Neuro Practice Quiz

A patient is suspected of having a brain tumor. The signs and symptoms include memory deficits, visual disturbances, weakness of right upper and lower extremities, and personality changes. The nurse recognizes that the tumor is most likely located in the frontal lobe. occipital lobe. parietal lobe. temporal lobe.

frontal lobe.

The nurse performs discharge teaching for a 34-year-old male patient with a T2 spinal cord injury resulting from a construction accident. Which statement, if made by the patient to the nurse, indicates that teaching about recognition and management of autonomic dysreflexia is successful? "I can avoid this problem by taking medications to prevent leg spasms." "If I develop a severe headache, I will lie down for 15 to 20 minutes." "A reflex erection may cause an unsafe drop in blood pressure." "I will perform self-catheterization at least six times per day." .

"I will perform self-catheterization at least six times per day." .

The nurse cares for a 63-year-old woman taking prednisone and acyclovir for Bell's palsy. It is most important for the nurse to follow up on which patient statement? "I can take acetaminophen with the prescribed medications." "I will take these medications for 2 to 3 months." . "I can take both medications with food or milk." "Chances of a full recovery are good if I take the medications."

"I will take these medications for 2 to 3 months." .

After learning about rehabilitation for his spinal cord tumor, which statement shows the patient understands what rehabilitation is and can do for him "Rehabilitation will be more work done by me alone to try to get better." "With rehabilitation, I will be able to function at my highest level of wellness." . "I want to be rehabilitated for my daughter's wedding in 2 weeks." "I will be able to do all my normal activities after I go through rehabilitation."

"With rehabilitation, I will be able to function at my highest level of wellness." .

A patient with a suspected traumatic brain injury has bloody nasal drainage. What observation should cause the nurse to suspect that this patient has a cerebrospinal fluid (CSF) leak? A halo sign on the nasal drip pad . A positive reading for glucose on a Test-tape strip Decreased blood pressure and urinary output Clear nasal drainage along with the bloody discharge

A halo sign on the nasal drip pad .

For a 65-year-old woman who has lived with a T1 spinal cord injury for 20 years, which health teaching instructions should the nurse emphasize? A mammogram is needed every year. Bladder function tends to improve with age. Heart disease is not common in persons with spinal cord injury. As a person ages, the need to change body position is less important.

A mammogram is needed every year.

The nurse prepares to administer temozolomide (Temodar) to a 59-year-old white male patient with a glioblastoma multiforme (GBM) brain tumor. What should the nurse assess before giving the medication? Urine osmolality and urine specific gravity Absolute neutrophil count and platelet count . Cerebrosprinal fluid (CSF) pressure and cell count Serum potassium and serum sodium levels

Absolute neutrophil count and platelet count .

The patient with peripheral facial paresis on the left side of her face is diagnosed with Bell's palsy. What should the nurse include in teaching the patient about self-care (select all that apply)? Preparing for a nerve block to relieve pain Administration of corticosteroid medications . Surgeries available if conservative therapy is not effective Dark glasses and artificial tears to protect the eyes . Administration of antiseizure medications

Administration of corticosteroid medications . Dark glasses and artificial tears to protect the eyes .

A 19-year-old woman is hospitalized for a frontal skull fracture from a blunt force head injury. Clear fluid is draining from the patient's nose. What action by the nurse is most appropriate? Place the patient in a modified Trendelenburg position. Apply a loose gauze pad under the patient's nose. . Ask the patient to gently blow the nose to clear the drainage. Gently insert a catheter in the nares and suction the drainage.

Apply a loose gauze pad under the patient's nose. .

The physician orders intracranial pressure (ICP) readings every hour for a 23-year-old male patient with a traumatic brain injury from a motor vehicle crash. The patient's ICP reading is 21 mm Hg. It is most important for the nurse to take which action? Assess the patient's level of consciousness. . Document the ICP reading in the chart. Position the patient with head elevated 60 degrees. Determine if the patient has a headache.

