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Medical Surgical Nursing - Ch 57


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Generalized seizures differ from partial seizures in that:

a. partial seizures are confined to one side of the brain and remain focal in nature
b. generalized seizures result in loss of consciousness while partial seizures do not
d. Generalized seizures have bilateral synchronous epileptic discharge affecting the entire brain at the onset of the seizure, preventing any warning or aura. Loss of consciousness is also characteristic, but many partial seizures also include a loss of consciousness. Partial seizures begin in one side of the brain but may spread to involve the entire brain. Partial seizures that start with a local focus and spread to the entire brain, causing a secondary generalized seizure, are associated with a transient residual neurologic deficit postictally known as Todd's paralysis.
The nurse teaches the patient taking antiseizure drugs that the method most commonly used to meausre compliance and to monitor for toxicity is:

a. monthly EEGs
b. a daily seizure log
c. urine testing for drug levels
d. blood tes
d. Serum levels of antiseiaure drugs are monitored regularly to maintain therapeutic levels of the drug.
The nurse finds a patient in bed having a generalized tonic-clonic seizure. During the seizure activity, the nurse should:

a. turn the patient to the side
b. suction the patient and administer oxygen
c. insert an oral airway into the
a. Maintaining an airway during a seizure is important and may involve turning the patient to the side, supporting and protecting the head, or loosening constrictive clothing.
During assessment of a patient admitted to the hospital with an acute exacerbation of MS, the nurse would expect to find:

a. tremors, dysphasia, and ptosis
b. bowel and bladder incontinence and loss of memory
c. motor impairment, vis
c. Motor and sensory dysfunctions, including paresthesias as well as patchy blindness, blurred vision, and hearing loss, are the most common manifestions of MS. Bowel and bladder dysfunctions and ataxia also occur, but excessive involuntary movements, tremors, and memory loss are not seen in MS.
The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by:

a. MRI findings
b. T cell analysis of the blood
c. analysis of cerebrospinal fluid
d. history and clinical manifestations
d. There is no specific diagnostic test for MS, and a diagnosis is made primarily by history and clinical manifestions. In later MS, CT and MRI may detect sclerotic plaques. Some patients have elevations of oligoclonal immunoglobulin G, lymphocytes, and monocytes in cerebrospinal fluid, but these findings do not establish a diagnosis of MS.
Mitoxantone (Novantrone) is being considered as treatment for a patient with progressive-relapsing MS. The nurse explains that a disadvantage of this drug compared with other drugs used for multiple sclerosis is that is:

a. must be given subq
b. Mitoxantrone (Novantrone) is an immunosuppressant drug that reduces both B and T lymphocytes and impairs antigen presentation. It is similar to other immunosuppresants in that it increases the risk for infection, but it cannot be used for more than 2 to 3 years because it causes cardiac toxicity. It is administered IV monthly.
A patient with a tremor is evaluated for Parkinson's disease. The nurse explains to the patient that Parkinson's disease can be confirmed by:

a. CT and MRI scans
b. relief of symptoms with administration of dopaminergic agents
c. th
b. Although clinical manifestations are characteristic in Parkinson's disease, there are no lab or diagnostic tests specific for the condition. A diagnosis is made when there are at least two of the three signs of the classic triad, and it is confirmed with a positive response to antiparkinsonian medication. Essential tremors increase during voluntary movement, while the tremors of Parkinson's disease are more prominent at rest.
An observation of the patient made by the nurse that is most indicative of Parkinson's disease is:

a. large and embellished handwriting
b. a weakness of one leg resulting in a limping walk
c. difficulty arising from a chair and begin
c. The bradykinesia of Parkinson's disease prevents automatic movements, and such activities as beginning to walk, rising from a chair, or even swallowing saliva cannot be executed unless they are consciously willed. Handwriting is affected by the tremor and results in the writing trailing off at the end of words. Specific limb weakness and muscle spasms are not characteristic of Parkinson's disease.
A patient with Parkinson's disease is started on levodopa. The nurse explains that this drug:

a. stimulates dopamine receptors in the basal ganglia
b. promotes the release of dopamine from brain neurons
c. is a precursor of dopamine
c. Peripheral dopamine does not cross the blood-brain barrier, but its precursor, levodopa, is able to enter the brain, where it is converted to dopamine, increasing the supply that is deficient in Parkinson's disease. Other drugs used to treat Parkinson's disease include bromocriptine, which stimulates dopamine receptors in the basal ganglia, and amantadine, which is believed to promote the release of dopamine from brain neurons. Carbidopa is an agent that is usually administered with levodopa to prevent the levodopa from being metabolized in peripheral tissues before it can reach the brain.
An appropriate nursing intervention to promote speech and swallowing in a patient with Parkinson's disease is:

a. massaging the facial and neck muscles
b. keeping the patient positioned in an upright position
c. encouraging deep brea
a. Speech and swallowing in the patient with Parkinson's disease can be facilitated by massaging the patient's facial and neck muscles to reduce the rigidity that makes chewing, swallowing, and talking difficult for the patient. An upright position and suctioning if secretions are present are necessary to prevent aspiration during eating.
To reduce the risk for falls in the patient with Parkinson's disease, the nurse teaches the patient to:

a. use an elevated toilet seat
b. use a walker or cane for support
c. consciously lift the toes when stepping
d. rock side t
c. The shuffling gait of Parkinson's disease causes the patient to be off balance and at risk for falling. Teaching the patient to use a wide stance with the fee apart, to lift the toes when walking, and to look ahead helps promote a more balanced gait. Use of an elevated toilet seat and rocking side to side will enable a patient to initiate movement. Canes and walkers are difficult for patients with Parkinson's disease to maneuver and may make the patient more prone to injury.

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