ITS THE FINAL COUNT DOWWWWNNNNN!!!!!

Which is a clinical manifestation of a cerebral tumor? 1Aphasia 2Dysphagia 3Nystagmus 4Hoarseness

1Aphasia is a clinical manifestation of a cerebral tumor. Dysphagia, nystagmus, and hoarseness are clinical manifestations of brainstem tumors.

A patient is having difficulty understanding spoken and written words and is saying made-up words and meaningless speech. What would be the possible reason behind the patient's condition? 1Mixed aphasia 2Global aphasia 3Receptive aphasia 4Expressive aphasia

3 Receptive aphasia occurs due to injury in Wernicke's area in the temporoparietal area. This leads to the patient having difficulty understanding spoken and written words, creating made-up words, and using meaningless speech. Mixed aphasia is difficulty in expression and reception, which includes difficulty speaking and writing. Global aphasia occurs due to severe damage in the receptive and expressive skills. Expressive aphasia occurs due to difficulty speaking and writing.

Which type of stroke is caused by aneurysm or hypertension? 1Embolic stroke 2Ischemic stroke 3Thrombotic stroke 4Hemorrhagic stroke

4 In a hemorrhagic stroke, vessel integrity is interrupted and bleeding occurs into the brain tissue or into the subarachnoid space due to aneurysm or hypertension. A stroke caused by an embolus or a dislodged clot is referred to as an embolic stroke. An acute ischemic stroke is caused by the occlusion or blockage of a cerebral artery by either a thrombus or an embolus. A stroke that is caused by a thrombus (clot) is referred to as a thrombotic stroke.

A nurse cares for a client with chronic hypercortisolism. Which action should the nurse take? a. Wash hands when entering the room. b. Keep the client in airborne isolation. c. Observe the client for signs of infection. d. Assess the clients daily chest x-ray.

A (Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory chemicals. As a result, these clients are at greater risk of infection and may not have the expected inflammatory manifestations when an infection is present. The nurse needs to take precautions to decrease the clients risk. It is not necessary to keep the client in isolation. The client does not need a daily chest x-ray.)

Which key interventions should be implemented postoperatively for the patient after undergoing a hypophysectomy? (Select all that apply.) A. Report any postnasal drip. B. Keep the head of the bed elevated. C. Have the patient avoid coughing soon after surgery. D. Monitor for a light-yellow color at the edge of clear drainage. E. Instruct the patient to take thyroid and glucocorticoid replacement for at least 6 months.

A, B, C, D

A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values should the nurse associate with this disorder? (Select all that apply.) a. Sodium: 150 mEq/L b. Sodium: 130 mEq/L c. Potassium: 2.5 mEq/L d. Potassium: 5.0 mEq/L e. pH: 7.28 f. pH: 7.50

A, C, F (Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.)

A client had an embolic stroke and is having an echocardiogram. When the client asks why the provider ordered a test on my heart, how should the nurse respond? a. Most of these types of blood clots come from the heart. b. Some of the blood clots may have gone to your heart too. c. We need to see if your heart is strong enough for therapy. d. Your heart may have been damaged in the stroke too.

ANS: A An embolic stroke is caused when blood clots travel from one area of the body to the brain. The most common source of the clots is the heart. The other statements are inaccurate.

After a stroke, a client has ataxia. What intervention is most appropriate to include on the clients plan ofcare? a. Ambulate only with a gait belt. b. Encourage double swallowing. c. Monitor lung sounds after eating. d. Perform post-void residuals.

ANS: A Ataxia is a gait disturbance. For the clients safety, he or she should have assistance and use a gait belt whenambulating. Ataxia is not related to swallowing, aspiration, or voiding.

A client has a brain abscess and is receiving phenytoin (Dilantin). The spouse questions the use of the drug,saying the client does not have a seizure disorder. What response by the nurse is best? a. Increased pressure from the abscess can cause seizures. b. Preventing febrile seizures with an abscess is important. c. Seizures always occur in clients with brain abscesses. d. This drug is used to sedate the client with an abscess.

