An adult female patient presents with new-onset diplopia (double vision), altered balance, numbness on one side of the face, and urinary and bowel incontinence. Which finding is consistent with the suspected diagnosis?

Correct Answer: A

Rationale: The correct answer is A: Lhermitte sign. Lhermitte sign is characterized by an electric shock-like sensation that radiates down the spine and limbs upon neck flexion, indicating a lesion in the cervical spinal cord. In this case, the patient's symptoms of diplopia, altered balance, facial numbness, and incontinence suggest a neurological issue, possibly multiple sclerosis (MS), which commonly presents with Lhermitte sign. Choice B: Stereognosis involves the ability to recognize objects by touch, not relevant to the patient's symptoms. Choice C: Gel phenomenon is unrelated to the neurological symptoms described. Choice D: Kernig sign is typically associated with meningitis, which does not align with the patient's presentation of neurological deficits suggestive of MS.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) The NA performs the patient's complete bath and oral care. This is the action that requires intervention because it involves providing personal hygiene care, which is outside the scope of practice for a nursing assistant. Option A is correct as the NA assisting the patient to ambulate aligns with promoting physical mobility. Option B is incorrect as reminding the patient not to look at his feet is a helpful cue for individuals with Parkinson's disease to improve their gait. Option D is also acceptable as it encourages the patient's independence in feeding, which is important for maintaining physical function. Educationally, it is crucial to emphasize the scope of practice for nursing assistants and the importance of adhering to professional boundaries. Providing clear guidelines on what tasks they can and cannot perform ensures patient safety and quality care delivery. Additionally, understanding the specific needs of patients with Parkinson's disease is essential for tailoring care interventions to promote their functional independence and well-being.

Correct Answer: A

Rationale: In this scenario, option A, which instructs the nursing assistant to position the patient sitting up in bed before feeding her, is the correct answer. This is because positioning the patient in an upright position helps prevent aspiration, a common risk for stroke patients with swallowing difficulties. By sitting the patient up, gravity assists in the safe passage of food down the esophagus. Option B, checking the patient's gag and swallowing reflexes, is important but should have been done by the healthcare provider or nurse before the feeding task. Nursing assistants should not independently assess these reflexes. Option C is incorrect as it promotes rushing through the feeding process, which can increase the risk of aspiration and compromise the patient's safety and dignity. Option D is also incorrect because suctioning between bites of food is not a standard practice and should only be done if there is a specific medical indication for it. Educationally, this question highlights the importance of proper positioning during feeding for stroke patients to prevent complications like aspiration pneumonia. It emphasizes the role of nursing assistants in following established protocols for patient safety and the importance of understanding the rationale behind each task in patient care.

Correct Answer: A

Rationale: In the management of epilepsy, the primary factor in determining the choice of anticonvulsant medication is seizure classification (Option A). Seizure classification is crucial as different types of seizures respond better to specific anticonvulsants. For example, absence seizures are typically treated with different medications than focal seizures. The other options are not the primary factor in choosing an anticonvulsant medication. The size of the dosage (Option B) is important for determining the therapeutic range and ensuring efficacy but is not the primary factor in initial selection. The age of the patient (Option C) is a consideration due to potential side effects and dosing adjustments, but it is not the primary factor in choosing the medication. Side effects produced (Option D) are important to monitor and manage, but they are not the primary factor in the initial selection of the anticonvulsant. In an educational context, understanding the rationale behind choosing anticonvulsant medications based on seizure classification is essential for healthcare professionals involved in the care of patients with epilepsy. It ensures that the most appropriate treatment is selected, leading to better seizure control and improved quality of life for patients. Educating healthcare providers on this principle enhances their clinical decision-making skills and ultimately improves patient outcomes.

Correct Answer: B

Rationale: The correct answer is B) observing for myasthenic crisis. When a patient's medication is being adjusted, especially in the case of Susan who may be on medications affecting neuromuscular transmission like those for myasthenia gravis, it is crucial to monitor for potential complications such as myasthenic crisis. This is a life-threatening condition characterized by severe muscle weakness that can lead to respiratory failure. Prioritizing the observation for signs and symptoms of myasthenic crisis ensures prompt recognition and intervention if it occurs, which is essential for patient safety and well-being. Option A) developing a therapeutic relationship, while important for overall care, is not the priority when a patient's medication is being adjusted and a potential crisis needs to be monitored for. Option C) initiating a teaching plan and Option D) instructing her family about medications are also important aspects of care but do not take precedence over the immediate safety concern of monitoring for myasthenic crisis. In an educational context, understanding the prioritization of care based on the patient's condition and potential complications is vital for healthcare providers to ensure effective and safe patient management. This question highlights the importance of critical thinking and clinical decision-making in prioritizing nursing interventions during medication adjustments and potential crisis situations in neurological system assessments.