MILESTONE - NEURO & SENSORY

MILESTONE - NEUROLOGICAL & SENSORY

Multiple Choice

The nurse is performing an admission assessment on a client who has a history of glaucoma and uses latanoprost eye drops. Which assessment finding would indicate a side/adverse effect of these eye drops?

• Irregular pulse

• Periorbital edema

• Elevated blood pressure

• Brown pigmentation of the iris

​RATIONALE

• Latanoprost is a topical medication used to lower intraocular pressure in clients with open-angle glaucoma and ocular hypertension.

• The most significant side/adverse effect is heightened brown pigmentation of the iris.

• Other side effects include blurred vision, burning, stinging, conjunctival hyperemia, and punctate keratopathy.

• The heightened pigmentation does not progress further once the medication is discontinued but does not regress.

• The other options are not noted with this medication.

Multiple Choice

Pilocarpine hydrochloride is prescribed for a client with glaucoma. The nurse checks the medication supply room to ensure that atropine sulfate is available for administration in the event that systemic toxicity occurs from the use of pilocarpine hydrochloride. The nurse also monitors for which sign of systemic toxicity?

• Flushing

• Anorexia

• Bradycardia

• Hypertension

​RATIONALE

• Systemic absorption of pilocarpine hydrochloride can produce toxicity, manifested as vertigo, bradycardia, tremors, hypotension, syncope, cardiac dysrhythmias, and seizures.

• Atropine sulfate is the antidote for systemic reactions that occur with pilocarpine.

• Flushing and anorexia are not specifically associated with this medication.

Multiple Choice

A client who is scheduled for cataract surgery requires preoperative instillation of cyclopentolate eye drops as prescribed. The client asks the nurse why this medication is needed, and the nurse provides education. Which statement by the client indicates that teaching has been effective?

• "The medication dilates the pupil of the operative eye."

• "The medication constricts the pupil of the operative eye."

• "The medication is needed for the initiation of miosis in the operative eye."

• "The medication provides the necessary lubrication to the nonoperative eye."

​RATIONALE

• Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication that is used preoperatively to dilate the eye.

• It is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours.

• The statements in the other options are incorrect.

Multiple Choice

The primary health care provider prescribes the instillation of mydriatic eye drops to both eyes of a client. The nurse administers the eye drops and monitors the client for an effective response from the medication, as indicated by which response? 

• A

• B

• C

• D

​RATIONALE

• The top figure identifies unequal pupil size. This finding may be normal in some individuals, but the client with unequal pupil size needs to be assessed for central nervous system disease.

• The figure that is second from the top identifies constricted pupils.

• The third figure from the top identifies a unilateral dilated pupil, indicating cranial nerve III damage.

• Mydriatic eye drops dilate the pupils. The bottom figure identifies dilated pupils.

Multiple Choice

A client with glaucoma is receiving acetazolamide. The nurse educator provides education to a group of nurses about the indications for and effect of this medication. Which statement by one of the nurses indicates that the teaching has been effective?

• "This works to prevent hypertension."

• "This works to prevent hyperthermia."

• "This works to decrease intraocular pressure."

• "This works to maintain an adequate blood pressure for cerebral perfusion."

​RATIONALE

• Acetazolamide is a carbonic-anhydrase inhibitor used to treat glaucoma.

• The medication decreases the formation of aqueous humor.

• The statements in the remaining options are not indicative of the purpose of this medication.

Multiple Choice

In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the primary health care provider's prescriptions, expecting which type of eye drops to be prescribed?

• A miotic agent

• A thiazide diuretic

• An osmotic diuretic

• A mydriatic medication

​RATIONALE

• A mydriatic medication produces mydriasis or dilation of the pupil.

• Mydriatic medications are used preoperatively in the client with a cataract.

• These medications act by dilating the pupils; they also constrict blood vessels.

• A miotic medication constricts the pupil. A

• n osmotic diuretic may be used to decrease intraocular pressure.

• A thiazide diuretic is not likely to be prescribed for a client with a cataract.

Multiple Choice

When teaching a client with glaucoma about the effects of a miotic medication, the nurse would tell the client that the medication will produce which effect?

• Reshape the lens to eliminate blurred vision

• Dilate the pupil to reduce intraocular pressure

• Interrupt the drainage of aqueous humor from the eye

• Lower intraocular pressure and improve blood flow to the retina

​RATIONALE

• Miotics are used to lower the intraocular pressure, which then increases blood flow to the retina.

• This in turn decreases retinal damage and loss of vision.

• Miotics cause a contraction or constriction of the ciliary muscle and widen the trabecular meshwork.