Assess the patient's level of consciousness

The nurse is providing care for a patient who has been admitted to the hospital with a head injury and who requires regular neurologic and vital sign assessment. Which assessments will be components of the patient's score on the Glasgow Coma Scale (GCS) (select all that apply)? Best motor response . Judgment Best verbal response . Eye opening . Abstract reasoning Cranial nerve function

Best motor response . Best verbal response . Eye opening .

Which clinical manifestation would the nurse interpret as a manifestation of neurogenic shock in a patient with acute spinal cord injury? Neurogenic spasticity Bounding pedal pulses Hypertension Bradycardia .

Bradycardia

The nurse is caring for a patient admitted with a subdural hematoma following a motor vehicle accident. Which change in vital signs would the nurse interpret as a manifestation of increased intracranial pressure (ICP)? Hypotension Bradycardia . Tachypnea Narrowing pulse pressure

Bradycardia .

A 68-year-old man with suspected bacterial meningitis has just had a lumbar puncture in which cerebrospinal fluid was obtained for culture. Which medication should the nurse administer first? Phenytoin Codeine Acetaminophen Ceftriaxone

Ceftriaxone

A 68-year-old patient with a spinal cord injury has a neurogenic bowel. Beyond the use of bisacodyl suppositories and digital stimulation, which measures should the nurse teach the patient and the caregiver to assist the patient with bowel evacuation (select all that apply)? Use oral laxatives every day. Drink more milk. Drink 1800 to 2800 mL of water or juice. . Establish bowel evacuation time at bedtime. Eat 20-30 g of fiber per day. .

Eat 20-30 g of fiber per day. .

A 42-year-old man is admitted to the hospital with a diagnosis of Guillain-Barré syndrome. The physician orders include IV Sandoglobulin. What is important for the nurse to assess for before administration? Elevated aspartate aminotransferase and alanine aminotransferase Elevated activated partial thromboplastin time (aPTT) Elevated serum creatinine and blood urea nitrogen (BUN) . Elevated fasting blood glucose and serum albumin

Elevated serum creatinine and blood urea nitrogen (BUN) .

A 25-year-old male patient who is a professional motocross racer has anterior spinal cord syndrome at T10. His history is significant for tobacco, alcohol, and marijuana use. What is the nurse's priority during rehabilitation? Prevent urinary tract infections. Teach him about using the gastrocolic reflex. Monitor the patient every 15 minutes. Encourage him to verbalize his feelings. .

Encourage him to verbalize his feelings. .

Which manifestations in a patient with a T4 spinal cord injury should alert the nurse to the possibility of autonomic dysreflexia? Headache and rising blood pressure . Abdominal distention and absence of bowel sounds Irregular respirations and shortness of breath Decreased level of consciousness or hallucinations

Headache and rising blood pressure .

A patient has a systemic blood pressure of 120/60 and an ICP of 24 mm Hg. After calculating the patient's cerebral perfusion pressure (CPP), how does the nurse interpret the results? Normal intracranial pressure Impaired blood flow to the brain . Adequate autoregulation of blood flow High blood flow to the brain

Impaired blood flow to the brain .

When planning care for a patient with a C5 spinal cord injury, which nursing diagnosis has the highest priority? Altered family and individual coping caused by the extent of trauma Altered patterns of urinary elimination caused by tetraplegia Risk for impairment of tissue integrity caused by paralysis Ineffective airway clearance caused by high cervical spinal cord injury .

Ineffective airway clearance caused by high cervical spinal cord injury .

A male patient suffered a diffuse axonal injury from a traumatic brain injury (TBI). He has been maintained on IV fluids for 2 days. The nurse seeks enteral feeding for this patient based on what rationale? Dehydration can be better avoided with feedings. Sodium restrictions can be managed. Free water should be avoided. Malnutrition promotes continued cerebral edema.

Malnutrition promotes continued cerebral edema.

