Nokea
The home health nurse is caring for the client newly diagnosed with multiple sclerosis. Which client issue is of most importance?
- A. The client refuses to have a gastrostomy feeding.
- B. The client wants to discuss if she should tell her fiancé.
- C. The client tells the nurse life is not worth living anymore
- D. The client needs the flu and pneumonia vaccines.
Correct Answer: C
Rationale: Expressing feelings of hopelessness or suicidal ideation requires immediate intervention to ensure the client's safety and provide emotional support.
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Regarding the optic pathways
- A. Combined inferior rectus and superior oblique gives lateral gaze
- B. Abducent paralysis makes eye turn down and out
- C. Superior rectus makes eye turn up and out
- D. Trochlear paralysis, eye cannot look downwards when turned out
Correct Answer: D
Rationale: The trochlear nerve (IV) innervates the superior oblique muscle, which depresses and abducts the eye. Paralysis of this nerve prevents downward gaze when the eye is turned inward.
A young adult client complains of blurred vision and muscle spasms that come and go over the past several months. On what information from the client's history should the nurse focus to help identify this help problem?
- A. Family history of Parkinson disease
- B. Family history of epilepsy
- C. Is an immigrant from Germany
- D. Has been depressed
Correct Answer: C
Rationale: A family history of MS or related autoimmune conditions, as well as geographic factors (e.g., higher prevalence in northern latitudes), can provide clues to the diagnosis. Depression is common in MS but is not diagnostic.
Which is the most common neurotransmitter in the brain?
- A. serotonin
- B. glutamate
- C. dopamine
- D. GABA
Correct Answer: B
Rationale: Glutamate is the most abundant excitatory neurotransmitter in the brain and is involved in nearly all excitatory brain functions. It plays a key role in synaptic plasticity, learning, and memory. Glutamate binds to receptors on postsynaptic neurons, promoting the transmission of signals. However, excessive glutamate activity can lead to excitotoxicity, causing neuronal damage and contributing to conditions like stroke and neurodegenerative diseases.
A 33-year-old female presents with drooping of her eyelid that seem to occur while reading or watching television. This appears to get worse later in the day. She also reports that at times she sees "double." A few weeks ago, she was prescribed an antibiotic medication for a urinary tract infection. She does not recall the name of the antibiotic. On physical exam, bilateral ptosis, with the left affected more than the right is seen. Pupillary function intact. A glove is filled with ice, and subsequently applied to the patient's eyelid. After two minutes, the patient's ptosis has improved. Which of the following is most likely to yield rapid symptom improvement?
- A. Corticosteroids
- B. Plasma exchange
- C. Acetylcholinesterase inhibitor
- D. Thymectomy
Correct Answer: C
Rationale: The patient's symptoms of ptosis and diplopia that worsen with activity and improve with rest are classic for myasthenia gravis. The ice pack test, which improves ptosis, further supports this diagnosis. Acetylcholinesterase inhibitors, such as pyridostigmine, are the first-line treatment for symptomatic improvement in myasthenia gravis. Corticosteroids and plasma exchange are used for long-term management or severe cases, while thymectomy is a surgical option for thymoma-associated myasthenia gravis.
An increase in intra-ocular pressure occurs with:
- A. normal blinking
- B. coughing
- C. hypercarbia
- D. all above
Correct Answer: D
Rationale: Intraocular pressure increases during normal blinking, coughing, and hypercarbia due to changes in intrathoracic pressure and blood flow.