AMSN Neurological Nursing Care 2 — Questions and Answers
Question 1: A patient diagnosed with Guillain-Barré syndrome (GBS) is most at risk for which life-threatening complication?
- Renal failure
- Respiratory failure (Correct answer)
- Hepatic encephalopathy
- Diabetic ketoacidosis
Correct answer: Respiratory failure
GBS causes ascending paralysis that can involve the respiratory muscles, leading to respiratory failure requiring mechanical ventilation.
Question 2: Which symptom is characteristic of Parkinson's disease that the medical-surgical nurse should assess for?
- Intention tremor at rest that worsens with movement
- Resting tremor, rigidity, and bradykinesia (Correct answer)
- Sudden onset paralysis and aphasia
- Ascending muscle weakness
Correct answer: Resting tremor, rigidity, and bradykinesia
The classic triad of Parkinson's disease is resting tremor, muscle rigidity, and bradykinesia (slowness of movement).
Question 3: A patient with multiple sclerosis (MS) reports worsening symptoms after a hot shower. The nurse recognizes this as:
- An MS relapse requiring IV steroids
- Uhthoff's phenomenon — temporary worsening with heat (Correct answer)
- A hypertensive crisis
- A sign of medication toxicity
Correct answer: Uhthoff's phenomenon — temporary worsening with heat
Uhthoff's phenomenon is the temporary worsening of MS symptoms with heat exposure due to impaired nerve conduction in demyelinated fibers.
Question 4: A patient with a cervical spinal cord injury at C4 suddenly develops bradycardia and hypotension with warm, flushed skin below the injury. The nurse should recognize this as:
- Autonomic dysreflexia
- Neurogenic shock (Correct answer)
- Septic shock
- Hypovolemic shock
Correct answer: Neurogenic shock
Neurogenic shock following high spinal cord injury causes loss of sympathetic tone, resulting in bradycardia, hypotension, and vasodilation below the injury.
Question 5: Which intervention is the priority when a patient with a C6 spinal cord injury develops severe hypertension (BP 210/115 mmHg), pounding headache, and diaphoresis above the level of injury?
- Administer antihypertensive medication immediately
- Sit the patient upright and identify/remove the noxious stimulus (Correct answer)
- Apply a warming blanket
- Insert a urinary catheter only after obtaining a physician order
Correct answer: Sit the patient upright and identify/remove the noxious stimulus
Autonomic dysreflexia requires immediate upright positioning and identification/removal of the triggering noxious stimulus (usually a distended bladder or bowel) as the first intervention.
Question 6: A post-operative craniotomy patient has a urine output of 600 mL/hour with a specific gravity of 1.001. The nurse suspects:
- Syndrome of inappropriate antidiuretic hormone (SIADH)
- Diabetes insipidus (DI) (Correct answer)
- Acute kidney injury
- Urinary tract infection
Correct answer: Diabetes insipidus (DI)
Diabetes insipidus presents with large volumes of very dilute urine (low specific gravity), common after pituitary or hypothalamic surgery.
AMSN Neurological Nursing Care 2
A patient diagnosed with Guillain-Barré syndrome (GBS) is most at risk for which life-threatening complication?