A 19-year-old man is admitted to the emergency department with a C6 spinal cord injury after a motorcycle crash. Which medication should the nurse anticipate that she will administer first? Methylprednisolone sodium succinate Metoclopramide Enoxaparin IV immunoglobulin

Methylprednisolone sodium succinate

What nursing intervention should be implemented in the care of a patient who is experiencing increased ICP? Maintain physical restraints to prevent episodes of agitation. Monitor fluid and electrolyte status carefully. . Position the patient in a high Fowler's position. Administer vasoconstrictors to maintain cerebral perfusion.

Monitor fluid and electrolyte status carefully. .

The nurse on the clinical unit is assigned to four patients. Which patient should she assess first? Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0-to-10 scale Patient who had a craniotomy for a brain tumor who is now 3 days postoperative and has had continued vomiting Patient with a skull fracture whose nose is bleeding Older patient with a stroke who is confused and whose daughter is present

Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0-to-10 scale The patient with meningitis should be seen first; patients with meningitis must be observed closely for manifestations of elevated ICP, which is thought to result from swelling around the dura and increased cerebrospinal fluid (CSF) volume. Sudden change in the level of consciousness or change in behavior along with a sudden severe headache may indicate an acute elevation of ICP. The patient who has undergone cranial surgery should be seen second; although nausea and vomiting are common after cranial surgery, it can result in elevations of ICP. Nausea and vomiting should be treated with antiemetics. The patient with a skull fracture needs to be evaluated for CSF leakage occurring with the nose bleed and should be seen third. Confusion after a stroke may be expected; the patient should have a family member present.

The nurse is caring for a patient admitted for evaluation and surgical removal of a brain tumor. The nurse will plan interventions for this patient based on knowledge that brain tumors can lead to which complications (select all that apply)? Pituitary dysfunction . Parathyroid dysfunction Cerebral edema . Vision loss . Focal neurologic deficits .

Pituitary dysfunction . Cerebral edema . Vision loss . Focal neurologic deficits .

The nurse assesses a patient for signs of meningeal irritation and observes for nuchal rigidity. What indicates the presence of this sign of meningeal irritation? Tonic spasms of the legs Arching of the neck and back Resistance to flexion of the neck . Curling in a fetal position

Resistance to flexion of the neck .

The nurse is providing care for a patient who has been diagnosed with Guillain-Barré syndrome. Which assessment should be the nurse's priority? Musculoskeletal assessment Glasgow Coma Scale Pain assessment Respiratory assessment .

Respiratory assessment .

A 32-year-old female patient is diagnosed with diabetes insipidus after transsphenoidal resection of a pituitary adenoma. What should the nurse consider as a sign of improvement? Serum sodium of 120 mEq/L Serum osmolality of 290 mOsm/kg . Fasting blood glucose of 80 mg/dL Urine specific gravity of 1.001

Serum osmolality of 290 mOsm/kg .

The nurse is caring for a patient admitted with a spinal cord injury following a motor vehicle accident. The patient exhibits a complete loss of motor, sensory, and reflex activity below the injury level. The nurse recognizes this condition as which of the following? Central cord syndrome Spinal shock syndrome Anterior cord syndrome Brown-Séquard syndrome

Spinal shock syndrome .

Magnetic resonance imaging (MRI) has revealed the presence of a brain tumor in a patient. The nurse should recognize that the patient will most likely need which treatment modality? Surgery . Chemotherapy Radiation therapy Biologic drug therapy

Surgery .

A 22-year-old female with paraplegia after a spinal cord injury tells the home care nurse that bowel incontinence occurs two or three times each day. Which action by the nurse is most appropriate? Instruct the patient to avoid all caffeinated and carbonated beverages. Take magnesium citrate every morning with breakfast. Assess bowel movements for frequency, consistency, and volume. . Teach the patient to gradually increase intake of high-fiber foods.

Take magnesium citrate every morning with breakfast.

