MSNCB Neurological Nursing 3 — Questions and Answers
Question 1: A patient with myasthenia gravis develops worsening weakness, dysphagia, and difficulty breathing after a respiratory infection. This presentation is most consistent with:
- Cholinergic crisis
- Myasthenic crisis (Correct answer)
- Eaton-Lambert syndrome exacerbation
- Acute demyelinating episode
Correct answer: Myasthenic crisis
Myasthenic crisis is triggered by physiological stressors like infection and causes severe muscle weakness including respiratory muscles.
Question 2: Which clinical sign differentiates Parkinson's disease tremor from essential tremor?
- Tremor is present at rest in Parkinson's disease (Correct answer)
- Tremor is bilateral in Parkinson's disease
- Tremor worsens with caffeine in Parkinson's disease
- Tremor improves with alcohol in Parkinson's disease
Correct answer: Tremor is present at rest in Parkinson's disease
Parkinson's tremor is a resting tremor that diminishes with intentional movement, while essential tremor occurs with action or posture.
Question 3: A nurse notes CSF leaking from a patient's nose after a basilar skull fracture. The most appropriate nursing action is to:
- Pack the nares with gauze and notify the physician
- Test the drainage with a glucose oxidase strip and keep HOB elevated (Correct answer)
- Suction the nasal passage to prevent aspiration
- Apply ice packs to the nasal bridge
Correct answer: Test the drainage with a glucose oxidase strip and keep HOB elevated
CSF rhinorrhea is confirmed by testing for glucose; the HOB is elevated to reduce CSF pressure, and nasal packing is contraindicated due to infection risk.
Question 4: Which drug is the FIRST-LINE treatment for an ischemic stroke patient who presents within the thrombolytic window?
- Aspirin 325 mg PO
- IV alteplase (tPA) (Correct answer)
- Heparin IV infusion
- Clopidogrel 300 mg loading dose
Correct answer: IV alteplase (tPA)
IV alteplase (tPA) is the only FDA-approved thrombolytic for acute ischemic stroke and must be given within 3-4.5 hours of symptom onset.
Question 5: A patient with multiple sclerosis reports worsening of all symptoms when the room temperature is increased. This phenomenon is known as:
- Lhermitte's sign
- Uhthoff's phenomenon (Correct answer)
- Charcot's triad
- Babinski sign
Correct answer: Uhthoff's phenomenon
Uhthoff's phenomenon is the temporary worsening of MS symptoms with heat, due to impaired conduction through demyelinated axons.
Question 6: When administering nimodipine to a patient with subarachnoid hemorrhage, the primary purpose is to:
- Dissolve the blood clot in the subarachnoid space
- Prevent cerebral vasospasm (Correct answer)
- Reduce intracranial pressure
- Control seizure activity
Correct answer: Prevent cerebral vasospasm
Nimodipine, a calcium channel blocker, is given after subarachnoid hemorrhage specifically to prevent cerebral vasospasm and reduce neurological deficits.
Question 7: A patient with a spinal cord injury at T4 suddenly develops severe hypertension (BP 210/120), bradycardia, and profuse sweating above the injury level. The nurse's first action is to:
- Administer an antihypertensive medication immediately
- Sit the patient upright and identify the noxious stimulus (Correct answer)
- Place the patient in Trendelenburg position
- Apply a cooling blanket for hyperthermia management
Correct answer: Sit the patient upright and identify the noxious stimulus
Autonomic dysreflexia requires sitting the patient upright to lower BP and then identifying and removing the triggering noxious stimulus, most commonly a full bladder.
MSNCB Neurological Nursing 3
A patient with myasthenia gravis develops worsening weakness, dysphagia, and difficulty breathing after a respiratory infection.
This presentation is most consistent with: