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Which patient should be assigned to the traveling nurse, new to neurologic nursing care, who has been on the neurologic unit for 1 week?
- A. A 34-year-old patient newly diagnosed with multiple sclerosis (MS)
- B. A 68-year-old patient with chronic amyotrophic lateral sclerosis (ALS)
- C. A 56-year-old patient with Guillain-Barré syndrome (GBS) in respiratory distress
- D. A 25-year-old patient admitted with C4 level spinal cord injury (SCI)
Correct Answer: A
Rationale: A newly diagnosed MS patient would likely have stable conditions and be appropriate for a less experienced nurse.
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Which test evaluates a patient's coordination and balance?
- A. The finger-to-nose and heel-to-shin tests.
- B. The Snellen chart test for visual acuity.
- C. The Rinne and Weber tests for hearing.
- D. The Romberg test for proprioception.
Correct Answer: A
Rationale: The finger-to-nose and heel-to-shin tests assess coordination and balance. The Snellen chart tests vision, the Rinne and Weber tests assess hearing, and the Romberg test evaluates proprioception.
What central fiber tract connects forebrain and brain stem structures with the hypothalamus?
- A. cardiac accelerator nerve
- B. medial forebrain bundle
- C. dorsal longitudinal fasciculus
- D. corticospinal tract
Correct Answer: B
Rationale: The correct answer is B: medial forebrain bundle. This tract connects the forebrain and brain stem structures with the hypothalamus, playing a crucial role in regulating various physiological functions. It is involved in the control of emotions, reward pathways, and feeding behaviors. The other choices are incorrect because: A) cardiac accelerator nerve is involved in regulating heart rate, not connecting forebrain structures with the hypothalamus; C) dorsal longitudinal fasciculus is associated with eye movements and visual processing, not connecting forebrain with the hypothalamus; D) corticospinal tract is responsible for voluntary motor movements, not involved in connecting forebrain structures with the hypothalamus.
A myelogram is ordered for Mr. Tucker to determine the extent of injury. Which of the following would be avoided following this procedure?
- A. Watching him for a possible sensitivity reaction
- B. Elevating his head and thorax 15-30° for 8 hours
- C. Restricting fluid intake for 12 hours
- D. Administering aspirin for headache
Correct Answer: C
Rationale: Fluid restriction can increase the risk of complications after a myelogram.
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.
A week following a spinal cord injury at T2, a patient experiences movement in his leg and tells the nurse that he is recovering some function. What is the nurse's best response to the patient?
- A. It is really still too soon to know if you will have a return of function.'
- B. That could be a really positive finding. Can you show me the movement?'
- C. That's wonderful. We will start exercising your legs more frequently now.'
- D. I'm sorry but the movement is only a reflex and does not indicate normal function.'
Correct Answer: B
Rationale: Further evaluation is needed to confirm functional recovery.