Medical-Surgical Nursing Exam 19

1. Which of the following terms is used to describe rapid, jerky, involuntary, purposeless movements of the extremities?

1. Chorea
   Choreiform movements, such as grimacing, may also be observed in the face.
2. Bradykinesia
   Bradykinesia refers to very slow voluntary movements and speech.
3. Dyskinesia
   Dyskinesia refers to impaired ability to execute voluntary movements.
4. Spondylosis
   Spondylosis refers to degenerative arthritis of the cervical or lumbar vertebrae.

2. Which of the phases of a migraine headache usually lasts less than an hour?

1. Aura
   The aura phase occurs in about 20% of patients who have migraines and may be characterized by focal neurological symptoms.
2. Prodrome
   The prodrome phase occurs hours to days before a migraine headache.
3. Headache
   The headache phase lasts from 4 to 72 hours.
4. Recovery
   During the post-headache phase, patients may sleep for extended periods.

3. The most common type of brain neoplasm is the

1. glioma.
   Gliomas are the most common brain neoplasms, accounting for about 45% of all brain tumors.
2. angioma.
   Angiomas account for approximately 4% of brain tumors.
3. meningioma.
   Meningiomas account for 15-20% of all brain tumors.
4. neuroma.
   Neuromas account for 7% of all brain tumors.

4. Which of the following diseases is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of small patches of demyelination in the brain and spinal cord?

1. Multiple sclerosis
   The cause of MS is not known and the disease affects twice as many women as men.
2. Parkinson’s disease
   Parkinson’s disease is associated with decreased levels of dopamine caused by destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain.
3. Huntington’s disease
   Huntington’s disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dance-like movement and dementia.
4. Creutzfeldt-Jakob’s disease
   Creutzfeldt-Jakob’s disease is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain.

5. Which of the following diseases is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain?

1. Parkinson’s disease
   In some patients, Parkinson’s disease can be controlled; however, it cannot be cured.
2. Multiple sclerosis
   Multiple sclerosis is a chronic, degenerative, progressive disease of the CNS characterized by the occurrence of small patches of demyelination in the brain and spinal cord.
3. Huntington’s disease
   Huntington’s disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dance-like movement and dementia.
4. Creutzfeldt-Jakob’s disease
   Creutzfeldt-Jakob’s disease is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain.

6. Which of the following diseases is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dance-like movement and dementia?

1. Huntington’s disease
   Because it is transmitted as an autosomal dominant genetic disorder, each child of a parent with HD has a 50% risk of inheriting the illness.
2. Multiple sclerosis
   Multiple sclerosis is a chronic, degenerative, progressive disease of the CNS characterized by the occurrence of small patches of demyelination in the brain and spinal cord.
3. Parkinson’s disease
   Parkinson’s disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain.
4. Creutzfeldt-Jakob’s disease
   Creutzfeldt-Jakob’s disease is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain.

7. Which of the following diseases is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain?

1. Creutzfeldt-Jakob’s disease
   The disease causes severe dementia and myoclonus.
2. Multiple sclerosis
   Multiple sclerosis is a chronic, degenerative, progressive disease of the CNS characterized by the occurrence of small patches of demyelination in the brain and spinal cord.
3. Parkinson’s disease
   Parkinson’s disease is associated with decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain.
4. Huntington’s disease
   Huntington’s disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dance-like movement and dementia.

8. Bell’s palsy is a disorder of which cranial nerve?

1. Facial (VII)
   Bell’s palsy is characterized by facial dysfunction, weakness, and paralysis
2. Trigeminal (V)
   Trigeminal neuralgia is a disorder of the trigeminal nerve and causes facial pain.
3. Vestibulocochlear (VIII)
   Meniere’s syndrome is a disorder of the vestibulocochlear nerve.
4. Vagus (X)
   Guillain-Barre syndrome is a disorder of the vagus nerve.

9. The most common cause of acute encephalitis in the United States is

1. Herpes Simplex Virus (HSV).
   Viral infection is the most common cause of encephalitis. HSV is the most common cause of acute encephalitis in the U.S.
2. Cryptococcus neoformans.
   C. neoformans is one of several fungi that may cause fungal encephalitis. Fungal infections of the central nervous system occur rarely in healthy people.
3. Western equine bacteria.
   The Western equine encephalitis virus is one of four types of arboviral encephalitis that occur in North America.
4. Candida albicans.
   C. albicans is one of several fungi that may cause fungal encephalitis. Fungal infections of the central nervous system occur rarely in healthy people.