ANS: A Brain abscesses can lead to seizures as a complication. The nurse should explain this to the spouse. Phenytoinis not used to prevent febrile seizures.

A nurse is providing community screening for risk factors associated with stroke. Which client would thenurse identify as being at highest risk for a stroke? a. A 27-year-old heavy cocaine user b. A 30-year-old who drinks a beer a day c. A 40-year-old who uses seasonal antihistamines d. A 65-year-old who is active and on no medications

ANS: A Heavy drug use, particularly cocaine, is a risk factor for stroke. Heavy alcohol use is also a risk factor, but one beer a day is not considered heavy drinking. Antihistamines may contain phenylpropanolamine, which also increases the risk for stroke, but this client uses them seasonally and there is no information that they are abused or used heavily. The 65-year-old has only age as a risk factor.

A client with myasthenia gravis (MG) asks the nurse to explain the disease. What response by the nurse is best? a. "MG is an autoimmune problem in which nerves do not cause muscles to contract." b. "MG is an inherited destruction of peripheral nerve endings and junctions." c. "MG consists of trauma-induced paralysis of specific cranial nerves." d. "MG is a viral infection of the dorsal root of sensory nerve fibers."

ANS: A MG is an autoimmune disorder in which nerve fibers are damaged and their impulses do not lead to muscle contraction. MG is not an inherited or viral disorder and does not paralyze specific cranial nerves.

The nurse working in the emergency department assesses a client who has symptoms of stroke. For what modifiable risk factors should the nurse assess? (Select all that apply.) a. Alcohol intake b. Diabetes c. High-fat diet d. Obesity e. Smoking

ANS: A, C, D, E Alcohol intake, a high-fat diet, obesity, and smoking are all modifiable risk factors for stroke. Diabetes is not modifiable but is a risk factor that can be controlled with medical intervention.

A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for adrenal insufficiency? (Select all that apply.) a. A 22-year-old female with metastatic cancer b. A 43-year-old male with tuberculosis c. A 51-year-old female with asthma d. A 65-year-old male with gram-negative sepsis e. A 70-year-old female with hypertension

ANS: A, B, D Metastatic cancer, tuberculosis, and gram-negative sepsis are primary causes of adrenal insufficiency. Active tuberculosis is a contributing factor for syndrome of inappropriate antidiuretic hormone. Hypertension is a key manifestation of Cushing's disease. These are not risk factors for adrenal insufficiency.

A nursing student studying traumatic brain injuries (TBIs) should recognize which facts about these disorders? (Select all that apply.) a. A client with a moderate trauma may need hospitalization. b. A Glasgow Coma Scale score of 10 indicates a mild brain injury. c. Only open head injuries can cause a severe TBI. d. A client with a Glasgow Coma Scale score of 3 has severe TBI. e. The terms mild TBI and concussion have similar meanings.

ANS: A, D, E Mild TBI is a term used synonymously with the term concussion. A moderate TBI has a Glasgow Coma Scale(GCS) score of 9 to 12, and these clients may need to be hospitalized. Both open and closed head injuries can cause a severe TBI, which is characterized by a GCS score of 3 to 8.

A client with a traumatic brain injury is agitated and fighting the ventilator. What drug should the nurseprepare to administer? a. Carbamazepine (Tegretol) b. Dexmedetomidine (Precedex) c. Diazepam (Valium) d. Mannitol (Osmitrol)

ANS: B Dexmedetomidine is often used to manage agitation in the client with traumatic brain injury. Carbamazepine is an antiseizure drug. Diazepam is a benzodiazepine. Mannitol is an osmotic diuretic.

A student nurse is preparing morning medications for a client who had a stroke. The student plans to hold the docusate sodium (Colace) because the client had a large stool earlier. What action by the supervising nurseis best? a. Have the student ask the client if it is desired or not. b. Inform the student that the docusate should be given. c. Tell the student to document the rationale. d. Tell the student to give it unless the client refuses.

ANS: B Stool softeners should be given to clients with neurologic disorders in order to prevent an elevation inintracranial pressure that accompanies the Valsalva maneuver when constipated. The supervising nurse should instruct the student to administer the docusate. The other options are not appropriate. The medication could be held for diarrhea.

