Neurosurgical Nursing (NLE 1-5)

Neurosurgical Nursing Practice Test

1. A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease?

a. Ambenonium (Mytelase)
b. Pyridostigmine (Mestinon
c. Edrophonium (Tensilon)
d. Carbachol (Carboptic)

2. A client with seizure disorder comes to the physician's office for a routine checkup. Knowing that the client takes phenytoin (Dilantin) to control seizures, the nurse assesses for which common adverse drug reaction?

a. Excessive gum tissue growth
b. Drowsiness
c. Hypertension
d. Tinnitus

3. Neurosurgical nursing question about teaching a client about levodopa-carbidopa (Sinemet) therapy for Parkinson's disease, the nurse should include which instruction?

a. "Report any eye spasms."
b. "Take this medication at bedtime."
c. "Stop taking this drug when your symptoms disappear."
d. "Be aware that your urine may appear darker than usual."

4. A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order:

a. electromyography (EMG).
b. Doppler scanning.
c. Doppler ultrasonography.
d. quantitative spectral phonoangiography.

5. The nurse is teaching a client who has facial muscle weakness and has recently been diagnosed with myasthenia gravis. The nurse should teach the client that myasthenia gravis is caused by:

a. genetic dysfunction.
b. upper and lower motor neuron lesions.
c. decreased conduction of impulses in an upper motor neuron lesion.
d. a lower motor neuron lesion.

Neurosurgical Nursing:
Answers and Rationale

1) C
- Because of its short duration of action, edrophonium is the drug of choice for diagnosing myasthenia gravis. It's also used to differentiate myasthenia gravis from cholinergic toxicity. Ambenonium is used as an antimyasthenic. Pyridostigmine serves primarily as an adjunct in treating severe anticholinergic toxicity; it's also an antiglaucoma agent and a miotic. Carbachol reduces intraocular pressure during ophthalmologic procedures; topical carbachol is used to treat open-angle and closed-angle glaucoma.

2) A
- Phenytoin can lead to excessive gum tissue growth. However, brushing the teeth two or three times daily helps retard such growth. Some clients may require excision of excessive gum tissue every 6 to 12 months. Phenytoin may cause central nervous system stimulation, leading to insomnia, nervousness, and twitching; it doesn't cause drowsiness. Other adverse reactions to phenytoin include hypotension, not hypertension; and visual disturbances, not tinnitus.

3) D
- Neurosurgical nursing answer - Levodopa-carbidopa, used to replace insufficient dopamine in clients with Parkinson's disease, may cause harmless darkening of the urine. The drug doesn't cause eye spasms, although blurred vision is an expected adverse effect. The client should take levodopa-carbidopa shortly before meals, not at bedtime, and must continue to take it for life.

4) A
- To help confirm ALS, the physician typically orders EMG, which detects abnormal electrical activity of the involved muscles. To help establish the diagnosis of ALS, EMG must show widespread anterior horn cell dysfunction with fibrillations, positive waves, fasciculations, and chronic changes in the potentials of neurogenic motor units in multiple nerve root distribution in at least three limbs and the paraspinal muscles. Normal sensory responses must accompany these findings. Doppler scanning, Doppler ultrasonography, and quantitative spectral phonoangiography are used to detect vascular disorders, not muscular or neuromuscular abnormalities.

5) D- Myasthenia gravis is characterized by a weakness of muscles, especially in the face and throat, caused by a lower motor neuron lesion at the myoneural junction. It isn't a genetic disorder. A combined upper and lower motor neuron lesion generally occurs as a result of spinal injuries. A lesion involving cranial nerves and their axons in the spinal cord would cause decreased conduction of impulses at an upper motor neuron.

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