10. Which of the following reflects basic nursing measures in the care of the patient with viral encephalitis?

1. Providing comfort measures
   Providing comfort measures directed at the headache, include dimmed lights, limited noise, and analgesics are the basic nursing measures in the care of the patient with a viral encephalitis.
2. Administering narcotic analgesics
   Narcotic analgesics may mask neurologic symptoms; therefore, they are used cautiously.
3. Administering amphotericin B.
   With viral encephalitis, acyclovir therapy is commonly prescribed; Amphotericin B is used in the treatment of fungal encephalitis.
4. Monitoring cardiac output
   Nursing management of the patient with viral encephalitis includes monitoring of blood chemistry test results and urinary output to alert the nurse to the presence of renal complications related to acyclovir therapy.

11. Nursing management of the patient with new variant Creutzfeldt-Jakob Disease (nvCJD) includes

1. providing supportive care.
   The nvCJD is a progressive fatal disease with no treatment available. Due to the fatal outcome of nvCJD, nursing care is primarily supportive.
2. initiating isolation procedures.
   Prevention of disease transmission is an important part of providing nursing care. Although patient isolation is not necessary, use of standard precautions is important. Institutional protocols are followed for blood and body fluid exposure and decontamination of equipment.
3. preparing for organ donation.
   Organ donation is not an option because of the risk for disease transmission.
4. administering amphotericin B.
   Amphotericin B is used in the treatment of fungal encephalitis; no treatment is available for nvCJD.

12.Three medications referred to as the ‘ABC drugs’ are currently the main pharmacological therapy for multiple sclerosis. Which of the following statements reflects information to be included in patient teaching?

1. Flu-like symptoms can be controlled with nonsteroidal anti-inflammatory drugs (NSAIDs) and usually resolve after a few months of therapy.
   Seventy-five percent of patients taking one of the interferons experience flu-like symptoms that can be controlled with NSAIDS and usually resolve after a few months of therapy.
2. Take interferon beta-la (Avonex) with food or milk.
   Interferon beta-la is given by intramuscular injection once a week.
3. Take interferon beta-1b (Betaseron) at night before bedtime for best effects.
   Interferon beta-1b is administered subcutaneously once a week.
4. Take glatiramer acetate (Copaxone) on an empty stomach.
   Glatiramer acetate is administed by intramuscular injection once a week.

13. Korsakoff’s syndrome is characterized by

1. psychosis, disorientation, delirium, insomnia, and hallucinations.
   Korsakoff’s syndrome is a personality disorder characterized by psychosis, disorientation, delirium, insomnia, and hallucinations.
2. severe dementia and myocLonus.
   Creutzefeldt-Jacob disease results in severe dementia and myoclonus.
3. tremor, rigidity, and bradykinesia.
   The three cardinal signs of Parkinson’s disease are tremor, rigidity, and bradykinesia.
4. choreiform movement and dementia.
   Huntington’s disease results in progressive involuntary choreiform (dancelike) movement and dementia.

14. The primary North American vector transmitting arthropod-borne virus encephalitis is the

1. mosquito
   Arthropod vectors transmit several types of viruses that cause encephalitis. The primary vector in North America is the mosquito.
2. tick.
   The primary vector in North America is the mosquito.
3. horse.
   The primary vector in North America is the mosquito.
4. flea.
   The primary vector in North America is the mosquito.

15. The initial symptoms of new variant Creutzfeldt-Jakob Disease (nvCJD) are

1. anxiety, depression, and behavioral changes.
   Anxiety, depression, and behavioral changes are the initial symptoms of nvCJD
2. memory and cognitive impairment.
   Memory and cognitive impairment occur late in the course of nvCJD
3. diplopia and bradykinesia.
   Anxiety, depression and behavioral changes are the initial symptoms of nvCJD
4. akathisia and dysphagia.
   Anxiety, depression and behavioral changes are the initial symptoms of nvCJD

16. A patient with fungal encephalitis receiving amphotericin B complaints of fever, chills, and body aches. The nurse knows that these symptoms

1. may be controlled by the administration of diphenhydramine (Benedryl) and acetaminophen (Tylenol) approximately 30 minutes prior to administration of the amphotericin.
   Administration of amphotericin B may cause fever, chills and body aches. The administration of diphenhydramine (Benedryl) and acetaminophen (Tylenol) approximately 30 minutes prior to the administration of amphotericin B may prevent these side effects.
2. indicate renal toxicity and a worsening of the patient’s condition.
   Renal toxicity due to amphotericin B is dose limiting. Monitoring the serum creatinine and blood urea nitrogen levels may alert the nurse to thedevelopment of renal insufficiency and the need to address the patients’ renal status.
3. are primarily associated with infection with Coccidioides immitis and Aspergillus.
   Vascular changes are associated with C. immitis and Aspergillus Manifestations of vascular change may include arteritis or cerebral infarction.
4. indicate the need for immediate blood and cerebral spinal fluid (CSF) cultures.
   Blood and CSF cultures help diagnosis fungal encephalitis.

