Chapter 61: Nursing Management: Chronic Neurological Conditions:
Lewis’s Medical-Surgical Nursing, 5th Edition
1. 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.
Answer: B
Explanation: These symptoms could indicate a cholinergic crisis (overmedication with
cholinesterase inhibitors), which can lead to bradycardia, excessive secretions, and
respiratory failure. This is a medical emergency requiring immediate notification of the
health care provider. The other actions would be inappropriate without first determining the
cause of the symptoms.
2. 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."
Answer: C
Explanation: Resting in a dark, quiet area is a recommended nonpharmacological strategy
for managing a migraine attack. Topiramate is a preventive medication taken daily, not
during an attack. Aspirin or other NSAIDs can be taken with triptans like sumatriptan.
Alcohol is a common migraine trigger.
3. The nurse is caring for a patient with Parkinson's disease who is admitted to the
hospital for treatment of an acute infection. Which of the following nursing
interventions will be included in the plan of care? (Select all that apply.)
A. Use an elevated toilet seat.
B. Cut patient's food into small pieces.
C. Provide high protein foods at each meal.
D. Place an arm chair at the patient's bedside.
E. Observe for sudden exacerbation of symptoms.
Answer: A, B, D
Explanation: An elevated toilet seat assists with transfers. Cutting food helps with the self-
,care deficit related to bradykinesia and tremor. An armchair provides leverage for standing
up. High-protein meals can interfere with the absorption of levodopa. Parkinson's disease has
a gradual progression; sudden exacerbations are not typical and would suggest a different
problem.
4. The nurse is assessing a patient with myasthenia gravis. Which of the following
parameters is most important for the nurse to assess?
A. Check pupillary size.
B. Monitor grip strength.
C. Observe respiratory effort.
D. Assess level of consciousness.
Answer: C
Explanation: Myasthenic crisis, involving severe muscle weakness that compromises
respiration, is a life-threatening complication of MG. Therefore, respiratory status is the
highest priority. The other parameters are also assessed but are not as immediately critical.
5. A patient has a tonic-clonic seizure while the nurse is in the patient's room. Which of
the following actions should the nurse take?
A. Insert an oral airway during the seizure to maintain a patent airway.
B. Restrain the patient's arms and legs to prevent injury during the seizure.
C. Avoid touching the patient to prevent further nervous system stimulation.
D. Time and observe and record the details of the seizure and postictal state.
Answer: D
Explanation: Detailed observation and documentation of the seizure and postictal state are
crucial for diagnosis and treatment. Inserting an oral airway during a seizure is dangerous and
can cause injury. Restraining the patient can cause musculoskeletal harm. The nurse should
intervene to protect the patient from injury, such as by guiding them to the floor if they are
not in bed.
6. The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS) who is
hospitalized with pneumonia. Which of the following actions should be included in the
plan of care?
A. Assist with active range of motion.
B. Observe for agitation and paranoia.
C. Give muscle relaxants as needed to reduce spasms.
D. Use simple words and phrases to explain procedures.
Answer: A
Explanation: ALS causes progressive muscle weakness. Active ROM helps maintain muscle
function and joint mobility for as long as possible. Cognitive function is typically spared in
,ALS, so simplifying language is unnecessary. Muscle relaxants can exacerbate weakness and
respiratory depression. Psychotic symptoms are not characteristic of ALS.
7. The nurse is preparing to admit a patient who has been treated for status epilepticus
in the emergency department. Which of the following equipment should the nurse have
available in the room? (Select all that apply.)
A. Side rail pads
B. Tongue blade
C. Oxygen mask
D. Suction tubing
E. Nasogastric tube
Answer: A, C, D
Explanation: Padded side rails help prevent injury during a seizure. Oxygen and suction
equipment are essential for managing airway and breathing during the postictal period.
Tongue blades should never be inserted into the mouth during a seizure. A nasogastric tube is
not routinely required for seizure management.
8. The nurse is assessing a patient at the health clinic who has a severe migraine
headache and tells the nurse about having four similar headaches in the last 3 months.
Which of the following actions should the nurse take initially?
A. Refer the patient for stress counselling.
B. Ask the patient to keep a headache diary.
C. Suggest the use of muscle-relaxation techniques.
D. Teach about the effectiveness of the triptan drugs.
Answer: B
Explanation: The initial nursing action is further assessment. A headache diary can help
identify triggers, patterns, and characteristics of the headaches, which is essential for accurate
diagnosis and effective management. The other interventions may be implemented later based
on the assessment findings.
