NCLEX

NCLEX Case Study: Nursing Care of the Patient With a Neurological Disorder

By March 18, 2018 No Comments

The nurse on a medical unit is providing care for 32-year-old Martha Newman, who has multiple sclerosis (MS). She was diagnosed after she gave birth to a healthy baby girl 5 years earlier.

Select all that apply:

How is multiple sclerosis (MS) diagnosed?
A. History and physical examination
B. MRI
C. Bonescan
D. Electroencephalogram(EEG)

Multiple-choice:

In patients with multiple sclerosis (MS), the MRI scan reveals:
A. Multiple bright white lesions
B. Increased cerebral spinal fluid
C. Narrowing of the fourth ventricle
D. Several petechial hemorrhages

Select all that apply:

Which clinical manifestations are associated with multiple sclerosis (MS)?
A. Weakness
B. Fatigue
C. Vertigo
D. Visualdisturbances
E. Paresthesia
F. Muscle spasms
G. Headache
H. Pain
I. Impaired memory
J. Depression

Martha tells the nurse that she has really been struggling with fatigue. She asks about ways to help increase her energy level.

Select all that apply:

Which strategies for alleviating fatigue should the nurse provide a patient with multiple sclerosis (MS)?
A. Avoid environments with extremely cold temperatures
B. Maintain an adequate sleep regimen
C. Discontinue medication during periods of extreme fatigue
D. Uphold a routine exercise regimen
E. Avoid alcohol and tobacco products
F. Consume fresh fruits and vegetables daily

As part of the discharge-teaching plan, the nurse tells Martha that at times performing physical activity may become difficult; however, water therapy is an excellent alternative to promote physical activity. The nurse also advises Martha to review the information on the MS society’s website. She is scheduled for a follow-up in the MS clinic.


Margaret, a 44-year-old female, accompanied by her husband, presents to the emergency room with complaints of dizziness, blurred vision, numbness and weakness of the right arm,and slurred speech.According to her husband,the patient’s symptoms began about 20 to 30 minutes ago.

Multiple-choice:

Which physician order should the nurse anticipate?
A. Obtain a CT of the head, stat
B. Initiate heparin drip per protocol
C. Administer aspirin 325 mg orally, stat
D. Administer atropine 2 mg intravenous (IV), stat

Select all that apply:

Identify risk factors for ischemic stroke:
A. Hypertension(HTN)
B. Diabetesmellitus
C. Smoking
D. Sickle cell anemia
E. Highcholesterol
F. Depression

The HCP orders an EKG. Margaret’s husband questions the purpose for the EKG.

Multiple-choice:

Which statement depicts the nurse’s comprehension of factors that contribute to ischemic strokes?
A. “The symptoms indicate that a pacemaker may be necessary.”
B. “It is routine for patients older than the age of 40 years to have an EKG completed as a precaution.”
C. “It is to check for an irregular heart rhythm, which may contribute to a stroke.”
D. “To determine whether management of a heart attack will be necessary.”

No intracranial hemorrhage is noted on the CT and the HCP orders reteplase (Retavase) to be administered.

Select all that apply:

Which are absolute contraindications to reteplase (Retavase)?
A. 51 years of age
B. Systolic blood pressure (BP): 188 mmHg
C. Currently on Coumadin with a prothrombin time (PT) of 49 seconds and an international normalized ratio (INR) of 2.5
D. Platelet count of 51,000

After receiving reteplase (Retavase), Margaret is transferred to the intensive care unit for close observation of hemodynamic status, including monitoring for signs of bleeding, monitoring vital signs every 15 minutes, and hourly neurological checks.


Mr. Rodriquez, a 52-year-old patient who was diagnosed with Parkinson’s disease 4 years ago, arrives for a routine follow-up with his PCP. His wife joins him for this particular visit, because she has noticed that her husband is having difficulty swallowing.

Select all that apply:

Which clinical manifestations are associated with Parkinson’s disease?
A. Mask-likeexpression
B. Decline in intellect
C. Pillrolling
D. Cogwheelmovement E. Shufflinggate
F. Micrographia
G. Drooling
H. Aphasia
I. Tremor
J. Dysphonia

Select all that apply:

Complications commonly found in a patient with Parkinson’s disease include:
A. Depression
B. Diarrhea
C. Dyskinesia
D. Dysphagia
E. Dementia
F. Dysphonia

As a result of his dysphagia, Mr. Rodriguez and his wife receive instruction regarding diet modification as well as using a specific technique for swallowing.

Multiple-choice:

Which diet is recommended for a patient with Parkinson’s disease who is having difficulty swallowing?
A. Pureed food with thin liquids
B. Semisolid food with thick liquids
C. Solid food with thick liquids
D. Semisolid food with thin liquids

Ordering:

Place the swallowing technique for a patient with Parkinson’s disease in the correct order from 1 to 3:
_______ Close lips and teeth
_______ Lift the tongue up and back to swallow
_______ Place semisolid food on the tongue

Select all that apply:

Which nursing interventions will support nutritional intake in a patient with Parkinson’s disease?
A. Drinking fluids after swallowing food
B. Cutting food into bite-sized pieces
C. Providing six small meals each day
D. Increasing time allotted to eat meals

As Mr. Rodriguez does not exhibit any clinical manifestations of dyskinesia, the HCP renews his prescription of levodopa–carbidopa (Sinemet) and a follow-up appointment is scheduled.

Select all that apply:

Clinical manifestations of dyskinesia that are associated with long-term use of Sinemet include:
A. Facialgrimaces
B. Sleepdisturbances
C. Jerking movement of extremities
D. Smackingmovements
E. Hallucinations
F. Involuntary jerking of the trunk


Jessica, a 23-year-old college student, is admitted to the hospital with an unconfirmed diagnosis of myasthenia gravis (MG) and requires diagnostic work-up.