A client with Guillain-Barré syndrome is admitted to the hospital. The nurse plans caregiving priority to interventions that address which priority client problem? a. Anxiety b. Low fluid volume c. Inadequate airway d. Potential for skin breakdown

ANS: C Airway takes priority. Anxiety is probably present, but a physical diagnosis takes priority over a psychosocial one. The client has no reason to have low fluid volume unless he or she has been unable to drink for some time. If present, airway problems take priority over a circulation problem. An actual problem takes precedence over a risk for a problem.

The nurse assesses a clients Glasgow Coma Scale (GCS) score and determines it to be 12 (a 4 in eachcategory). What care should the nurse anticipate for this client? a. Can ambulate independently b. May have trouble swallowing c. Needs frequent re-orientation d. Will need near-total care

ANS: C This client will most likely be confused and need frequent re-orientation. The client may not be able to ambulate at all but should not do so independently, not because of mental status. Swallowing is not assessed with the GCS. The client will not need near-total care.

A client has documented acromegaly. During a physical assessment before surgery for a knee replacement, the nurse discovers that she has a moderately enlarged liver. Which is the nurse's best action? a. Counsel the client on the health risks of alcoholism .b. Assess for jaundice of the skin and eyes. c. Document the finding and monitor the client. d. Draw blood for liver function studies.

ANS: C Clients with acromegaly or gigantism commonly have organomegaly of the heart and liver. Other than documenting the finding and monitoring the client, these actions would be inappropriate because the finding is commonly associated with acromegaly.

A client in the intensive care unit is scheduled for a lumbar puncture (LP) today. On assessment, the nursefinds the client breathing irregularly with one pupil fixed and dilated. What action by the nurse is best? a. Ensure that informed consent is on the chart. b. Document these findings in the clients record. c. Give the prescribed preprocedure sedation. d. Notify the provider of the findings immediately.

ANS: D This client is exhibiting signs of increased intracranial pressure. The nurse should notify the provider immediately because performing the LP now could lead to herniation. Informed consent is needed for an LP,but this is not the priority. Documentation should be thorough, but again this is not the priority. The preprocedure sedation (or other preprocedure medications) should not be given as the LP will most likely be canceled.

A nurse receives a report on a client who had a left-sided stroke and has homonymous hemianopsia. What action by the nurse is most appropriate for this client? a. Assess for bladder retention and/or incontinence. b. Listen to the clients lungs after eating or drinking. c. Prop the clients right side up when sitting in a chair. d. Rotate the clients meal tray when the client stops eating.

ANS: D This condition is blindness on the same side of both eyes. The client must turn his or her head to see the entire visual field. The client may not see all the food on the tray, so the nurse rotates it so uneaten food is now within the visual field. This condition is not related to bladder function, difficulty swallowing, or lack of trunk control.

TERMS I Couldnt find on here: Alexia- cant comprehend written language agraphia- loss of ability to write acalculia- inability to do simple math (my baseline) hemiplegia & hemiparesis- paralysis on one side Quadriparesis- muscle weakness in all four limbs hypotonia- poor muscle tone (also my baseline) agnosia- loss of ability to identify objects or people apraxia- inability to perform learned movements on command inattention/ neglect syndrome- lack awareness of affected side ptosis- upper eyelid droops over eye nystagmus- involuntary rapid eye movement paresthesia- tingling/ prickling sensation

Alexia- cant comprehend written language agraphia- loss of ability to write acalculia- inability to do simple math (my baseline) hemiplegia & hemiparesis- paralysis on one side Quadriparesis- muscle weakness in all four limbs hypotonia- poor muscle tone (also my baseline) agnosia- loss of ability to identify objects or people apraxia- inability to perform learned movements on command inattention/ neglect syndrome- lack awareness of affected side ptosis- upper eyelid droops over eye nystagmus- involuntary rapid eye movement paresthesia- tingling/ prickling sensation

A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, I feel like I am going crazy. How should the nurse respond? a. I will ask your doctor to order a psychiatric consult for you. b. You feel this way because of your hormone levels. c. Can I bring you information about support groups? d. I will close the door to your room and restrict visitors.

