ATI Med-Surg Neurosensory Dynamic Quizzing

A nurse is caring for a client who had a cerebrovascular accident (CVA). The client appears alert and engaged during a visit but does not respond verbally to questions. The nurse should document this as which of the following alterations? A. Expressive aphasia B. Dysarthria C. Receptive aphasia D. Dysphagia

A. Expressive aphasia

During a neurological assessment, a nurse asks the client to name all of his children, their ages, and their birth dates. Which of the following types of memory is the nurse testing? A. Remote B. Sensory C. Immediate D. Recall

A. Remote

A nurse is preparing an older adult client who had a transient ischemic attack (TIA) for discharge. The nurse should teach the client to monitor which of the following parameters at home? A. Blood glucose B. Blood pressure C. Daily weight D. Sensation in the feet

B. Blood pressure

A nurse is caring for a client who is experiencing autonomic dysreflexia due to a C5 spinal cord injury. After checking the client's vital signs, which of the following actions should the nurse perform next? A. Administer nifedipine B. Place the client in a high-Fowler's position C. Check for urinary retention D. Check for a fecal impaction

B. Place the client in a high-Fowler's position

A nurse is caring for a client who has a brainstem injury. Which of the following physiological functions should the nurse monitor? A. Understanding speech B. Respiratory effort C. Decision-making ability D. Temperature control

B. Respiratory effort

A nurse is assessing a client who reports vision loss. The client describes the loss as beginning with a "flash" of light followed by a "curtain" across the field of vision. The nurse should identify that these manifestations indicate which of the following eye disorders? A. Glaucoma B. Retinal detachment C. Macular degeneration D. Cataracts

B. Retinal detachment

A nurse is caring for a client who begins to have a generalized tonic-clonic seizure while lying in bed. Which of the following actions should the nurse take? A. Insert an oral airway B. Turn the client onto a side C. Restrict movement of the client's limbs D. Place a pillow under the client's head

B. Turn the client onto a side

A nurse is caring for a client during the first 72 hr following a cerebrovascular accident (VA). Which of the following actions should the nurse take? A. Turn the client's head to the side with the head of the bed elevated 60° B. Place the head of the bed flat with pillows under the client's neck and feet C. Elevate the head of the bed 25° to 30° with the client in a neutral midline position D. Position the client in a dorsal recumbent position with pillows under the head and knees

C. Elevate the head of the bed 25° to 30° with the client in a neutral midline position

A nurse names 3 objects for the client to remember, asks the client to repeat them, and tells the client he will have to repeat them again in a few minutes. After 5 min, the nurse asks the client to name the objects. The nurse is using this strategy to test which type of memory? A. Remote B. sensory C. Immediate D. Recall

C. Immediate

A nurse is assessing a client who recently experienced a head injury. Which of the following findings should the nurse identify as an indication of short-term memory impairment? A. Inability to remember current age B. Inability to count backward C. Inability to locate eyeglasses D. Inability to recall names of family members

C. Inability to locate eyeglasses

A nurse is assessing a client who has increased intracranial pressure and has received intravenous mannitol. Which of the following findings indicates a therapeutic effect of this medication? A. Decreased blood glucose B. Decreased bronchospasms C. Increased urine output D. Increased temperature

C. Increased urine output

A nurse is caring for a client who has an impairment of cranial nerve Il. Which of the following actions should the nurse perform to promote the client's safety? A. Initiate seizure precautions. B. Ensure the client receives a soft diet. C. Provide an obstacle-free path for ambulation. D. Instruct the client to use lukewarm water when showering.

