Chapter 64- Management of Patients With Neurologic Infections, Autoimmune
Chapter 64: Management of Patients With Neurologic Infections, Autoimmune
... [Show More] Disorders, and
Neuropathies
Multiple Choice
1. A nurse caring for a patient with possible bacterial meningitis in the ICU knows that which of
the following assessment findings would be expected for a patient with bacterial meningitis?
A) Pain upon ankle dorsiflexion of the foot
B) Neck flexion produces flexion of knees and hips
C) Inability to stand with eyes closed and arms extended without swaying
D) Numbness and tingling in the lower extremities
Ans: B
Chapter: 64
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 1
Patient Needs: A-1
Feedback: Clinical manifestations of bacterial meningitis include positive Brudzinski's sign.
Neck flexion producing flexion of knees and hips correlates with a positive Brudzinski's sign.
Positive Homan's sign (pain upon dorsiflexion of the foot) and negative Romberg's sign (inability
to stand with eyes closed and arms extended) are not expected assessment findings for the patient
with bacterial meningitis. Peripheral neuropathy manifests as numbness and tingling in the lower
extremities and is not an initial assessment to rule out bacterial meningitis.
2. The nurse teaching a patient with trigeminal neuralgia about factors that precipitate an attack
would be correct in teaching him to avoid:
A) Washing his face
B) Exposing his skin to sunlight
C) Using artificial tears
D) Drinking liquids at room temperature
Ans: A
Chapter: 64
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 5
Patient Needs: D-1
Feedback: Washing the face should be avoided if possible due to the fact that this activity can
trigger an attack of pain in a patient with trigeminal neuralgia. Exposing the skin to sunlight is
not harmful to this patient. Using artificial tears and drinking liquids at room temperature are
appropriate behaviors.
3. A nurse admitting a patient with possible Creutzfeldt-Jakob disease (CJD) knows that which
of the following diagnostic tests is used to identify this disease?
A) Lumbar puncture
B) Arterial blood gas analysis
C) CT scan
D) Cerebral angiography
Ans: D
Chapter: 64
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 1
Patient Needs: A-1
Feedback: Recent detection of a polyclonal antibody (protein 14-3-3) in cerebrospinal fluid
(CSF) has enabled the diagnosis of CJD. Arterial blood gases are not necessary until the later
stages of CJD and are not utilized diagnostically. A CT scan is used to rule out disorders that may
mimic the symptoms of CJD. Cerebral angiography is not diagnostic of CJD.
4. Which of the following clinical manifestations would alert the nurse caring for a patient with
Guillain-Barré syndrome that his status is deteriorating?
A) Tidal volume of 500 mL
B) Residual lung volume of 1200 mL
C) Vital capacity of 11 mL/kg
D) Oxygen saturation of 97%
Ans: C
Chapter: 64
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Patient Needs: B-2
Feedback: A vital capacity of 12 to 15 mL/kg in a patient with Guillain-Barre' means that the
patient's condition has deteriorated to the point that he may need to be mechanically ventilated.
Thus, a vital capacity of 11 mL/kg is a warning. The tidal volume, residual lung volume, and
oxygen saturation are within normal values. Breathing in a Guillain Barre' patient would become
increasingly labored as the paralysis ascended toward the intercostals and diaphragm.
5. When developing a plan of care for a patient with Guillain-Barre' syndrome, the nurse knows
that which of the following nursing interventions would receive priority?
A) Using the incentive spirometer as prescribed
B) Maintaining the patient on bed rest
C) Assisting the patient with activities of daily living
D) Determining abnormalities of cognitive function
Ans: A
Chapter: 64
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Patient Needs: A-1
Feedback: Impaired gas exchange would be the priority. Respiratory function can be maximized
with incentive spirometry and chest physiotherapy. Nursing interventions aimed at enhancing
physical mobility and preventing a deep vein thrombosis are utilized. Assisting the patient with
activities of daily living is important but would not be the priority nursing intervention. GuillainBarre' does not affect cognitive function or level of consciousness.
6. Upon admission, the physician orders baclofen (Lioresal) for a patient diagnosed with
multiple sclerosis. The nurse knows that which of the following is an expected outcome of this
medication?
A) Reduction in the appearance of new lesions on the MRI
B) Decreased muscle spasms in the lower extremities
C) Increased muscle strength in the upper extremities
D) Limited severity and duration of exacerbations
Ans: B
Chapter: 64
Cognitive Level: Knowledge
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Patient Needs: D-2
Feedback: Baclofen, a GABA agonist, is the medication of choice in treating spasms. It can be
administered orally or by intrathecal injection. Avonex and Betaseron reduce the appearance of
new lesions on the MRI. Anticholinesterase agents increase muscle strength in the upper
extremities. Corticosteroids limit the severity and duration of exacerbations.
7. The physician has ordered a Tensilon test to rule out myasthenia gravis. The nurse knows that
which of the following medications would be used to counteract the side effects of the Tensilon?
A) Baclofen (Lioresal)
B) Atropine (AtroPen)
C) Epinephrine (Adrenalin)
D) Narcan (Naloxone)
Ans: B
Chapter: 64
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Patient Needs: D-2
Feedback: Atropine 0.4 mg controls the side effects of Tensilon, which include bradycardia,
sweating, and cramping. Baclofen is a skeletal muscle relaxant used in the treatment of multiple
sclerosis. Epinephrine is used in the treatment of anaphylaxis, cardiac arrest, and bronchospasm.
Narcan is used to reverse the narcotic-induced respiratory depression. [Show Less]