B (Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.)

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The clients serum sodium level is 114 mEq/L. Which action should the nurse take first? a. Consult with the dietitian about increased dietary sodium. b. Restrict the clients fluid intake to 600 mL/day. c. Handle the client gently by using turn sheets for re-positioning. d. Instruct unlicensed assistive personnel to measure intake and output.

B (With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. Adding sodium to the clients diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client should be on intake and output; however, this will monitor only the clients intake, so it is not the best answer. Reducing intake will help increase the clients sodium.)

A nurse cares for a client who is prescribed vasopressin (DDAVP) for diabetes insipidus. Which assessment findings indicate a therapeutic response to this therapy? (Select all that apply.) a. Urine output is increased. b. Urine output is decreased. c. Specific gravity is increased. d. Specific gravity is decreased. e. Urine osmolality is increased. f. Urine osmolality is decreased.

B, C, E (Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolality, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.)

A nurse teaches a client with Cushings disease. Which dietary requirements should the nurse include in this clients teaching? (Select all that apply.) a. Low calcium b. Low carbohydrate c. Low protein d. Low calories e. Low sodium

B, D, E (The client with Cushings disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein intake will help decrease muscle loss.)

Decreased production of all of the anterior pituitary hormones results in which condition? A. Adenohypophysis B. Panhypopituitarism C. Primary pituitary dysfunction D. Secondary pituitary dysfunction

B. Panhypopituitarism

A nurse assesses a client who is recovering from a transsphenoidal hypophysectomy. The nurse notes nuchal rigidity. Which action should the nurse take first? a. Encourage range-of-motion exercises. b. Document the finding and monitor the client. c. Take vital signs, including temperature. d. Assess pain and administer pain medication.

C (Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection; usually the client will also have a fever and tachycardia. Range-of-motion exercises are inappropriate because meningitis is a possibility. Documentation should be done after all assessments are completed and should not be the only action. Although pain medication may be a palliative measure, it is not the most appropriate initial action.)

A client with Cushing's disease begins to laugh loudly and inappropriately, causing the family in the room to be uncomfortable. What is the nurse's best response? a. "Don't mind this. The disease is causing this." b. "I need to check the client's cortisol level." c. "The disease can sometimes affect emotional responses." d. "Medication is available to help with this."

C. "The disease can sometimes affect emotional responses."

Which statement about hyperaldosteronism is correct? A. Painful "Charlie horse" are common from hyperkalemia B. It occurs more often in men than in women C. It's a common cause of hypertension in the population D. Hypokalemia and hypertension are the main issues

D. Hypokalemia and hypertension are the main issues

A client is referred to a home health agency after a transsphenoidal hypophysectomy. Which action does the RN case manager delegate to the home health aide who will see the client daily? a. Document symptoms of incisional infection or meningitis. b. Give over-the-counter laxatives if the client is constipated. c. Set up medications as prescribed for the day. d. Test any nasal drainage for the presence of glucose.

D. Test any nasal drainage for the presence of glucose.

Which is a clinical manifestation of brainstem tumors? 1Aphasia 2Dysphagia 3Paresthesia 4Hyperesthesia

Dysphagia is a clinical manifestation of brainstem tumors. Aphasia, paresthesia, and hyperesthesia are clinical manifestations of cerebral tumors.

What is the priority expected outcome in a patient with GBS? a. Maintain airway patency and gas exchange. b. Promote communication. c. Manage pain. d. Prevent complications of immobility.

a

A client with a traumatic brain injury from a motor vehicle crash is monitored for signs of increased intracranial pressure (ICP). Which sign does the nurse monitor for? a. Changes in breathing pattern b. Dizziness c. Increasing level of consciousness d. Reactive pupils

a Changes in breathing pattern Changes in breathing pattern may cause hypoxia and hypercapnia, which can increase ICP. Dizziness is indicative of brain injury. Increasing level of consciousness and reactive pupils are desired outcomes for this client.