C. Provide an obstacle-free path for ambulation.

During a neurological assessment, a nurse asks how the client arrived at the appointment and with whom. Which of the following types of memory is the nurse testing? A. Remote B. Immediate C. Recall D. Past

C. Recall

A home health nurse is interviewing the adult child of a client who has Alzheimer's disease. The child is the client's sole caregiver and reports feeling fatigued and overwhelmed. Which of the following referrals should the nurse make for the caregiver? A. Attorney B. Physical therapy C. Respite care D. Occupational therapy

C. Respite care

A nurse is assessing a client who reports an acute visual disturbance that he describes as a "curtain" pulled over his visual field with occasional flashes of light. The nurse should notify the provider that this client might have which of the following disorders? A. Cataracts B. Angle-closure glaucoma C. Retinal detachment D. Macular degeneration

C. Retinal detachment

A nurse is caring for a client who has a closed traumatic brain injury and is experiencing increased intracranial pressure (ICP). This increase in ICP is due to which of the following? A. Decreased cerebral perfusion B. Leakage of cerebral spinal fluid C. Rigid skull containing cranial contents D. Brain herniated into the brainstem

C. Rigid skull containing cranial contents

A nurse is caring for a client who has receptive aphasia. Which of the following communication problems should the nurse expect when assessing the client? A. The client cannot name simple objects or formulate sentences or phrases. B. The client has difficulty articulating correctly due to muscle weakness of the mouth and tongue. C. The client is unable to understand words or sentences she hears. D. The client speaks words that substitute for those she intends to say.

C. The client is unable to understand words or sentences she hears.

A nurse is providing teaching to a client who has a new diagnosis of myasthenia gravis (MG). Which of the following pieces of information should the nurse include? A. Use enemas to treat constipation caused by daily medications B. Take a hot bath when muscles ache C. Eat a low-calorie diet D. Set an alarm to ensure medication dosages are taken on time

D. Set an alarm to ensure medication dosages are taken on time

A nurse is caring for a client who has moderate Alzheimer's disease. Which of the following actions should the nurse take? A. Add gestures when speaking with the client B. Ask open-ended questions C. Limit visitors to 3 at a time D. Use different words if the client does not understand a statement

A. Add gestures when speaking with the client

A nurse is providing discharge teaching to a client who has had a transient ischemic attack (TIA). Which of the following instructions should the nurse include? A. Reduce dietary sodium B. Decrease dietary potassium C. Restrict intake of insoluble fiber D. Limit alcohol intake to 53 servings per day

A. Reduce dietary sodium

A nurse is caring for a client who is recovering from a recent stroke. Which of the following assessments is the nurse's priority? A. The client's ability to clear oral secretions B. The client's ability to communicate verbally C. The client's ability to move all extremities D. The client's ability to remain continent of urine

A. The client's ability to clear oral secretions

A nurse responds to a call from an assistive personnel that a client just had a seizure and is unconscious. Which of the following assessments is the nurse's priority? A. Measure the client's vital signs B. Perform a neurological examination C. Check airway patency D. Assess the client for injuries

C. Check airway patency

A nurse is caring for a client who experienced a traumatic brain injury. Which of the following findings indicates the client is experiencing increased intracranial pressure? A. Battle's sign B. Periorbital edema C. Dilated pupils D. Halo sign

C. Dilated pupils

A nurse is caring for a client who has expressive aphasia following a stroke. The nurse should identify that the stroke affected which of the following lobes of the client's brain? A. Occipital B. Temporal C.Frontal D. Limbic

C.Frontal

A nurse is triaging clients during a mass casualty event. Which of the following labels should the nurse assign to a client who has a head injury with fixed, dilated pupils? A. Red tag B. Yellow tag C. Green tag D. Black tag

D. Black tag

A nurse is teaching a client about computed tomography (CT) scanning of the brain. Which of the following teaching points should the nurse include? A. "You'll have to lie very still on a long, narrow table during the test." B. "You should be able to sit up during the test if you need to have a break." C. "You'll have many tiny electrodes placed on your scalp during the test." D. "You should expect the test to take at least an hour!"

