: C
Rationale: Tremor is the correct answer because it is one of the earliest and most characteristic symptoms of Parkinson's disease. The tremor is typically a resting tremor, which decreases with voluntary movement and is often described as ‘pill-rolling' due to its appearance. It results from the degeneration of dopaminergic neurons in the substantia nigra.
Which statement accurately describes dementia?
- A. Overproduction of β-amyloid protein causes all dementias.
- B. Dementia resulting from neurodegenerative causes can be prevented.
- C. Dementia caused by hepatic or renal encephalopathy cannot be reversed.
- D. Vascular dementia can be diagnosed by brain lesions identified with neuroimaging.
Correct Answer: D
Rationale: Neuroimaging can identify vascular lesions causing dementia
Nurse Thompson is reviewing the neurological assessment of Mr. Johnson, a 70-year-old patient who exhibits tremors and slow movements. She recalls that these symptoms are often linked to a specific neurological disorder characterized by reduced dopamine levels due to the loss of pigmented neurons in the substantia nigra region of the basal ganglia. Which disease does Nurse Thompson recognize as associated with these findings?
- A. Multiple sclerosis.
- B. Huntington's disease.
- C. Creutzfeldt-Jakob's disease.
- D. Parkinson's disease.
Correct Answer: D
Rationale: Parkinson's disease is characterized by the loss of dopaminergic neurons in the substantia nigra, leading to tremors, bradykinesia, and rigidity.