Which are risk factors for stroke?Select all that apply. a. High blood pressure b. Previous stroke or transient ischemic attack (TIA) c. Smoking d. Use of oral contraceptives e. Female gender

a, b, c, d High blood pressure, Previous stroke or transient ischemic attack (TIA), Smoking, Use of oral contraceptives Common modifiable risk factors for developing a stroke include smoking and the use of oral contraceptives, specifically in women over the age of 35 and in women over the age of 30 who smoke. Other risk factors include high blood pressure and history of a previous TIA. Gender is not a known risk factor for stroke; however, the female client is at risk for delayed recognition of early stroke symptoms.

Which patients are at increased risk for stroke? (Select all that apply.) a. 66-year-old man with diabetes mellitus b. 35-year-old healthy woman who uses oral contraceptives c. 47-year-old woman who exercises regularly d. 35-year-old man with history of multiple transient ischemic attacks e. 25-year-old woman with Bell's palsy f. 53-year-old man with chronic alcoholism

a, b, d, f

Which interventions are necessary for a patient with adrenal insufficiency (Addison's crisis)? A. IV infusion of NS B. IV infusion of 3% saline C. Hourly glucose monitoring D. Insulin administration E. IV potassium therapy F. Administer IV hydrocortisone sodium

a, c, d, f

Which statements about diabetes insipidus are accurate? A. It's caused by ADH deficiency B. It's characterized by a decrease in urination C. Urine output of greater than 4L/24 hours is the first diagnosis indication D. The water loss increases plasma osmolarity E. Nephrogenic DI can be caused by lithium F. Increased thirst is a mechanism of the body to attempt maintaining fluid balance.

a, c, d, f

Which statements about MG are accurate? (Select all that apply.) a. It is an acquired autoimmune disease. b. It usually occurs in young adults. c. It occurs lightly more in men than women. d. It is often accompanied by weight gain and distal weakness. e. It is associated with hyperplasia of thymus gland. f. It is characterized by remissions and exacerbations.

a, c, e, f

A patient is recovering from a transphenoidal hypophysectomy. What postoperative nursing interventions apply to this patient? (Select all that apply.) a. Encouraging the patient to perform deep-breathing exercises b. Vigorous coughing and deep-breathing exercises c. Instructing on the use of a soft-bristled toothbrush for brushing the teeth d. Struct monitoring of fluid balance e. Hourly neurologic checks for first 24 hours f. Instructing the patient to alert the nurse regarding postnasal drip

a, d, e, f

A client with syndrome of inappropriate antidiuretic hormone (SIADH) is admitted with a serum sodium level of 105 mEq/L (105 mmol/L). Which request by the health care provider does the nurse carry out first? a. Administer infusion of 150 mL of 3% NaCl over 3 hours. b. Draw blood for hemoglobin and hematocrit (H&H). c. Insert an indwelling catheter and monitor urine output. d. Weigh the client on admission and daily thereafter.

a. Administer infusion of 150 mL of 3% NaCl over 3 hours.

The nurse is planning to administer medications to a client with diabetes insipidus (DI) who has dry lips and mucous membranes and poor skin turgor. Which intervention will the nurse provide first a. Encourage oral fluid intake b. Offer lip balm c. Perform a 24-hour urine test d. Withhold desmopressin acetate (DDAVP)

a. Encourage oral fluid intake

A patient has been diagnosed with subarachnoid hemorrhage. Which drug does the nurse anticipate will be ordered to control cerebral vasospasm? a. Nimodipine (Nimotop) b. Phenytoin (Dilantin) c. Dexamethazone (Decaddron) d. Clopidogrel (Plavix)

a. Nimodipine (Nimotop)

