EXAM 4 NEURO MED SURG 2

Psychostimulants are prescribed to a patient with a TBI. The nurse knows these drugs stimulate what part of the brain to improve the patient's alertness and attention span? 1.Occipital lobe 2. Frontal lobe 3. Temporal lobe 4. Parietal lobe

2

A client is somewhat nervous about undergoing magnetic resonance imaging (MRI). Which statement by the nurse would provide the most reassurance to the client about the procedure? 1. "The MRI machine is a long, narrow, hollow tube and may make you feel somewhat claustrophobic." 2. "You will be able to eat before the procedure unless you get nauseated easily. If so, you should eat lightly." 3. "Even though you are alone in the scanner, you will be in voice communication with the technologist at all times during the procedure." 4. "It is necessary to remove any metal or metal- containing objects before having the MRI done to avoid the metal being drawn into the magnetic field."

3

A patient was discharged from the ED after a head trauma. What medication should you teach family/patient to avoid? 1. Zofran 2. Claritin 3. Ambien 4. Tylenol

3

A client with a traumatic brain injury is on mechanical ventilation. The nurse promotes normal intracranial pressure (ICP) by ensuring that the client's arterial blood gas (ABG) results are within which ranges? 1. PaO2 60 to 100 mm Hg (60 to 100 mm Hg), PaCo2 25 to 30 mm Hg (25 to 30 mm Hg) 2. PaO2 60 to 100 mm Hg (60 to 100 mm Hg), PaCo2 30 to 35 mm Hg (30 to 35 mm Hg) 3. PaO2 80 to 100 mm Hg (80 to 100 mm Hg), PaCo2 25 to 30 mm Hg (25 to 30 mm Hg) 4. PaO2 80 to 100 mm Hg (80 to 100 mm Hg), PaCo2 35 to 38 mm Hg (35 to 38 mm Hg)

4

. While conversing with a patient who had a stroke six months ago, you note their speech is hard to understand and slurred. This is known as: A.Dysarthria B. Apraxia C. Alexia D. Dysphagia

A

You're preparing to help the neurologist with conducting a Tensilon test. Which antidote will you have on hand in case of an emergency? A. Atropine B. Protamine sulfate C. Narcan D. Leucovorin

A

What are some of the most common causes of TBI? (SATA) A. Falls. B. Motor vehicle Crashes C. Sports injuries D. Eating ice cream too quickly E. Child abuse.

A B C E

A patient's family has noticed some recent changes in their mother's behavior that are starting to worry them. As the nurse, you would know that the following are signs and symptoms that point to dementia. Select all that apply: A- Agitation B- Trouble with memory C- Misplacing belongings D- Changes in mood and social withdrawal E- Poor judgment F- Trouble with completing menial tasks that they have done for years

ALL

1-A nurse is assessing a client with suspected multiple sclerosis. Which findings would the nurse expect? A. Fatigue. B. Ataxia. C.Apnea. D.Resting tremors. E. Intentional Tremors

ANS: A, B, E

A patient has experienced a stroke in the left cerebral hemisphere. What clinical presentation does the nurse expect? (Select all that apply.) A. Aphasia B. Decreased proprioception C. Disoriented to time and place D. Agraphia E. Difficulty with math calculation

ANS: A, D, E

When a patient with a TBI is being treated with mannitol, which of the following should the nurse know about administration of the drug? Select all that apply. A.Mannitol reduces intracranial hypertension. B. When administering by IV, a filter needle must be used. C. The nurse should monitor the patient's neurologic status. D. I/O should be accurately calculated.

ANS: All of the above

Which lifestyle factor plays the biggest role in increasing the risk for stroke? A. Overweight B. Little or no exercise C. High BP D. Smoking

Answer D. Smoking.

