Neuro Practice Questions (GEE)

A client who recently had a stroke requires a cane to ambulate. When teaching about cane use, explain that the reason for holding a cane on the uninvolved side is to: A. prevent leaning. B. distribute weight away from the involved side. C. maintain stride length D. prevent edema

Answer: A Rationale: Holding a cane on the uninvolved side distributes weight away from the involved side. Holding the cane close to the body prevents leaning. Use of a cane won't maintain stride length or prevent edema.

In treating a client with brain damage that led to hemispatial neglect, or neglect syndrome, what should the nurse expect? A. The client is unable to speak properly B. The client is not aware of parts of their body C. Inability to use either hand D. Sensory loss leading to reduced function

Answer: B Rationale: In neglect syndrome, typically caused by brain damage, the client loses the ability to notice stimuli on parts of their body. This is the defining symptom. It does not require sensory loss.

The nurse is assessing the motor function of an unconscious male client. The nurse would plan to use which plan to use which of the following to test the client's peripheral response to pain? A. Sternal rub B. Nail bed pressure C. Pressure on the orbital rim D. Squeezing of the sternocleidomastoid muscle

Answer: B Rationale: Motor testing in the unconscious client can be done only by testing response to painful stimuli. Nail bed pressure tests a basic peripheral response. Cerebral responses to pain are tested using sternal rub, placing upward pressure on the orbital rim, or squeezing the clavicle or sternocleidomastoid muscle.

A patient returns to the emergency department less than 24 hours after having a fiberglass cast applied for a fractured right radius. Which of the following patient complaints would cause the nurse to be concerned about impaired perfusion to the limb? A. Severe itching under the cast. B. Severe pain in the right shoulder. C. Severe pain in the right lower arm. D. Increased warmth in the fingers.

Answer: C Rationale: Impaired perfusion to the right lower arm as a result of a closed cast may cause neurovascular compromise and severe pain, requiring immediate cast removal. Itching under the cast is common and fairly benign. Neurovascular compromise in the arm would not cause pain in the shoulder, as perfusion there would not be affected. Impaired perfusion would cause the fingers to be cool and pale. Increased warmth would indicate increased blood flow or infection.

A client has a Fiberglas cast on the right arm. Which action should the nurse include in the care plan? A. Keeping the casted arm warm by covering it with a light blanket B. Avoiding handling the cast for 24 hours or until it is dry C. Evaluating pedal and posterior tibial pulses every 2hours D. Assessing movement and sensation in the fingers of the right hand

Answer: D Rationale: The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast. Unlike a plaster cast, a Fiberglas cast dries quickly and can be handled without damage soon after application. The nurse should assess the brachial and radial pulses distal to the cast.

To help prevent osteoporosis, the nurse should advise a young woman to: A. Avoid trauma to the affected bone. B. Sleep on a firm mattress. C. Consume at least 1,000 mg of calcium daily. D. Keep the serum uric acid level in the normal range.

Answer: C Rationale: To help prevent osteoporosis, the nurse should encourage the client to consume at least the recommended daily allowance (RDA) of calcium. Before menopause, the RDA is 1,000 mg; after menopause, it is 1,500 mg. Because osteoporosis affects all bones, A is inappropriate. B and D don't relate to osteoporosis.

A client is preparing for discharge from the emergency department after sustaining an ankle sprain. The client is instructed to avoid weight bearing on the affected leg and is given crutches. After instruction, the client demonstrates proper crutch use in the hallway. What additional information is most important to know before discharging the client? A. Whether the client needs to navigate stairs routinely at home B. Whether pets are present in the home C. Whether the client parks his car on the street D. Whether the client drives a car with a stick shift

Answer: A Rationale: Knowing whether the client must routinely navigate steps at home is most important. If the client must navigate steps, special crutch-walking techniques must be taught to safely navigate the stairs. The other choices can pose problems for the client; however, they aren't important to know before discharging the client with crutches.

An older patient with osteoarthritis is preparing for discharge. Which of the following information is correct? A. Increased physical activity and daily exercise will help decrease discomfort associated with the condition. B. Joint pain will diminish after a full night of rest. C. Nonsteroidal anti-inflammatory medications should be taken on an empty stomach. D. Acetaminophen (Tylenol) is a more effective anti-inflammatory than ibuprofen (Motrin).