A patient with a right cerebral hemisphere stroke may have safety issues related to which factor? a. Poor impulse control b. Alexia and agraphia c. Loss of language and analytical skills d. Slow and cautious behavior

a. Poor impulse control

A client has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus (DI) secondary to lithium overdose. The client has a prescription for Desmopressin (DDAVP). Which outcome indicates a positive response to treatment? a. Urine output of 60-80 mL/hour b. Blood glucose level of 110 mg/dL (6.1 mmol/L) c. Ability to sit quietly and read a magazine d. Potassium level within expected range

a. Urine output of 60-80 mL/hour

A client has had a traumatic brain injury and is mechanically ventilated. Which technique does the nurse use to prevent increasing intracranial pressure (ICP)? a. Assessing for Turner's sign b. Maintaining PaCO2 levels at 35 mm Hg c. Placing the client in the Trendelenburg position d. Suctioning the client frequently

b Maintaining PaCO2 levels at 35 mm HgAfter the first 24 hours when a client is mechanically ventilated, keeping the PaCO2 levels at 35 mm Hg prevents vasodilation, which could increase ICP. CO2 is a powerful vasodilator. Turner's sign is a bluish gray discoloration in the flank region caused by acute pancreatitis. The head of the bed should be at 30 degrees; the Trendelenburg position will cause the client's ICP to increase. Although some suctioning is necessary, frequent suctioning should be avoided because it increases ICP.

The nurse admits a client with suspected myasthenia gravis (MG). The nurse anticipates that the health care provider will request which medication to aid in the diagnosis of MG? a. Atropine b. Edrophonium chloride (Tensilon) c. Methylprednisolone (Solu-Medrol) d. Morphine sulfate

b Edrophonium chloride (Tensilon)Edrophonium chloride (Tensilon) and neostigmine bromide (Prostigmin) may be used for testing for MG. Tensilon is used most often because of its rapid onset and brief duration of action. This drug inhibits the breakdown of acetylcholine (ACh) at the postsynaptic membrane, which increases the availability of ACh for excitation of postsynaptic receptors. Atropine has parasympatholytic effects and is the antidote for edrophonium chloride. Methylprednisolone (Solu-Medrol) is a glucocorticoid that is used to treat inflammatory disorders. Morphine is an opioid analgesic and is not used in the diagnosis of MG.

A client has been admitted with a diagnosis of stroke (brain attack). The nurse suspects that the client has had a right hemisphere stroke because the client exhibits which symptoms? a. Aphasia and cautiousness b. Impulsiveness and smiling c. Inability to discriminate words d. Quick to anger and frustration

b Impulsiveness and smiling Impulsiveness and smiling are symptoms indicative of a right hemisphere stroke. Aphasia, cautiousness, the inability to discriminate words, quick to anger, and frustration are symptoms indicative of a left hemisphere stroke.

A client presents to the emergency department with acute adrenal insufficiency and the following vital signs: P 118 beats/min, R 18 breaths/min, BP 84/44 mm Hg, pulse oximetry 98%, and T 98.8°F oral. Which nursing intervention is the highest priority for this client? a. Administering furosemide (Lasix) b. Providing isotonic fluids c. Replacing potassium losses d. Restricting sodium

b. Providing isotonic fluids

The nurse is performing an assessment of an adult patient with new-onset acromegaly. What does the nurse expect to find? a. Extremely long arms and legs b. Thickened lips c. Changes in menses with infertility d. Rough, extremely dry skin

b. Thickened lips

What is considered a positive diagnostic finding of a Tensilon test? a. After the cholinesterase inhibitor is administered, there are no observable changes in muscle strength or tone. b. Within 30 to 60 seconds after receiving the cholinesterase inhibitor, there is increased muscle tone that lasts 4 to 5 minutes. c. Within 30 minutes of receiving the cholinesterase inhibitor, there is improved muscle strength that lasts for several weeks. d. After the cholinesterase inhibitor is first administered, the patient will experience muscle weakness and then return to baseline.

b. Within 30 to 60 seconds after receiving the cholinesterase inhibitor, there is increased muscle tone that lasts 4 to 5 minutes.

The nurse is assessing a client with a traumatic brain injury after a skateboarding accident. Which symptom is the nurse most concerned about? a. Amnesia b. Head laceration c. Asymmetric pupils d. Restlessness

c Asymmetric pupils Asymmetric (uneven) pupils, loss of light reaction, or unilateral or bilateral dilated pupils are a sign of a severe traumatic brain injury. Pupil changes are treated as herniation of the brain from increased intracranial pressure (ICP) until proven differently. The nurse should report and document any changes in pupil size, shape, and reactivity to the health care provider immediately because they could indicate an increase in ICP. Amnesia, a head laceration, and restlessness can be symptoms of mild traumatic brain injuries.

