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3. The most common form of seizure has two phases: tonic (muscle contraction and spasms) and clonic (jerky, dysrhythmic muscle contraction), and is called: Which disease is the most common type of hyperthyroidism? A. Graves B.Hashimoto’s Disease C. Cushing’s D. Addison’s

4. These behaviors describe grand mal seizures, which are the most common type of seizure. It is an auto-immune disease that causes over-secretion of thyroid hormone. Back to Board

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6. Types of seizures • Tonic seizure-sustained muscle contraction • Clonic seizure- dysrhythmic muscle contraction • Absence seizure-petit mal brief loss of consciousness • Myoclonic- jerking of one limb (associated with neuro disorder) • Partial seizures- involve only one hemisphere of the brain • Sensory seizure- visual , auditory, or taste hallucination • Pseudo seizure-caused by a type of neurosis Back to Board

7. The most common form of seizure has two phases: tonic (muscle contraction and spasms) and clonic (jerky, dysrhythmic muscle contraction), and is called: Which disease is the most common type of hyperthyroidism? A. Graves D. Addison’s

8. A nurse is teaching a client about her health plan when taking phenytoin (Dilantin). Which of the following would not be included in her teaching plan? Which one a clinical manifestation of Type I Diabetes? B. Paresthesia A. Polyuria C.Polyphagia D. Polydipsia

9. Phenytoin is excreted in the urine and requires adequate hydration. Paresthesias is manifested in Type II diabetes. Polyuria is type I diabetes. Back to Board

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12. A nurse is teaching a client about her health plan when taking phenytoin (Dilantin). Which of the following would not be included in her teaching plan? Which one a clinical manifestation of Type I Diabetes? A. Polyuria B.Paresthesia

13. Phenytoin is contraindicated during pregnancy because of the possibility of: A nurse develops a plan of care for a patient with hyperthyroidism which includes which of the following in the plan? A. Provide small meals B.Provide extra blankets C. Provide a high fiber diet. D. Provide a restful environment

14. Phenytoin taken during pregnancy, especially the first trimester, may lead to teratogenic effects. Because of the hyper metabolic state, the patient with hyperthyroidism needs to be provided with an environment that is restful, physically and mentally. Six full meals a day that are well balanced and high in calories are required because of the accelerated metabolic rate. Foods that increase peristalsis such as high fiber food, needs to be avoided. These patient suffer from heat intolerance and require cool environment. Back to Board

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17. Phenytoin is contraindicated during pregnancy because of the possibility of: A nurse develops a plan of care for a patient with hyperthyroidism which includes which of the following in the plan? B.Provide extra blankets D. Provide a restful environment

18. A client enters the emergency department. The paramedics report that the child has been having a seizure that has lasted for 45 minutes. In addition to securing and maintaining an airway, the nurse would anticipate initially administering: A patient is admitted to the emergency room, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? B. Maintain airway A. Administer fluid replacement C. Warm the patient D. Administer thyroid hormone.

19. Diazepam IV is the drug of choice with status epilepticus. The initial nursing action would be to maintain airway, oxygen would be administered, followed by fluid replacement, keeping the patient warm, monitoring vital signs and administering thyroid hormones by the IV route. Back to Board

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22. A client enters the emergency department. The paramedics report that the child has been having a seizure that has lasted for 45 minutes. In addition to securing and maintaining an airway, the nurse would anticipate initially administering: A patient is admitted to the emergency room, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially. A. Administer fluid replacement B. Maintain Airway

23. Valproic acid (Depakene) is prescribed for various types of seizures. This anticonvulsant is contraindicated for clients with: A nurse is preparing a teaching plan for a patient with diabetes mellitus regarding proper foot care. Which instruction is included in the plan? A. apply moisturizing lotion to dry feet, but not between the toes B. soak feet in hot water C. Avoid using a mild soap on the feet. D. Always, have a podiatrist; never cut them yourself.

24. Valproic acid is known to be hepatotoxic. The patient is instructed to use a moisturizing lotion on the feet and avoid applying the lotion between the toes. The patient would be instructed to not soak the feet and avoid hot water to prevent burns. The patient may cut the toenails straight across, and could consult a podiatrist if the toenails were thick or hard to cut and if vision was poor. The patient is instructed to wash the feet daily with a mild soap. Back to Board

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27. Valproic acid (Depakene) is prescribed for various types of seizures. This anticonvulsant is contraindicated for clients with: A nurse is preparing a teaching plan for a patient with diabetes mellitus regarding proper foot care. Which instruction is included in the plan. A. apply moisturizing lotion to dry feet, but not between the toes D. Always, have a podiatrist; never cut them yourself.