17. The patient with Herpes Simplex Virus (HSV) encephalitis is receiving acyclovir (Zovirax). The nurse monitors blood chemistry test results and urinary output for

1. renal complications related to acyclovir therapy.
   Monitoring of blood chemistry test results and urinary output will alert the nurse to the presence of renal complications related to acyclovir therapy.
2. signs and symptoms of cardiac insufficiency.
   Monitoring of blood chemistry test results and urinary output will alert the nurse to the presence of renal complications related to acyclovir therapy.
3. signs of relapse.
   Monitoring of blood chemistry test results and urinary output will alert the nurse to the presence of renal complications related to acyclovir therapy. To prevent relapse treatment with acyclovir should continue for up to 3 weeks.
4. signs of improvement in the patient’s condition.
   Monitoring of blood chemistry test results and urinary output will alert the nurse to the presence of renal complications related to acyclovir therapy.

18. Medical management of arthropod-borne virus (arboviral) encephalitis is aimed at

1. controlling seizures and increased intracranical pressure.
   There is no specific medication for arboviral encephalitis. Medical management is aimed at controlling seizures and increased intracranial pressure.
2. preventing renal insufficiency.
   Medical management is aimed at controlling seizures and increased intracranial pressure.
3. maintaining hemodynamic stability and adequate cardiac output.
   Medical management is aimed at controlling seizures and increased intracranial pressure.
4. preventing muscular atrophy.
   Medical management is aimed at controlling seizures and increased intracranial pressure.

19. The patient receiving mitoxantrone (Novantrone) for treatment of secondary progressive multiple sclerosis (MS) is closely monitored for

1. leukopenia and cardiac toxicity.
   Mitoxantrone is an antineoplastic agent used primarily to treat leukemia and lyphoma but is also used to treat secondary progressive MS. Patients need to have laboratory tests ordered and the results closely monitored due to the potential for leukopenia and cardiac toxicity.
2. mood changes and fluid and electrolyte alterations.
   Patients receiving corticosteroids are monitored for side effects related to corticosteroids such as mood changes and fluid and electrolyte alterations.
3. renal insufficiency.
   Patients receiving mitoxantrone are closely monitored for leukopenia and cardiac toxicity.
4. hypoxia.
   Patients receiving mitoxantrone are closely monitored for leukopenia and cardiac toxicity.

20. What percentage of patients who survived the polio epidemic of the 1950s are now estimated to have developed post-polio syndrome?

1. 60-80%
   Patients who survived the polio epidemic of the 1950s, many now elderly, are developing new symptoms of weakness, fatigue and musculoskeletalpain. It is estimated that between 60% and 80% of the 640,000 polio survivors are experiencing the phenomenon known as post-polio syndrome.
2. 50%
   It is estimated that between 60 and 80% of patients who survived the polio epidemic of the 1950s are now experiencing post-polio syndrome.
3. 25-30%
   It is estimated that between 60 and 80% of patients who survived the polio epidemic of the 1950s are now experiencing post-polio syndrome.
4. 10%                                                                                                                                                                    It is estimated that between 60 and 80% of patients who survived the polio epidemic of the 1950s are now experiencing post-polio syndrome.

21. Which of the following statements describe the pathophysiology of post-polio syndrome?

1. The exact cause is unknown, but aging or muscle overuse is suspected.
   The exact cause of post-polio syndrome is not known but researchers suspect that with aging or muscle overuse the neurons not destroyed originally by the poliovirus are unable to continue generating axon sprouts.
2. The exact cause is unknown, but latent poliovirus is suspected.
   The exact cause of post-polio syndrome is not known.
3. Post-polio syndrome is caused by an autoimmune response.
   The exact cause of post-polio syndrome is not known.
4. Post-polio syndrome is caused by long-term intake of a low-protein, high-fat diet in polio survivors.
   The exact cause of post-polio syndrome is not known.