In planning long-term care for a patient after a craniotomy, what must the nurse include when teaching the patient, family, and caregiver? The family will be unable to cope with role reversals. Seizure disorders may occur in weeks or months. There are often residual changes in personality and cognition. Referrals will be made to eliminate residual deficits from the damage.

There are often residual changes in personality and cognition. .

While on a mission trip, the nurse is caring for a patient diagnosed with tetanus. The patient has been given tetanus immune globulin (TIG). What should be the focus of collaborative care (select all that apply)? Administration of penicillin Administration of polyvalent antitoxin Teach correct processing of canned foods. Tracheostomy for mechanical ventilation . Control of spasms with diazepam.

Tracheostomy for mechanical ventilation . Control of spasms with diazepam.

Which intervention should the nurse perform in the acute care of a patient with autonomic dysreflexia? Urinary catheterization . Administration of benzodiazepines Suctioning of the patient's upper airway Placement of the patient in the Trendelenburg position

Urinary catheterization .

The patient with increased ICP from a brain tumor is being monitored with a ventriculostomy. What nursing intervention is the priority in caring for this patient. Ventilator use to hyperoxygenate the patient Administer IV mannitol . Be aware of changes in ICP related to leaking CSF. Use strict aseptic technique with dressing changes. .

Use strict aseptic technique with dressing changes. .

A patient with intracranial pressure monitoring has a pressure of 12?mm?Hg. The nurse understands that this pressure reflects a normal balance between brain tissue, blood, and cerebrospinal fluid. the loss of autoregulatory control of intracranial pressure. a severe decrease in cerebral perfusion pressure. an alteration in the production of cerebrospinal fluid.

a normal balance between brain tissue, blood, and cerebrospinal fluid.

Vasogenic cerebral edema increases intracranial pressure by altering the endothelial lining of cerebral capillaries. leaking molecules from the intracellular fluid to the capillaries. shifting fluid in the gray matter. altering the osmotic gradient flow into the intravascular component.

altering the endothelial lining of cerebral capillaries. Vasogenic cerebral edema occurs mainly in the white matter. It is caused by changes in the endothelial lining of cerebral capillaries.

During assessment of the patient with trigeminal neuralgia, the nurse should (select all that apply) ask the patient to describe factors that initiate an episode. lightly palpate the affected side of the face for edema. assess the gag reflex and respiratory rate and depth. test for temperature and sensation perception on the face. inspect all aspects of the mouth and teeth.

ask the patient to describe factors that initiate an episode. test for temperature and sensation perception on the face. inspect all aspects of the mouth and teeth

Nursing management of a patient with a brain tumor includes (select all that apply) assisting and supporting the family in understanding any changes in behavior planning for seizure precautions and teaching the patient and the caregiver about antiseizure drugs. discussing with the patient methods to control inappropriate behavior. limiting self-care activities until the patient has regained maximum physical functioning. using diversion techniques to keep the patient stimulated and motivated.

assisting and supporting the family in understanding any changes in behavior. planning for seizure precautions and teaching the patient and the caregiver about antiseizure drugs

The most common early symptom of a spinal cord tumor is impaired sensation of pain, temperature, and light touch. back pain that worsens with activity. paralysis below the level of involvement. urinary incontinence.

back pain that worsens with activity. The most common early symptom of a spinal cord tumor outside the cord is pain in the back, with radicular pain simulating intercostal neuralgia, angina, or herpes zoster. The location of the pain depends on the level of compression. The pain worsens with activity, coughing, straining, and lying down.

A nursing measure that is indicated to reduce the potential for seizures and increased intracranial pressure in the patient with bacterial meningitis is keeping the room dark and quiet to minimize environmental stimulation. maintaining the patient on strict bed rest with the head of the bed slightly elevated. controlling fever with prescribed drugs and cooling techniques. administering codeine for relief of head and neck pain.

controlling fever with prescribed drugs and cooling techniques.