9. The nurse is caring for a patient with a history of cluster headache who awakens
during the night with a severe stabbing headache. Which of the following actions should
the nurse take first?
A. Start the prescribed PRN oxygen at 8 L/minute.
B. Put a moist hot pack on the patient's neck.
C. Give the prescribed PRN acetaminophen.
D. Notify the patient's health care provider immediately.
Answer: A
Explanation: High-flow oxygen is a first-line, fast-acting, nonpharmacological treatment for
an acute cluster headache attack. It should be initiated immediately. Oral analgesics are
, ineffective due to the rapid onset and intensity of the pain. Hot packs are more useful for
tension headaches. The health care provider does not need to be notified immediately if
oxygen is effective and part of the standing orders.
10. A patient has a new prescription for bromocriptine mesylate to control symptoms of
Parkinson's disease. Which of the following information obtained by the nurse may
indicate a need for a decrease in the dose?
A. The patient has a persistent dry cough.
B. The patient has four loose stools in a day.
C. The patient develops a deep vein thrombosis.
D. The patient's blood pressure is 90/46 mm Hg.
Answer: D
Explanation: Hypotension is a common adverse effect of bromocriptine. The other findings
are not associated with this medication.
11. The nurse is providing teaching to a patient with myasthenia gravis (MG) about
management of the disease. Which of the following information should the nurse
include in the teaching plan?
A. Perform physically demanding activities in the morning.
B. Anticipate the need for weekly plasmapheresis treatments.
C. Do frequent weight-bearing exercise to prevent muscle atrophy.
D. Protect the extremities from injury due to poor sensory perception.
Answer: A
Explanation: Muscle strength in MG is often best in the morning and worsens with fatigue.
Scheduling strenuous activities for the morning is a key energy conservation technique.
Plasmapheresis is reserved for crises or severe exacerbations. Muscle atrophy is not a feature
of MG, and sensation remains intact.
12. The nurse is assessing a patient in the outpatient clinic with restless legs syndrome.
Which of the following over-the-counter medications should the nurse discuss with the
patient?
A. Multivitamin
B. Acetaminophen
C. Ibuprofen
D. Diphenhydramine
Answer: D
Explanation: Antihistamines like diphenhydramine can worsen the symptoms of restless legs
syndrome. The other medications are not known to aggravate this condition.
Lewis’s Medical-Surgical Nursing, 5th Edition
1. 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.
Answer: B
Explanation: These symptoms could indicate a cholinergic crisis (overmedication with
cholinesterase inhibitors), which can lead to bradycardia, excessive secretions, and
respiratory failure. This is a medical emergency requiring immediate notification of the
health care provider. The other actions would be inappropriate without first determining the
cause of the symptoms.
2. 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."
Answer: C
Explanation: Resting in a dark, quiet area is a recommended nonpharmacological strategy
for managing a migraine attack. Topiramate is a preventive medication taken daily, not
during an attack. Aspirin or other NSAIDs can be taken with triptans like sumatriptan.
Alcohol is a common migraine trigger.
3. The nurse is caring for a patient with Parkinson's disease who is admitted to the
hospital for treatment of an acute infection. Which of the following nursing
interventions will be included in the plan of care? (Select all that apply.)
A. Use an elevated toilet seat.
B. Cut patient's food into small pieces.
C. Provide high protein foods at each meal.
D. Place an arm chair at the patient's bedside.
E. Observe for sudden exacerbation of symptoms.
Answer: A, B, D
Explanation: An elevated toilet seat assists with transfers. Cutting food helps with the self-
,care deficit related to bradykinesia and tremor. An armchair provides leverage for standing
up. High-protein meals can interfere with the absorption of levodopa. Parkinson's disease has
a gradual progression; sudden exacerbations are not typical and would suggest a different
problem.
4. The nurse is assessing a patient with myasthenia gravis. Which of the following
parameters is most important for the nurse to assess?
A. Check pupillary size.
B. Monitor grip strength.
C. Observe respiratory effort.
D. Assess level of consciousness.
Answer: C
Explanation: Myasthenic crisis, involving severe muscle weakness that compromises
respiration, is a life-threatening complication of MG. Therefore, respiratory status is the
highest priority. The other parameters are also assessed but are not as immediately critical.
5. A patient has a tonic-clonic seizure while the nurse is in the patient's room. Which of
the following actions should the nurse take?