22. Which of the following statements reflect nursing interventions of a patient with post-polio syndrome?

1. Providing care aimed at slowing the loss of strength and maintaining the physical, psychological and social well being of the patient.
   No specific medical or surgical treatment is available for this syndrome and therefore nursing plays a pivotal role in the team approach to assisting patients and families in dealing with the symptoms of progressive loss of muscle strength and significant fatigue. Nursing interventions are aimed at slowing the loss of strength and maintaining the physical, psychological and social well being of the patient.
2. Administering antiretroviral agents.
   No specific medical or surgical treatment is available for this syndrome.
3. Planning activities for evening hours rather then morning hours.
   Patients need to plan and coordinate activities to conserve energy and reduce fatigue. Important activities should be planned for the morning as fatigue often increases in the afternoon and evening.
4. Avoiding the use of heat applications in the treatment of muscle and joint pain.
   Pain in muscles and joints may be a problem. Nonpharmacologic techniques such as the application of heat and cold are most appropriate because these patients tend to have strong reactions to medications.

23. Which of the following terms is used to describe edema of the optic nerve?

1. Papilledema
   Papilledema is edema of the optic nerve.
2. Scotoma
   Scotoma is a defect in vision in a specific area in one or both eyes.
3. Lymphedema
   Lymphedema is the chronic swelling of an extremity due to interrupted lymphatic ciruclation, typically from an axillary dissection.
4. Angioneurotic edema
   Angioneurotic edema is a condition characterized by urticaria and diffuse swelling of the deeper layers of the skin.

24. Degenerative neurologic disorders include which of the following?

1. Huntington’s disease
   Huntington’s disease is a chronic, progressive, degenerative neurologic hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia.
2. Paget’s disease
   Paget’s disease is a musculoskeletal disorder, characterized by localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae.
3. Osteomyelitis
   Osteomyelitis is an infection of the bone.
4. Glioma
   Malignant glioma is the most common type of brain tumor.

25. Bone density testing in patients with post-polio syndrome has demonstrated

1. low bone mass and osteoporosis.
   Bone density testing in patients with post-polio syndrome has demonstrated low bone mass and osteoporosis. Thus, the importance of identifying risks, preventing falls, and treating osteoporosis must be discussed with patients and their families.
2. osteoarthritis.
   Bone density testing in patients with post-polio syndrome has demonstrated low bone mass and osteoporosis.
3. calcification of long bones.
   Bone density testing in patients with post-polio syndrome has demonstrated low bone mass and osteoporosis.
4. no significant findings.
   Bone density testing in patients with post-polio syndrome has demonstrated low bone mass and osteoporosis.

26. Which of the following terms refers to mature compact bone structures that form concentric rings of bone matrix?

1. Lamellae
   Lamellae are mineralized bone matrix.
2. Endosteum
   Endosteum refers to the marrow cavity lining of hollow bone.
3. Trabecula
   Trabecula refers to lattice-like bone structure.
4. Cancellous bone
   Cancellous bone refers to spongy, lattice-like bone structure.

27. An osteon is defined as a

1. microscopic functional bone unit.
   The center of an osteon contains a capillary.
2. bone-forming cell.
   An osteoblast is a bone-forming cell.
3. bone resorption cell.
   An osteoclast is a bone resorption cell.
4. mature bone cell.
   An osteocyte is a mature bone cell.

28. Which of the following terms refers to the shaft of the long bone?

1. Diaphysis
   The diaphysis is primarily cortical bone.
2. Epiphysis
   An epiphysis is an end of a long bone.
3. Lordosis
   Lordosis refers to an increase in lumbar curvature of spine.
4. Scoliosis
   Scoliosis refers to lateral curving of the spine.

29. Paresthesia is the term used to refer to

1. abnormal sensations.
   Abnormal sensations, such as burning, tingling, and numbness, are referred to as paresthesias.
2. absence of muscle movement suggesting nerve damage.
   The absence of muscle tone suggesting nerve damage is referred to as paralysis.
3. involuntary twitch of muscle fibers.
   Involuntary twitch of muscle fibers is referred to as fasciculation.
4. absence of muscle tone.
   A muscle which holds no tone is termed flaccid.

30. Which of the following terms refers to a grating or crackling sound or sensation?

1. Crepitus
   Crepitus may occur with movement of ends of a broken bone or irregular joint surface.
2. Callus
   Callus is fibrous tissue that forms at the fracture site.
3. Clonus
   Clonus refers to rhythmic contraction of muscle.
4. Fasciculation
   Fasciculation refers to involuntary twitch of muscle fibers.