Neurologic Nursing

Why C is correct

The C4 injury carries the greatest risk. The phrenic nerve, the nerve from the neck that works the diaphragm (the main breathing muscle), leaves the cord high in the neck. An injury from C1 to C4 can stop breathing.

Why the other options are wrong

• A — "Client with an injury at the T1 level": A T1 injury lies below all the nerves to the diaphragm.
• B — "Client with an injury at the C6 level": At C6 the diaphragm's nerve supply is intact, though the chest and belly muscles help less.
• D — "Client with an injury at the C5 level": A C5 injury leaves more of the diaphragm's nerve supply working than C4. Diaphragm weakness can occur at C5, but the nerve roots above it still reach the muscle.

Why A is correct

Thin liquids move fastest and scatter most, which makes them the hardest consistency to control, and that is why water provokes coughing while soft food passes. Modifying consistency is the first-line adjustment because it slows the bolus and keeps her drinking.

Why the other options are wrong

• B — Withhold her liquids pending a swallow study: a formal evaluation is appropriate, but stopping all fluids while awaiting it trades a manageable aspiration risk for dehydration.
• C — Request a feeding tube for her hydration: a tube is a later decision for a client whose oral intake is failing overall; she is still managing soft food, so this skips several safer steps.
• D — Offer her liquids through a narrow straw: straws are often assumed to help, but they deliver a fast thin bolus into the pharynx before she can position it, worsening exactly the control she has lost.

Why A is correct

The thiopurine methyltransferase (TPMT) level measures the enzyme that breaks down azathioprine, a drug that lowers the immune system's activity. With low TPMT, ordinary doses can dangerously lower the blood counts, so the level is checked first.

Why the other options are wrong

• B — "Acetylcholine receptor antibody level": The acetylcholine receptor antibody level measures the antibodies that attack the muscle's signal receivers. It is a valid test for confirming the disease, but it says nothing about azathioprine safety.
• C — "Fasting blood sugar level": The fasting blood sugar level shows the sugar in the blood after a night without food. It matters with prednisone, which can bring on diabetes, but azathioprine's danger lies in the blood counts.
• D — "Creatine kinase level": The creatine kinase level rises when muscle tissue breaks down, which is not how azathioprine causes harm.

Why C is correct

Parkinson disease can make the skin oily, especially on the forehead and at the sides of the nose, and an oily scalp can cause dandruff. These skin changes come from the disease itself.

Why the other options are wrong

• A — "a skin change from her levodopa-carbidopa": Oily skin and dandruff are listed as symptoms of the disease itself, not of the drug. Skin effects such as a rash and heavier sweating can occur with levodopa-carbidopa, but they are a different set of changes.
• B — "a skin change that comes with older age": Age does not explain this pattern; an oily forehead, oily sides of the nose and dandruff match the skin problems Parkinson disease causes.
• D — "a skin change from washing her face less often": The oil comes from the disease, not from how often she washes her face.

Why D is the answer

D does not occur in Guillain-Barre syndrome (GBS), where the immune system attacks nerves lying outside the brain and spinal cord. Its weakness is flaccid, meaning floppy and limp. Spasticity, a tight, stiff pull in the muscles, points to spinal cord damage, which casts doubt on GBS.

Why the other options are not the answer

• A — "Pneumonia or a urinary infection acquired in the hospital": Accurate. These infections can occur in any client kept in bed in a hospital.
• B — "Joints that stiffen and shorten in limbs that stay weak": Accurate. Stiff joints are genuine in GBS, but unlike D this is a contracture, a joint shortened in a limb that stays weak for a long time.
• C — "A drop in blood sodium that needs prompt correction": Accurate. Low blood sodium can occur in any client with GBS and is corrected promptly.