ATI Medical/Surgical Neurosensory AH1
A nurse is collecting data from a client who has a brain tumor. Which of the following indicates cranial nerve
... [Show More] involvement?
A. Dysphagia
B. Positive Babinski sign
C. Decreased deep-tendon reflexes
D. Ataxia
Rationale: Dysphagia, or difficulty swallowing, can occur as a result of damage to cranial nerves IX (glossopharyngeal) or X (vagus). A positive Babinski sign, or the turning up of the toes upon plantar stimulation, is associated with an upper motor neuron lesion. The cranial nerves primarily innervate the face, neck, and a few organs. Decreased deep-tendon reflexes indicate impairment in the electrical conduction of spinal nerves that interfere with reflex arcs. The cranial nerves primarily innervate the face, neck, and a few organs. Ataxia, or uncoordinated movements of the extremities, can indicate damage to the cerebellum or motor pathways. The cranial nerves primarily innervate the face, neck, and a few organs.
A nurse in a acute care facility is preparing to admit a client who has myasthenia gravis. Which of the following suppliesshould the nurse place on the client's bedside?
A. Metered-dose inhaler
B. Continuous passive motion machine
C. External defibrillator pads
D. Oral-nasal suction equipment
Rationale: The client who has myasthenia gravis is at risk for aspiration because of progressive weakness of the oropharyngeal muscles. Myasthenia gravis causes muscle weakness due to an autoimmune disease that affects the acetylcholine receptors. The nurse should place oxygen and oral-nasal suction equipment at the bedside in the event of aspiration or respiratory distress. External defibrillator pads are used for a client who has a cardiac dysrhythmia; however, they are not indicated for aclient who has myasthenia gravis. A continuous passive motion machine is used to provide continuous motion of a joint for a client who is postoperative following joint surgery; however, it is not indicated for a client who has myasthenia gravis. A metered-dose inhaler is used to administer [Show Less]