A. Insert an oral airway during the seizure to maintain a patent airway.
B. Restrain the patient's arms and legs to prevent injury during the seizure.
C. Avoid touching the patient to prevent further nervous system stimulation.
D. Time and observe and record the details of the seizure and postictal state.
Answer: D
Explanation: Detailed observation and documentation of the seizure and postictal state are
crucial for diagnosis and treatment. Inserting an oral airway during a seizure is dangerous and
can cause injury. Restraining the patient can cause musculoskeletal harm. The nurse should
intervene to protect the patient from injury, such as by guiding them to the floor if they are
not in bed.
6. The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS) who is
hospitalized with pneumonia. Which of the following actions should be included in the
plan of care?
A. Assist with active range of motion.
B. Observe for agitation and paranoia.
C. Give muscle relaxants as needed to reduce spasms.
D. Use simple words and phrases to explain procedures.
Answer: A
Explanation: ALS causes progressive muscle weakness. Active ROM helps maintain muscle
function and joint mobility for as long as possible. Cognitive function is typically spared in
,ALS, so simplifying language is unnecessary. Muscle relaxants can exacerbate weakness and
respiratory depression. Psychotic symptoms are not characteristic of ALS.
7. The nurse is preparing to admit a patient who has been treated for status epilepticus
in the emergency department. Which of the following equipment should the nurse have
available in the room? (Select all that apply.)
A. Side rail pads
B. Tongue blade
C. Oxygen mask
D. Suction tubing
E. Nasogastric tube
Answer: A, C, D
Explanation: Padded side rails help prevent injury during a seizure. Oxygen and suction
equipment are essential for managing airway and breathing during the postictal period.
Tongue blades should never be inserted into the mouth during a seizure. A nasogastric tube is
not routinely required for seizure management.
8. The nurse is assessing a patient at the health clinic who has a severe migraine
headache and tells the nurse about having four similar headaches in the last 3 months.
Which of the following actions should the nurse take initially?
A. Refer the patient for stress counselling.
B. Ask the patient to keep a headache diary.
C. Suggest the use of muscle-relaxation techniques.
D. Teach about the effectiveness of the triptan drugs.
Answer: B
Explanation: The initial nursing action is further assessment. A headache diary can help
identify triggers, patterns, and characteristics of the headaches, which is essential for accurate
diagnosis and effective management. The other interventions may be implemented later based
on the assessment findings.
9. The nurse is caring for a patient with a history of cluster headache who awakens
during the night with a severe stabbing headache. Which of the following actions should
the nurse take first?
A. Start the prescribed PRN oxygen at 8 L/minute.
B. Put a moist hot pack on the patient's neck.
C. Give the prescribed PRN acetaminophen.
D. Notify the patient's health care provider immediately.
Answer: A
Explanation: High-flow oxygen is a first-line, fast-acting, nonpharmacological treatment for
an acute cluster headache attack. It should be initiated immediately. Oral analgesics are
, ineffective due to the rapid onset and intensity of the pain. Hot packs are more useful for
tension headaches. The health care provider does not need to be notified immediately if
oxygen is effective and part of the standing orders.
10. A patient has a new prescription for bromocriptine mesylate to control symptoms of
Parkinson's disease. Which of the following information obtained by the nurse may
indicate a need for a decrease in the dose?
A. The patient has a persistent dry cough.
B. The patient has four loose stools in a day.
C. The patient develops a deep vein thrombosis.
D. The patient's blood pressure is 90/46 mm Hg.
Answer: D
Explanation: Hypotension is a common adverse effect of bromocriptine. The other findings
are not associated with this medication.
11. The nurse is providing teaching to a patient with myasthenia gravis (MG) about
management of the disease. Which of the following information should the nurse
include in the teaching plan?
A. Perform physically demanding activities in the morning.
B. Anticipate the need for weekly plasmapheresis treatments.
C. Do frequent weight-bearing exercise to prevent muscle atrophy.
D. Protect the extremities from injury due to poor sensory perception.
Answer: A
Explanation: Muscle strength in MG is often best in the morning and worsens with fatigue.
Scheduling strenuous activities for the morning is a key energy conservation technique.
Plasmapheresis is reserved for crises or severe exacerbations. Muscle atrophy is not a feature
of MG, and sensation remains intact.
12. The nurse is assessing a patient in the outpatient clinic with restless legs syndrome.
Which of the following over-the-counter medications should the nurse discuss with the
patient?
A. Multivitamin
B. Acetaminophen
C. Ibuprofen
D. Diphenhydramine
Answer: D
Explanation: Antihistamines like diphenhydramine can worsen the symptoms of restless legs
syndrome. The other medications are not known to aggravate this condition.