Multiple-choice:

Which is a clinical manifestation associated with myasthenia gravis (MG)?
A. Cogwheelrigidity
B. Loss of coordination
C. Intermittent periods of visual disturbance
D. Progressive weakness throughout the day
E. Ascendingparalysis

Multiple-choice:

Myasthenia gravis (MG) is confirmed by:
A. Positive Brudzinski’s sign
B. Positive Kernig’s sign
C. Positive edrophonium (Tensilon) test
D. Positive sweat chloride test

The nurse tells Jessica that a Tensilon test will be performed and explains the purpose and findings of the examination.

Multiple-choice:

Which medication should be readily available during the Tensilon test?
A. Epinephrine
B. Atropine
C. Narcan
D. Amiodarone

Multiple-choice:

Which patient response to the administration of Tensilon confirms the diagnosis of myasthenia gravis (MG)?
A. Symptom improvement of just the ptosis
B. Rapid but brief improvement of symptoms
C. Prolonged improvement of symptoms
D. Brief exaggeration of symptoms

Jessica is diagnosed with MG and begins pyridostigmine bromide (Mestinon) therapy. The nurse explains the many factors that can exacerbate the disease and about the prevention of a myasthenic crisis.

Select all that apply:

Precipitating factors for myasthenic crisis include:
A. Physicaloverexertion
B. Emotionalstress
C. Taking excess medication
D. Omitting a dose of medication
E. Pregnancy
F. Influenza

Jessica is discharged from the hospital and is scheduled to follow up with her neurologist in 2 weeks.


Fernando, a 22-year-old male, presents to the emergency room following a motor vehicle accident. He was unrestrained and had no passengers in the vehicle. Currently, he is on a backboard and has a cervical collar in place.

Multiple-choice:

Which does the nurse assess first?
A. Level of consciousness and orientation
B. Heart rate (HR) and blood pressure (BP)
C. Muscle strength and reflexes
D. Airway patency and breathing pattern

Fernando is alert with his eyes open; answers questions without any difficulty; and is oriented to person, place, and time.There are multiple abrasions and bruises on his face. He is unable to move or feel his upper or lower extremities.The nurse uses the Glasgow Coma Scale to determine the extent of neurological injury.

Multiple-choice:

Using the aforementioned Glasgow Coma Scale, which score does the nurse assign to this patient?
A. Score of 15
B. Score of 3
C. Score of 10
D. Score of 6

Multiple-choice:

What is the minimum score possible on the Glasgow Coma Scale?
A. 3
B. 4
C. 6
D. 8

Multiple-choice:

What is the maximum score possible on the Glasgow Coma Scale?
A. 13
B. 15
C. 9
D. 20

A CT scan is ordered and confirms a C2 spinal injury. Multiple abrasions and bruises are noted on his face; however, the CT scan of the head is negative. The provider has written orders for an IV bolus followed by a continuous infusion of methylprednisolone. The patient weighs 155 lb.

Calculation:

Order: 30 mg/kg intravenous (IV) bolus to be given over 15 minutes Calculate the bolus dose: ___________________

Calculation:

The prescriber’s order calls for methylprednisolone intravenous (IV) infusion of 5.4 mg/kg/hr for 23 hours to begin 45 minutes after the bolus dose. The label on the IV bag reads: Methylprednisolone 100 mg/
50 mL D5W. How many mL/hr will deliver the correct dose?
A. 190mL/hr B. 125mL/hr C. 140mL/hr D. 150mL/hr

Fernando is admitted to the trauma-surgical intensive care unit (ICU) for close observation.

Select all that apply:

Which is true regarding the administration of methylprednisolone to a patient with a spinal cord injury?
A. Methylprednisolone should be given within the first 8 hours following injury.
B. Methylprednisolone is associated with adverse effects such as hypoglycemia.
C. Methylprednisolone increases the risk of infection and stress ulcers.
D. Methylprednisolone is only indicated in patients with severe hypotension and bradycardia.

Select all that apply:

Acute complications that may occur following a spinal cord injury include:
A. Neurogenicshock
B. Deep vein thrombosis (DVT)
C. Pneumonia
D. Myocardial infarction (MI)
E. Respiratoryfailure
F. Autonomic dysreflexia

The nurse understands that patients are at risk for seizures after sustaining a head injury and prepares to initiate seizure precautions.

Select all that apply:

Which of the following constitute seizure precautions?
A. Maintain bed in low position
B. Keep side rails up and padded
C. Keep bright lights on to easily visualize the patient
D. Ensure suction is available at the bedside
E. Keep a tongue depressor at the bedside to use as a bite guard
F. Maintain a low-stimulus environment

The new graduate nurse asks the charge nurse about a positive Babinski sign on a patient following a cervical spine injury.

Multiple-choice:

Which statement regarding a positive Babinski reflects the nurse’s comprehension of spinal cord injuries?
A. “A positive Babinski is a good sign indicating adequate spinal cord perfusion.”
B. “A positive Babinski is a normal neurological finding in all age groups.”
C. “A positive Babinski indicates injury to nerves innervating muscles involved in voluntary movement.”
D. “A positive Babinski is a sign of nervous system excitation requiring implementation of seizure
precautions.”

Select all that apply:

Which interventions minimize the risk of deep vein thrombosis (DVT) in a patient with an acute spinal injury?
A. Anticoagulation
B. Range of motion (ROM) exercises
C. Antiembolismstockings
D. Pneumatic compression devices
E. Antiplateletmedication
F. Hydration

Fernando will be transferred to a rehabilitation facility that specializes in spinal cord injuries once medically stable.

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