• The other options are incorrect.

Multiple Choice

Select the statement below that best describes how Galantamine works to treat a patient with Alzheimer’s disease.

• “This medication decreases the amount of glutamate readily available at the receptor site.”

• “Galantamine prevents the breakdown of acetylcholine.”

• “This medication decreases the levels of acetylcholine in the brain.”

• “Galantamine decrease beta-amyloid plaques in the brain.”

​RATIONALE

• The answer is B.

• Galantamine is a cholinesterase inhibitor and works to prevent the breakdown of acetylcholine by inhibiting the enzyme cholinesterase.

Multiple Choice

A patient taking a cholinesterase inhibitor is experiencing nausea and diarrhea. These side effects can be decreased by doing which of the following?

• Administering the medication on an empty stomach

• Administering the medication with meals

• Administering the medication two hours before a meal

• Administering the medication at bedtime

​RATIONALE

• The answer is B.

• This medication group can lead to GI upset.

• If this occurs, administering the med with meals can help decrease this side effect.

Multiple Choice

A patient with Severe Alzheimer’s Disease is prescribed to take Memantine. Which statement best describes how this medication works to treat this disease?

• “It increases acetylcholine levels in the brain.”

• “It prevents the enzyme cholinesterase from working.”

• “It limits how glutamate can engage the NMDA receptor in the brain.”

• “It decreases beta amyloid plaques in the brain.”

​RATIONALE

• The answer is C.

• Memantine is an NMDA receptor antagonist that limits how glutamate can engage the NMDA receptor in the brain.

Multiple Choice

What medication is relatively new that is given by IV infusion that can help decrease beta amyloid plaques in patients with Alzheimer’s disease?

• Memantine

• Galantamine

• Donepezil

• Aducanumab

​RATIONALE

• The answer is D. Aducanumab.

• Before a patient takes this medication their doctor may order diagnostic testing to confirm plaques are present like spinal tap or amyloid PET scan.

• Side effects are a potential brain bleed or swelling and will need brain scans periodically to monitor the brain.

Multiple Choice

A patient with a history of epilepsy is taking Phenytoin. The patient’s morning labs are back, and the patient’s Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will?

• Assess the patient for a rash

•  Initiate seizure precautions

• Hold the next dose of Phenytoin

• Continue to monitor the patient

​RATIONALE

• The answer is B.

• A normal Phenytoin level is 10 to 20 mcg/mL.

• The patient’s level is low; therefore, the patient is at risk for seizures.

• The nurse should initiate seizure precautions. Remember a patient being under medicated is a trigger for developing a seizure.

Multiple Choice

A patient is taking Phenytoin for treatment of seizures. Which statement by the patient requires you to re-educate the patient about this medication?

• “Every morning I take this medication with a full glass of milk with my breakfast.”

• “I know it is important to have my drug levels checked regularly.”

• “I will report a skin rash immediately to my doctor.”

• “This medication can lower my body’s ability to clot and fight infection.”

​RATIONALE

• The answer is A.

• This medication should NOT be taken with milk products or antacids because it affects absorption.

• All the other options are correct.

Multiple Choice

The nurse is ordered to administer Lorazepam to a patient experiencing status epilepticus. As a precautionary measure, the nurse will also have what reversal agent on standby?

• Narcan

•  Flumazenil

• Calcium Chloride

•  Idarucizumab

​RATIONALE

• The answer is B.

• Flumazenil is the reversal agent for Lorazepam, which is a benzodiazepine.

Multiple Select

A patient who is having a tonic-clonic seizure is prescribed Phenobarbital. During administration of this drug, it is important the nurse monitors for:

• Respiratory depression

• Disseminated intravascular clotting

• Disseminated intravascular clotting

• Hypotension

• Fever

​RATIONALE

• The answers are A and D. T

• his medication stimulates the GABA receptors and helps with inhibitory neurotransmission.

• It can lead to respiratory depression and hypotension, therefore, it is very important the nurse monitors the patient for this.

Multiple Choice

A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is incorrect about this medication:

• It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication.

• Body fluids can turn a dark color and stain clothes.

• This medication is most commonly prescribed with a vitamin B6 supplement.

• Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain.

​RATIONALE

• The answer is C.

• All the other options are CORRECT about this medication.

• However, the patient should avoid foods and supplements high in vitamin B 6 because it decreases the effectiveness of this medication.

Multiple Choice

You’re patient with Parkinson’s Disease has been taking Carbidopa/Levodopa for several years. The patient reports that his signs and symptoms actually become worse before the next dose of medication is due. As the nurse, you know what medication can be prescribed with this medication to help decrease this for happening?