28. A client with a new seizure disorder is ordered to receive phenobarbital (Luminal) for seizures. Which of the following would the nurse expect? A patient is brought to the emergency room in an unresponsive state, and a diagnosis hyperosmolar hyperglycemic nonketonic syndrome is made. The nurse would prepare immediately to initiate which of the following anticipated physician orders? A. 100 U NPH insulin B.Endotracheal intubation C. IV replacement of sodium bicarbonate D. IV infusion of normal saline

29. As a barbiturate, this medication is known for is sedative effect. The primary goal of treatment in HHNS is to rehydrate the patient to restore fluid volume and to correct electrolyte deficiency. IV fluid replacement is similar to that administered in DKA and begins with IV infusion of normal saline. Regular, not NPH would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. Intubation and mechanical ventilation are not required to treat HHNS. Back to Board

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32. A client with a new seizure disorder is ordered to receive phenobarbital (Luminal) for seizures. Which of the following would the nurse expect? A patient is brought to the emergency room in an unresponsive state, and a diagnosis hyperglycemic hyperosmolar nonketonic syndrome is made. The nurse would prepare immediately to initiate which of the following anticipated physician orders? C.Endotracheal intubation D. IV infusion of normal saline

33. The nurse determines that a client on phenytoin (Dilantin) is admitted to the emergency department with a level of 30 mcg/mL. The nurse would evaluate for which one of the following severe side effects? A nurse is monitoring a patient with diabetes insipidus. Desmopressin (DDAVP), has been prescribed for the patient. Which of the following outcomes reflects a therapeutic effect of this medication? A. Serum Osm > 320 msom/kg B. Increased Blood pressure C. Decrease urine output. D. Urine Osm < 100 mosm/kg

34. Gingival hyperplasia is a known and common side effect of high phenytoin levels. DDAVP is a synthetic form of anti-diuretic hormone that causes increase re-absorption of water which results in decreased urine output. The therapeutic response to DDAVP would demonstrate a decrease in serum Osm, because more fluid is retained, and increase in urine Osm because less fluid is excreted. Increase blood pressure is a side affect rather than a therapeutic effect of DDAVP. Back to Board

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36. The nurse determines that a client on phenytoin (Dilantin) is admitted to the emergency department with a level of 30 mcg/mL. The nurse would evaluate for which one of the following severe side effects? T A nurse is monitoring a patient with diabetes insipidus. Desmopressin (DDAVP), has been prescribed for the patient. Which of the following outcomes reflects a therapeutic effect of this medication. C. Decrease urine output. D. Urine Osm < 100 mosm/kg

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38. Clients with parkinsonism lack sufficient amounts of which of the following neurotransmitters? A patient with type I diabetes calls the nurse to report recurrent episodes of hypoglycemia with exercises. Which statement by the patient indicates an inadequate understanding of the peak action of NPH insulin and exercise? A. The best time for me to exercise is every afternoon B. The best time for me to exercise is after I eat. C. The best time for me to exercise is after breakfast D. The best time for me to exercise is after my morning snack.

39. Dopamine is deficient in Parkinson’s disease. Hypoglycemic reaction may occur in response to increased exercise. Patients should avoid exercise during the peak time of insulin. NPH insulin peaks at 6-14 hours; therefore afternoon exercise will occur during the peak of the medication. The other options do not address peak action time. Back to Board

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42. Clients with parkinsonism lack sufficient amounts of which of the following neurotransmitters? A patient with type I diabetes calls the nurse to report recurrent episodes of hypoglycemia with exercises. Which statement by the patient indicates an inadequate understanding of the peak action of NPH insulin and exercise? A. The best time for me to exercise is every afternoon B. The best time for me to exercise is after I eat. Back to Question

43. A client is admitted with the diagnosis of Parkinson’s disease. The nurse is vigilant for which of the following symptoms? A patient is hospitalized with possible SIADH. The patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial laboratory results to include a A. hematocrit of 52%. B. serum chloride of 110 mEq/L (110 mmol/L). C. blood urea nitrogen (BUN) of 22 mg/dl (11.5 mmol/L). D. serum sodium of 125 mEq/L (125 mmol/L).

44. Bradykinesia, or slow voluntary movement, is characteristic of this disorder. When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. The BUN is not helpful in diagnosis of SIADH and this BUN value is increased. The serum chloride level will usually decrease along with the sodium level. This chloride value is elevated. Back to Board

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47. A client is admitted with the diagnosis of Parkinson’s disease. The nurse is vigilant for which of the following symptoms? A patient is hospitalized with possible SIADH. The patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial laboratory results to include a B. serum chloride of 110 mEq/L (110 mmol/L). D. serum sodium of 125 mEq/L (125 mmol/L).

48. The client taking an anticholinergic drug to treat parkinsonism symptoms may experience many side effects. In writing this client’s care plan, which of the following side effects would not be included? When caring for a patient who has just had a parathyroidectomy, the nurse will plan to monitor the patient for A. increased levels of calcitonin B. increased levels of active vitamin D C. low serum calcium level D. low magnesium level

49. Anticholinergic drugs cause hypotension. Serum calcium levels are likely to fall after a parathyroidectomy, and it will be important to monitor the calcium level to avoid tetany. Magnesium and vitamin D levels impact parathyroid function, but these will not be relevant after a parathyroidectomy. Calcitonin is secreted by the thyroid gland. Back to QUESTION

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