Patient presents to the ER with a possible ischemic stroke, what symptoms might they have? a. blurred vision b. facial drooping c. diarrhea d. slurred speech e. muscle weakness

Answer: a, b, d, e

Modifiable stroke factors are : select all that apply a. hypertension b. tobacco use c. obesity d. gender e. diabetes mellitus

Answer: a,b,c,e

A patient comes in with muscle weakness, ptosis, and dysphagia resembling Myasthenia Gravis. The physician orders labs to test the patient's thyroid levels. What complication of Myasthenia Gravis is the physician testing for? A. Cholinergic Crisis B. Thyrotoxicosis C. Diplopia D. Hypothyroid Crisis

B

3-After taking care of a patient, diagnosed with MS 6 months ago, the patient states that she hasn't had any relief through medication therapy. What type of complementary therapies are successful in decreasing symptoms of MS? A. Weight bearing exercise B. Extreme Cardio Workout C. Acupuncture/relaxation and mediation D. Swimming

C

A 45 year old patient is diagnosed with moderate dementia after multiple strokes. During assessment of the patient the nurse would expect to find: a.) excessive sleepiness b.) difficulty eating and swallowing c.) loss of recent and long-term memory d.) inability to perform basic tasks

C

A client is admitted with Guillain-Barré syndrome (GBS). What assessment takes priority? a. Bladder control b. Cognitive perception c. Respiratory system d.Sensory functions

C

The nurse is caring for the client with increased intracranial pressure. The nurse would note which of the following trends in vital signs if the icp is rising? 1.increasing temperature, increased pulse, increasing respirations, decreasing blood pressure 2.increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure 3. decreasing temperature, increasing pulse, decreasing respirations, increasing blood pressure 4. decreasing temperature, increasing pulse, decreasing respirations, increasing blood pressure

2

A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons? 1. to reduce intraocular pressure 2. to prevent acute tubular necrosis 3. to promote osmotic diuresis to decrease ICP 4. to draw water into the vascular system to increase blood pressure

3

A child is admitted with a head injury after being in a motor vehicle accident. The nurse notes a clear drainage from the left ear. The nurse would suspect: A. Linear skull fracture B. Basilar skull fracture C. Subdural fracture D. Epidural hematoma

A

A client arrives in the emergency department with an ischemic stroke and receives tissue plasminogen activator (t-PA) administration. Which is the priority nursing assessment? A. Time of onset of current stroke B. Complete physical & history C. Current medications D. Upcoming surgical procedures

A

A client is admitted with bacterial meningitis. Which nursing intervention is the highest priority for this client? A) Assessing neurologic status at least every 2-4 hours B) Decreasing environmental stimuli C) Managing pain through drug and nondrug methods D) Strict monitoring of hourly intake and output

A

A client is taking long-term corticosteroids for myasthenia gravis. What teaching is most important? a. Avoid large crowds and people who are ill. b. Check blood sugars four times a day. c. Use two forms of contraception. d. Wear properly fitting socks and shoes.

A

A client who exhibits blurred and double vision and muscular weakness is informed of the diagnosis of MS. The client becomes visibly upset. Which response would the nurse make? A. That must have shocked you. Tell me what the health care provider told you about it. B. You should see a psychiatrist who will help you cope with this overwhelming news. C. Don't worry; early treatment often alleviates the symptoms of the disease. D. You should be glad that we caught it early so you can be cured.

A

A patient is being evaluated for Alzheimer's disease, the nurse explains to the patient's spouse that: a.) a diagnosis of Alzheimer's disease is made only after the cause of dementia is ruled out b.) new drugs have been shown to reverse Alzheimer's disease dramatically in some patients c.) A MRI will confirm the diagnosis of Alzheimer's disease d.) family history of Alzheimer's disease is the most important risk factor for acquiring the disease

A

A stroke victim regains consciousness three days after admission. They have right-sided hemiparesis and hemiplegia and also has expressive aphasia. They become upset when they are unable to speak simple words. The best approach for the nurse is to do which of the following? A.Stay with them and given them time and encouragement in attempting to speak. B. Say "I'm sure you want a glass of water. I'll get it for you. " C. Say "Don't get upset. You rest now and ill come back later and try to talk to" D. Encourage her attempts and say "don't worry, it will get easier every day."

A

The client diagnosed with atrial fibrillation has experienced a transient ischemic attack (TIA). Which medication would the nurse anticipate being ordered for the client on discharge? a. An oral anticoagulant medication. b. A beta blocker medication. c. An anti-hyperuricemic medication. d. A thrombolytic medication.