• Anticholinergic (Benztropine)

• Dopamine agonists (Ropinirole)

• COMT Inhibitor (Entacapone)

• Beta blockers (Metoprolol)

​RATIONALE

• The answer is C. Entacapone “Comtan” (is a catechol-O-methyltransferase inhibitors) and is used with levodopa/carbidopa to prevent the “wearing off” of the drug before the next dose is due. It blocks the COMT enzyme that will break down the levodopa in the blood to allow it to last longer.

Multiple Choice

14. A physician orders a patient to take Benztropine (Cogentin). The patient has never taken this medication before and is due to take the first dose at 1000. What statement by the patient requires you to hold the dose and notify the physician?

• “I forgot to tell the doctor I take eye drops for my glaucoma.”

•  “I had a PET scan last week.”

• “I take aspirin once day.”

• “My hands are experiencing tremors at rest.”

​RATIONALE

• The answer is A.

• This medication is contraindicated for patients with glaucoma.

Multiple Select

A patient is taking Rasagiline “Azilect” for treatment of Parkinson’s Disease. What foods do the patient want to limit in their diet? Select all that apply:

• Aged Cheese

• Liver

• Beer

• Fermented foods

• Shellfish

​RATIONALE

• The answers are B, D, and E. Rasagiline “Azilect” is a MAO Inhibitor Type B (Monoamine Oxidase Inhibitor).

• The patient should avoid foods high in tyramine which can cause a hypertensive crisis.

• This includes: aged cheese, smoked/cured meats, fermented food, beer.

Multiple Select

Which patients are NOT a candidate for tissue plasminogen activator (tPA) for the treatment of stroke?

• A patient with a CT scan that is negative.

• A patient whose blood pressure is 200/110.

• A patient who is showing signs and symptoms of ischemic stroke.

• A patient who received Heparin 24 hours ago.

​RATIONALE

The answers are B and D. Patients who are experiencing signs and symptoms of a hemorrhagic stroke, who have a BP for >185/110, and has received heparin or any other anticoagulants etc. are NOT a candidate for tPA. tPA is only for an ischemic stroke.

Multiple Choice

A patient with myasthenia gravis will be eating lunch at 1200. It is now 1000 and the patient is scheduled to take Pyridostigmine. At what time should you administer this medication so the patient will have the maximum benefit of this medication?

• As soon as possible

• 1 hour after the patient has eaten (at 1300)

• 1 hour before the patient eats (at 1100)

• at 1200 right before the patient eats

​RATIONALE

• The answer is C.

• Pyridostigmine is an anticholinesterase medication that will help improve muscle strength.

  • It is essential the patient has maximum muscle strength while eating for the chewing and swallowing process.

  • Therefore, the medication should be given 1 hour before the patient eats because this medication peaks (has the maximum effect) at approximately 1 hour after administration.

• How does the medication improve muscle strength? It does this by preventing the breakdown of acetylcholine. Remember the nicotinic acetylcholine receptors are damaged and the patient needs as much acetylcholine as possible to prevent muscle weakness. Therefore, this medication will allow more acetylcholine to be used…hence improving muscle strength.

Multiple Choice

You’re preparing to help the neurologist with conducting a Tensilon test. Which antidote will you have on hand in case of an emergency?

•  Atropine

• Protamine sulfate

• Narcan

• Leucovorin

​RATIONALE

• The answer is A.

• Atropine will help reverse the effects of the drug given during a Tensilon test, which is Edrophonium, in case an emergency arises.

• Edrophonium is a short-acting cholinergic drug, while atropine is an anticholinergic.

Multiple Choice

The nurse is providing instructions to a client with seizures who will be taking phenytoin. Which statement, if made by the client, would indicate an understanding of the information about this medication?

• "I need to perform good oral hygiene, including flossing and brushing my teeth."

• "I would try to avoid alcohol, but if I'm not able to, I can drink alcohol in moderation."

• "I need to take my medication before coming to the laboratory to have a blood level drawn."

• "I need to monitor for side effects and adjust my medication dose depending on how severe the side effects are."

​RATIONALE

• Phenytoin is an anticonvulsant used to treat seizure disorders.

• The client needs to see a dentist at regularly scheduled times because gingival hyperplasia is a side effect of this medication.

• The client needs to perform good oral hygiene, including flossing and brushing the teeth.

• The client needs to avoid alcohol while taking this medication.

• The client would also be instructed that follow-up serum blood levels are important and that, on the day of the scheduled laboratory test, the client needs to avoid taking the medication before the specimen is drawn.

• The client would not adjust medication dosages.