The nurse is monitoring a postoperative craniotomy client with increased intracranial pressure (ICP). Which pharmacologic agent does the nurse expect to be requested to maintain the ICP within a specified range? a. Dexamethasone (Decadron) b. Hydrochlorothiazide (HydroDIURIL )c. Mannitol (Osmitrol) d. Phenytoin (Dilantin)

c Mannitol (Osmitrol)Mannitol is an osmotic diuretic used specifically to treat cerebral edema. Glucocorticoids have no demonstrated benefit in reducing ICP. Hydrochlorothiazide is only a mild diuretic; a loop diuretic such as furosemide (Lasix) is commonly used along with mannitol to reduce ICP. Dilantin is used to treat seizure activity caused by increased ICP.

A client arrives in the emergency department with new-onset ptosis, diplopia, and dysphagia. The nurse anticipates that the client will be tested for which neurologic disease? a. Bell's palsy b. Guillain-Barré syndrome (GBS) c. Myasthenia gravis (MG) d. Trigeminal neuralgia

c Myasthenia gravis (MG)Sudden-onset ptosis, diplopia, and dysphagia are classic symptoms of MG. Laboratory studies and a cholinesterase inhibitor test (e.g., Tensilon challenge test) most likely will be done to confirm the diagnosis. Symptoms of Bell's palsy include facial paralysis; the face appears masklike and sags. Symptoms of GBS typically begin in the legs and spread to the arms and upper body. Trigeminal neuralgia is a chronic pain syndrome; this client's symptoms were of sudden onset.

A client is admitted with an exacerbation of Guillain-Barré syndrome (GBS), presenting with dyspnea. Which intervention does the nurse perform first? a. Calls the Rapid Response Team to intubate b. Instructs the client on how to cough effectively c. Raises the head of the bed to 45 degrees d. Suctions the client

c Raises the head of the bed to 45 degrees The head of the client's bed should be raised to 45 degrees because this allows for increased lung expansion, which improves the client's ability to breathe. Intubation is indicated only if dyspnea is severe or oxygen saturation does not respond to oxygen therapy. Close monitoring of respiratory status is indicated because of the acute stages of GBS. Instructing the client on how to cough effectively is not the priority in this case. The client should be suctioned only if needed to avoid vagal stimulation.

A client in the emergency department (ED) has slurred speech, confusion, and visual problems, and has been having intermittent episodes of worsening symptoms. The symptoms have a gradual onset. The client also has a history of hypertension and atherosclerosis. What does the nurse suspect that the client is probably experiencing? a. Embolic stroke b. Hemorrhagic stroke c. Thrombotic stroke d. Transient ischemic attack

c Thrombotic stroke The client's symptoms fit the description of a thrombotic stroke. Symptoms of embolic stroke have a sudden onset, unlike this client's symptoms. The client would be in a coma if a hemorrhagic stroke had occurred. Intermittent episodes of slurred speech, confusion, and visual problems are transient ischemic attacks, which often are warning signs of an impending ischemic stroke.

What test is used to differentiate a cholinergic crisis from a myasthenic crisis? a. EPS b. RNS c. Tensilon testing d. CSF protein level

c. Tensilon testing

The nurse is monitoring a client after supratentorial surgery. Which sign does the nurse report immediately to the provider? a. Periorbital edema b. Bilateral ecchymoses of both eyes c. Moderate amount of serosanguineous drainage on the head dressing d. Decorticate positioning

d Decorticate positioning The major complications of supratentorial surgery are increased intracranial pressure from cerebral edema or hydrocephalus and hemorrhage. Decorticate positioning indicates damage to the pathway between the brain and the spinal cord. The client usually is rigid with flexion of arms, clenched fists, and extended rigid legs. Periorbital edema and a small-to-moderate amount of serosanguineous drainage are expected after a craniotomy. Ecchymoses in the facial region, especially around the eyes, are expected after a craniotomy.