A

The nurse is working a shift in the hospital and is assigned to care for a client with advanced MS. Which of the following would most contribute to the client's overall level of functioning? A. Encourage the client's activity independence B. Educate on fall safety measures for the home C. Maximize fluid intake to prevent constipation D. Teach client to lower the water heater temperature at home

A

What other medical conditions would the nurse expect to see in a patient with restless leg syndrome? A. Diabetes and kidney failure B. Myasthenia gravis and decreased vision C. Trigeminal neuralgia and facial paralysis D. Peripheral vascular disease and multiple sclerosis

A

A client newly diagnosed with MS asks the nurse if he will experience pain. Which response should the nurse give? A. "Tell me about your fears regarding pain." B. "Analgesics will be prescribed to control the pain." C. "Pain is not a characteristic symptom of this condition." D. "Let's make a list of things to ask you primary health care provider."

C

When a patient with dementia is being admitted to the floor the nurse should: A.Give the patients the quietest room away from exits with the TV remaining off unless patient specifically requests it to be on. B. Give the patient the room by the nurse's station that is next to the elevator. C. Provide the patient a room that can be easily moved around to keep the environment new and fresh for the patient D. The placement of the room will not affect the ability of care that we can give the patient

A

You're assessing your patient's pupil size and vision after a stroke. The patient says they can only see half of the objects in the room. You document this finding as: A.Hemianopia B. Opticopsia C. Alexia D. Dysoptic

A

Some long term issues people may face after a TBI include (SATA) 1. Depression 2. Communication barriers 3. Labile emotions 4. Chron's Disease

ANS: 1, 2, 3

2-What would be a good education for a nurse to teach a patient with MS? A. Plan activities and allow enough time to complete activities B. Ensure there is rigorous activity daily to maintain muscle C. Going to a crowded environment is allowed, But wear a double mask for protection D. Always wear briefs to avoid embarrassing accidents

ANS: A

A client with a subarachnoid hemorrhage is prescribed a 1,000 mg loading dose of Dilantin IV. Which consideration is most important when administering this done? A.Therapeutic drug levels should be maintained between 20 to 30 mg/ml B.Rapid Dilantin administration can cause cardiac arrhythmias. C.Dilantin should be mixed in dextrose in water before administration D.Dilantin should be administered through an IV catheter in the clients hand.

B

A patient with MS asks a nurse how long he will have to wait until he can stop taking his medicine. How should the nurse respond? A. You can wait 6 weeks under the health care provider's discretion B. MS will require you to continue taking medication for life C. Medication will only by needed until your symptoms are under control. D. You will need to discuss medicinal requirements with your health care provider

B

A patient with a TBI has nonreactive and dilated pupils. What would the nurse anticipate? A. Loss of vision B. Brain stem herniation C. Intense headache D. Projectile vomiting

B

For a patient in the first stage of Alzheimer's disease the nurse should plan to focus the clients care on: a.) Offering healthy light snacks to help maintain the patient's nutritional status b.) Provide emotional support and individualized counseling c.) Monitor the client to prevent minor illnesses from turning into major problems d.) Suggest new activities for the client in the family to do together

B

In assessing a patient with low back pain, which priority assessment question or statement will the nurse provide? A. "How long have you had back pain?" B. "How does your back pain affect your activities of daily living?" C. "Tell me about your pain and what interventions are helpful in managing your pain." D. "Have you ever had magnetic resonance imaging to find a cause for your back pain?"

B

The family of a patient with Alzheimer's disease (AD) reports increasing symptoms of paranoia in the patient. Which nursing response is most appropriate? A. "There is often an underlying psychiatric condition with AD." B. "Some patients with dementia may experience paranoia, delusions, and even hallucinations." C. "This is a sign of rapid progression of the AD." D. "Inform the patient that their feelings are not real."

B

The nurse is assessing a client with MS and notes the client is experiencing tremors and muscle weakness. The client is scheduled for several tests that require transport off the floor, as well as a physical therapy session during the shift. Which of the following nursing actions would be most helpful for this client? A. Contact physical therapy to delay the session until the client is finished with the tests B. Coordinate with various disciplines to perform tests back to back C. Encourage activity independence for ADLs prior to going for tests. D. Administer analgesics as ordered to provide comfort for the day's activities

B

The nurse is caring for a patient with a diagnosis of Bell's palsy. The nurse understands that for a patient with Bell's palsy the symptoms are the most severe during which time period after beginning? A. 12 hours after onset B. 48 hours after onset C. 96 hours after onset D. 1 to 2 weeks after onset

B

You're assisting a patient who has right side hemiparesis and dysphagia with eating. It is very important to: A. Keep the head of bed less than 30'. B. Check for pouching of food in the right cheek. C. Prevent aspiration by thinning the liquids. D. Have the patient extend the neck upward away from the chest while eating.