The nurse should know that the patient may have elevated ICP causing serious disruption of motor fibers in the midbrain and brainstem and will expect the patient's posture to look like which posture represented below? dorsal recumbent decerebrate decorticate

decerebrate

The nurse is alerted to a possible acute subdural hematoma in the patient who has a linear skull fracture crossing a major artery. has focal symptoms of brain damage with no recollection of a head injury. has an immediate loss of consciousness with a brief lucid interval followed by decreasing level of consciousness. develops decreased level of consciousness and a headache within 48 hours of a head injury.

develops decreased level of consciousness and a headache within 48 hours of a head injury.

A nurse plans care for the patient with increased intracranial pressure with the knowledge that the best way to position the patient is to maintain patient on the left side with the head supported on a pillow. elevate the head of the bed to 30 degrees. use a continuous-rotation bed to continuously change patient position. keep the head of the bed flat.

elevate the head of the bed to 30 degrees.

A patient is admitted to the ICU with a C7 spinal cord injury and diagnosed with Brown-Séquard syndrome. On physical examination, the nurse would most likely find ipsilateral motor loss and contralateral sensory loss below C7. loss of position sense and vibration in both lower extremities. upper extremity weakness only. complete motor and sensory loss below C7.

ipsilateral motor loss and contralateral sensory loss below C7. Brown-Séquard syndrome is a result of damage to one half of the spinal cord. This syndrome is characterized by a loss of motor function, position sense, and vibratory sense, as well as by vasomotor paralysis on the same side (ipsilateral) as the injury. The opposite (contralateral) side has loss of pain and temperature sensation below the level of the injury.

A patient is admitted to the hospital with a C4 spinal cord injury after a motorcycle collision. The patient's BP is 84/50?mm?Hg, his pulse is 38 beats/minute, and he remains orally intubated. The nurse determines that this pathophysiologic response is caused by a temporary loss of sensation and flaccid paralysis below the level of injury. loss of parasympathetic nervous system innervation resulting in vasoconstriction. increased vasomotor tone after injury. loss of sympathetic nervous system innervation resulting in peripheral vasodilation.

loss of sympathetic nervous system innervation resulting in peripheral vasodilation.

During routine assessment of a patient with Guillain-Barré syndrome, the nurse finds the patient is short of breath. The patient's respiratory distress is caused by elevated protein levels in the CSF. degeneration of motor neurons in the brainstem and spinal cord. paralysis ascending to the nerves that stimulate the thoracic area. immobility resulting from ascending paralysis.

paralysis ascending to the nerves that stimulate the thoracic area.

During admission of a patient with a severe head injury to the emergency department, the nurse places the highest priority on assessment for patency of airway. neurologic status with the Glasgow Coma Scale. presence of a neck injury. cerebrospinal fluid leakage from the ears or nose.

patency of airway.

A patient with a C7 spinal cord injury undergoing rehabilitation tells the nurse he must have the flu because he has a bad headache and nausea. The nurse's first priority is to take the patient's blood pressure. check the patient's temperature. call the physician. elevate the head of the bed to 90 degrees.

take the patient's blood pressure. Autonomic dysreflexia is a massive, uncompensated cardiovascular reaction mediated by the sympathetic nervous system. Manifestations include hypertension (up to 300 mm Hg systolic), throbbing headache, marked diaphoresis above the level of the injury, bradycardia (30 to 40 beats/min), piloerection, flushing of the skin above the level of the injury, blurred vision or spots in the visual fields, nasal congestion, anxiety, and nausea. It is important to measure blood pressure when a patient with a spinal cord injury complains of headache. Other nursing interventions in this serious emergency are elevation of the head of the bed 45 degrees or sitting the patient upright, notification of the physician, and assessment to determine the cause. Table 61-8 lists the causes and symptoms of autonomic dysreflexia. The nurse must monitor blood pressure frequently during the episode. An á-adrenergic blocker or an arteriolar vasodilator may be administered.