A. "You'll have to lie very still on a long, narrow table during the test."

A nurse is providing teaching about degenerative complications to the partner of a client who has a new diagnosis of Parkinson's disease. Which of the following manifestations is the priority? A. Dysphagia B. Emotional lability C. Impaired speech D. Self-care dependency

A. Dysphagia

A nurse is preparing a client who has a brain tumor for computed tomography (CT). Which of the following factors affects the manner in which the nurse will prepare the client for the scan? A. No food or fluids consumed for 4 hr B. Difficulty recalling recent events C. Development of hives when eating shrimp D. Paresthesias in both hands

C. Development of hives when eating shrimp

An emergency room nurse is assessing a client who has a new traumatic brain injury. The nurse observes extension of the client's arms and legs, pronation of the arms, and plantar flexion of the feet. Which of the following actions is the nurse's priority? A. Monitor urinary output B. Administer an osmotic diuretic C. Provide supplemental oxygen D. Initiate seizure precautions

C. Provide supplemental oxygen

A nurse is providing teaching to a client who is scheduled for an electroencephalogram in the morning. Which of the following pieces of information should the nurse share? A. "You'll feel some mild electrical sensations like static electricity during the procedure." B. "Do not eat or drink anything except water after midnight." C."Shampoo your hair before the procedure and don't use any styling products afterward." D. "It's common to have temporary short-term memory loss after the procedure."

C."Shampoo your hair before the procedure and don't use any styling products afterward."

A nurse is caring for a client who has a cerebral lesion and develops hyperthermia. Which of the following areas of the client's brain is affected? A. Wernicke's area B. Cerebral cortex C. Basal ganglia D. Hypothalamus

D. Hypothalamus

A nurse in the emergency department is caring for a group of clients who all have an odor of alcohol on their breath and multiple injuries to the head and extremities. Which of the following clients should the nurse assess first? A. A client who is difficult to arouse and is unable to respond to questions B. A client who has slurred speech and exhibits anger C. A client who reports nausea and vomiting D. A client who is uncooperative and has uncoordinated movements

A. A client who is difficult to arouse and is unable to respond to questions

A nurse asks a client to stand with her feet together and her eyes open. After a few seconds, the nurse asks the client to close her eyes. If the client begins to fall, the nurse should interpret this finding as a positive Romberg test, indicating which of the following alterations? A. Cerebellar dysfunction B. Occipital lobe dysfunction C. Increased intraocular pressure D. Macular degeneration

A. Cerebellar dysfunction

A nurse is preparing a client for an electroencephalogram (EEG). Which of the following pieces of information should the nurse share with the client? A. "'Expect the test to take about 3 hr." B. "You'll begin by lying still with your eyes closed." C. "You'll sleep for the duration of the procedure." D. "Expect some mild electrical shocks during the test."

B. "You'll begin by lying still with your eyes closed."

A nurse is preparing a client for an electroencephalogram (EEG). When the client asks the nurse what this test does, which of the following responses should the nurse provide? A. "An EEG measures the electric signals to your brain from hearing, sight, and touch." B. "An EEG measures the electrical activity in your muscles." C. "An EEG identifies the magnetic fields produced by electrical activity in your brain." D. "An EEG records the electrical activity of your brain cells."

D. "An EEG records the electrical activity of your brain cells."

A nurse in the emergency department has assessed a client's airway, breathing, and circulation (ABC) following a head injury from a fall at work. Which of the following actions is the priority for the nurse to perform next? A. Question the client's coworkers about the mechanism of injury B. Check the client's pupils for equality and reaction to light C. Measure the client's alertness using the Glasgow Coma Scale D. Immobilize the client's cervical spine

D. Immobilize the client's cervical spine

A nurse is planning care for a client following a stroke. Which of the following interventions should the nurse identify as the priority in the client's plan of care? A. Prevent depression in the client B. Refer the client to occupational therapy C. support the client's family D. Monitor the client for increased intracranial pressure (ICP)

D. Monitor the client for increased intracranial pressure (ICP)

A nurse is caring for a client who has dementia and is experiencing anxiety. Which of the following actions should the nurse take? A. Place a vest restraint on the client to protect others in the environment B. Provide a variety of routines to keep the client from getting bored C. Explain to the client that episodes of anxiety will decrease over time D. Redirect the client to a different activity with a small group of people

D. Redirect the client to a different activity with a small group of people

A nurse is caring for a client who has a left intracranial hemorrhage from a stroke. Which of the following findings should the nurse expect? A. Spasticity of the left foot B. Negative Babinski reflex C. Ocular hypertension D. Right-sided hemiplegia

D. Right-sided hemiplegia