B

You're performing a head-to-toe assessment on a patient with multiple sclerosis. When you ask the patient to move the head and neck downward the patient reports an "electric shock" sensation that travels down the body. You would report your finding to the doctor that the patient is experiencing: A. Romberg's sign B. Lhermitte's sign C. Uhthoff's Sign D. Homan's sign

B

You're providing teaching to a group of patients with myasthenia gravis. Which of the following is not a treatment option for this condition? A. Plasmapheresis B. Cholinesterase medications C. Thymectomy D. Corticosteroids

B

A 64 year old patient with dementia is in the hospital recovering from an appendectomy one day ago. The nurse walks into the room to complete her morning assessment. Which of the following would be expected for the nurse to find upon assessment? A. Excessive nighttime sleepiness. B. Difficulty eating and swallowing. C. Loss of recent and long-term memory. D.Fluctuating ability to perform simple tasks.

C

A 68-year-old patient is being admitted with a possible stroke. Which information from the assessment indicates that the nurse should consult with the health care provider before giving the prescribed aspirin? A. The patient has dysphasia. B. The patient has atrial fibrillation. C. The patient reports that symptoms began with a severe headache. D. The patient has a history of brief episodes of right-sided hemiplegia.

C

A 69 year old patient is brought to the clinic by her spouse who tells the nurse that she is unable to solve common problems around the house. To obtain information about the patient's mental status, which question would the nurse ask the patient? a.) Are you unhappy b.) Where were you born? c.) What did you have for breakfast? d.) What is 2 + 2

C

A patient with a spinal cord injury at C5-C6 reports a sudden severe headache. The patient is flushed. Vital signs include a blood pressure of 190/100 mm Hg and heart rate of 52 beats/min. What is the priority nursing intervention? A. Notify the health care provider. B. Place the patient in a sitting position. C. Check the patient for fecal impaction. D. Check the urinary catheter for kinks or obstruction.

C

In order for tissue plasminogen activator (tPA) to be most effective in the treatment of stroke, it must be administered? A.6 hours after the onset of stroke symptoms B. 3 hours before the onset of stroke symptoms C. 3 hours after the onset of stroke symptoms D. 12 hours before the onset of stroke symptoms

C

The incidence of ischemic stroke in patients with TIAs and other risk factors is reduced with administration of ? a. Furosomide b. lorastatin c. daily dose of aspirin d. nimodpine

C

The nurse explains to the patient with a stroke who is scheduled for angiography that this test is used to determine the A. presence of increased ICP B. site and size of the infarction C. patency of the cerebral blood vessels D. presence of blood in the cerebrospinal fluid

C

The nurse is assessing a patient with Parkinson disease. The nurse notes that the patient has resistance to passive movement of the lower extremities with mildly restrictive movement. Which documentation is most appropriate? A. Rigidity B. Cogwheel C. Plastic D. Lead pipe

C

The nurse is discussing the purpose of an electroencephalogram (EEG) with the family of a client with massive cerebral hemorrhage and loss of consciousness. Which would it be most accurate for the nurse to tell family members that the test measures which of the following conditions? A.Extent of intercranial bleeding B. Sites of brain injury C. Activity of the brain D. Percent of functional brain tissue

C

The nurse is preparing a client for a Tensilon (edrophonium chloride) test. What action by the nurse is most important? a. Administering anxiolytics b. Having a ventilator nearby c. Obtaining atropine sulfate d. Sedating the client

C

The nurse understands which symptom is the earliest indicator of increased intracranial pressure when caring for a patient with a head injury? A. Increased pupil size B. Nausea and vomiting C. Agitation and confusion D. Elevated blood pressure

C

When caring for a patient with Parkinson disease, the nurse understands that progressive difficulty with which factor is a primary expected outcome? A. Nutrition B. Elimination C. Motor ability D. Effective communication

C

Which meal option would be the most appropriate for a patient with myasthenia gravis? A. Roasted potatoes and cubed steak B. Hamburger with baked fries C. Clam chowder with mashed potatoes D. Fresh veggie tray with sliced cheese cubes

C

Which patient below is at most risk for a hemorrhagic stroke? A. A 65 year old male patient with carotid stenosis. B. A 89 year old female with atherosclerosis. C. A 88 year old male with uncontrolled hypertension and a history of brain aneurysm repair 2 years ago. D. A 55 year old female with atrial flutter.

