Nokea
The nurse is caring for a patient with myasthenia gravis who has had a thymectomy and receives the usual dose of pyridostigmine. An hour later, the patient has nausea and severe abdominal cramps. Which of the following actions should the nurse take first?
- A. Auscultate the patient's bowel sounds.
- B. Notify the patient's health care provider.
- C. Administer the prescribed PRN antiemetic drug.
- D. Give the scheduled dose of prednisone.
Correct Answer: B
Rationale: The patient's history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed. The other actions will be appropriate if the patient is not experiencing a cholinergic crisis.
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The nurse assesses a patient in the health clinic who has symptoms of a stooped posture, shuffling gait, and pill rolling-type tremor. Which of the following prescriptions would the nurse anticipate?
- A. Oral corticosteroids
- B. Antiparkinsonian drugs
- C. Electroencephalogram (EEG) testing
- D. Magnetic resonance imaging (MRI)
Correct Answer: B
Rationale: The diagnosis of Parkinson's is made when two of the three characteristic signs of tremor, rigidity, and bradykinesia are present. The confirmation of the diagnosis is made on the basis of improvement when antiparkinsonian drugs are administered. This patient has symptoms of tremor and bradykinesia; the next anticipated step will be treatment with medications. MRI and EEG are not useful in diagnosing Parkinson's disease, and corticosteroid therapy is not used to treat it.
The nurse witnesses a patient with a seizure disorder as the patient suddenly jerks the arms and legs, falls to the floor, and regains consciousness immediately. Which of the following actions is priority for the nurse to take initially?
- A. Assess the patient for a possible head injury.
- B. Give the scheduled dose of divalproex
- C. Document the timing and description of the seizure.
- D. Notify the patient's health care provider about the seizure.
Correct Answer: A
Rationale: The patient who has had a myoclonic seizure and fall is at risk for head injury and should be evaluated and treated for this possible complication first. Documentation of the seizure, notification of the seizure, and administration of antiseizure drugs also are appropriate actions, but the initial action should be assessment for injury.
The nurse is teaching a patient about management of migraine headaches. Which of the following patient statements indicates that the teaching has been effective?
- A. I will take the topiramate as soon as any headaches start.
- B. I should avoid taking Aspirin and sumatriptan at the same time.
- C. I will try to lie down in a dark and quiet area when the headaches begin.
- D. A glass of wine might help me relax and prevent headaches from developing.
Correct Answer: C
Rationale: It is recommended that the patient with a migraine rest in a dark, quiet area. Topiramate is used to prevent migraines and must be taken for several months to determine effectiveness. Aspirin or other nonsteroidal anti-inflammatory medications can be taken with the triptans. Alcohol may precipitate migraine headaches.
A patient with Parkinson's disease has a nursing diagnosis of impaired physical mobility related to bradykinesia. Which of the following actions should the nurse include in the plan of care?
- A. Instruct the patient in activities that can be done while lying or sitting.
- B. Suggest that the patient rock from side to side to initiate leg movement.
- C. Have the patient take small steps in a straight line directly in front of the feet.
- D. Teach the patient to keep the feet in contact with the floor and slide them forward.
Correct Answer: B
Rationale: Rocking the body from side to side stimulates balance and improves mobility. The patient will be encouraged to continue exercising because this will maintain functional abilities. Maintaining a wide base of support will help with balance. The patient should lift the feet and avoid a shuffling gait.
The nurse is caring for a patient with multiple sclerosis (MS) who is to begin treatment with glatiramer acetate. Which of the following information should the nurse include in patient teaching?
- A. Recommendation to drink at least 3-4 L of water 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
Correct Answer: C
Rationale: 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.