C

Which stroke factor for a 48-year-old male patient in the clinic is most important for the nurse to address? a. The patient is 25 pounds above his ideal weight. b. The patient drinks a glass of red wine with dinner daily. c. The patient's blood pressure usually is 170/94. d. The patient works at a desk and relaxes by watching television.

C

Which stroke risk factor for a 48-year-old male patient in the clinic is most important for the nurse to address? A.The patient is 25 pounds above the ideal weight. B.The patient drinks a glass of red wine with dinner daily. C.The patient's usual blood pressure (BP) is 170/94 mm Hg. D.The patient works at a desk and relaxes by watching television.

C

You're educating a patient about the pathophysiology of myasthenia gravis. While explaining the involvement of the thymus gland, the patient asks you where the thymus gland is located. You state it is located? A. behind the thyroid gland B. within the adrenal glands C. behind the sternum in between the lungs D. anterior to the hypothalamus

C

What health history question will give the nurse the most information when evaluating a patient for Guillain-Barré syndrome (GBS)? A. "Did you get a flu vaccine in the past year?" B. "Has anyone else in your family ever had GBS?" C. "Have you ever been exposed to Epstein- Barr virus?" D. "Have you had a respiratory virus in the past 2 weeks?"

D

-The nurse is drawing labs from a central line to send out for antibody testing on a patient suspected of having Myasthenia Gravis. The patient's husband asks the nurse, "If these tests come back negative, does that mean she is negative for Myasthenia Gravis?" What is the nurse's best response? A. "If the tests come back negative for these antibodies, your wife does not have MG." B. "Your healthcare provider will have to answer that question. I'm not allowed to tell you about any lab results." C. "I'm not sure, but I can google it." D. "The antibody tests can confirm the diagnosis, but they do not necessarily tell us if she is negative."

D

A client diagnosed with dementia is to be discharged home and cared for by his wife. Which statement may cause the nurse to question the client's safety? A.) The client's wife works from home in sales B.) The client's wife does not let him prepare food by himself C.) The client enjoys playing with the family dog D.) The client's wife frequently leaves the back door open for the dog to come in and out

D

A nurse is working in a long-term care facility and is helping create a plan of care for a patient with moderate Alzheimer's disease. Which of the following interventions should be included in the care plan? A.) using a gait belt for ambulation b.) thickening all liquids c.) provide protective undergarments d.) reorient the patient to self in current events

D

A patient's wife asks the nurse why her husband did not receive the clot busting medication (tPA) she has been reading about. Her husband is diagnosed with a hemorrhagic stroke. What should the nurse respond to? a. He didn't arrive within the time frame for that therapy b. Not every is eligible for this drug. Has he had surgery lately? c. You should discuss the treatment of your husband with your doctor d. The medication you are talking about dissolves clots and could cause more bleeding in your husband's head

D

A pregnant female is concerned about how her diagnosis of MS will affect her baby. This medical condition is know to affect the baby by: A. Requiring the pregnant female to have a scleroGEM shot administered B. Increasing erythropoietin production in utero C. Little complication are known to affect the baby in labor D. MS has no affect on child development

D

If a person has an ischemic stroke, how quickly should the person be treated to minimize long term problems? A. Within 30 minutes B. Within 1 hour C. Within 2 hours D. Within 3 hours

D

The nurse understand which of the following is a risk factor associated with the development of multiple sclerosis? A. Smoking B. High-fat diet C. Age greater than 70 D. Gender 35

D

Select all the signs and symptoms below that can present in myasthenia gravis: A. Respiratory failure B. Increased salivation C. Diplopia D. Ptosis E. Slurred speech F. Restlessness G. Mask-like appearance of looking sleepy H. Difficulty swallowing

The answers are A, C, D, E, F (restlessness from hypoxia, which is experienced with respiratory failure), G, and H.