Answer: A Rationale: Physical activity and daily exercise can help to improve movement and decrease pain in osteoarthritis. Joint pain and stiffness are often at their worst during the early morning after several hours of decreased movement. Acetaminophen is a pain reliever, but does not have anti-inflammatory activity. Ibuprofen is a strong anti-inflammatory, but should always be taken with food to avoid GI distress.

The patient who had a stroke needs to be fed. What instruction should you give to the PCT who will feed the patient? A. Position the patient sitting up in bed before you feed her B. Check the patient's gag and swallowing reflexes. C. Feed the patient quickly because there are three more waiting D. Suction the patient's secretions between bites of food.

Answer: A Rationale: Positioning the patient in a sitting position decreases the risk of aspiration. The nursing assistant is not trained to assess gag or swallowing reflexes. The patient should not be rushed during feeding. A patient who needs to be suctioned between bites of food is not handling secretions and is at risk for aspiration. This patient should be assessed further before feeding

A client is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease? Select all that apply. A. "It's common in females after menopause." B. "It's a degenerative disease characterized by a decrease in bone density." C. "It's a congenital disease caused by poor dietary intake of milk products. D. "It can cause pain and injury." E. "Passive range-of-motion exercises can promote bone growth." F. "Weight-bearing exercise should be avoided."

Answer: A, B, D Rationale: Osteoporosis is a degenerative metabolic bone disorder in which the rate of bone resorption accelerates and the rate of bone formation decelerates, thus decreasing bone density. Postmenopausal women are at increased risk for this disorder because of the loss of estrogen. The decrease in bone density can cause pain and injury. Osteoporosis isn't a congenital disorder; however, low calcium intake does contribute to the disorder. Passive range-of-motion exercises may be performed but they won't promote bone growth. The client should be encouraged to participate in weight-bearing exercise because it promotes bone growth

You are creating a teaching plan for a patient with newly diagnosed migraine headaches. Which key items should be included in the teaching plan? (Choose all that apply). A. Avoid foods that contain tyramine, such as alcohol and aged cheese. B. Avoid drugs such as Tagamet, nitroglycerin and Nifedipine. C. Abortive therapy is aimed at eliminating the pain during the aura. D. A potential side effect of medications is rebound headache. E. Complementary therapies such as relaxation may be helpful F. Continue taking estrogen as prescribed by your physician.

Answer: A,B,C,D, & E Rationale: Medications such as estrogen supplements may actually trigger a migraine headache attack. All of the other statements are accurate.

Thrombolytic therapy is frequently used in the treatment of suspected stroke. Which of the following is a significant complication associated with thrombolytic therapy? A. Air embolus B. Hemorrhage C. Hypotension D. Seizures

Answer: B Rationale: Hemorrhage is a significant risk when treating a stroke victim with thrombolytic therapy intended to dissolve a suspected clot. Success of the treatment demands that it be instituted as soon as possible, often before the cause of stroke has been determined. Air embolus is not a concern. Thrombolytic therapy does not lead to hypotension or seizures.

A nurse in the emergency department is observing a 24-year-old for signs of increased intracranial pressure after a fall from a bicycle, resulting in head trauma. Which of the following signs or symptoms would be cause for concern? A. Bruising under one eye. B. Repeated vomiting. C. Signs of sleepiness at 11 PM. D. Inability to read short words from a distance of 18 inches.

Answer: B Rationale: Increased pressure caused by bleeding or swelling within the skull can damage delicate brain tissue and may become life threatening. Repeated vomiting can be an early sign of pressure as the vomit center within the medulla is stimulated. Bruising is expected after a fall. Blurred vision resulting from the head injury may take time to resolve. Sleepiness at 11 PM is not out of the ordinary.

A client is hospitalized for open reduction of a fractured femur. During postoperative assessment, the nurse monitors for signs and symptoms of fat embolism, which include: A. pallor and coolness of the affected leg. B. restlessness and petechiae. C. nausea and vomiting after eating. D. hypothermia and bradycardia.

Answer: B Rationale: Signs and symptoms of fat embolism include restlessness, petechiae, and an altered mental status. Pallor and coolness of the affected leg are associated with a clot in the leg, not fat embolism. Nausea and vomiting after eating may be related to gastric obstruction. Hypothermia isn't an expected result of an open reduction of a fracture. Bradycardia has no relation to fat emboli but may indicate a cardiac problem.

The nurse is positioning a client with increased intracranial pressure. Which of the following positions would the nurse avoid? A. Head midline B. Head turned to the side C. Neck in neutral position D. Head of bed elevated 30 to 45 degrees

Answer: B Rationale: The head of the client with increased intracranial pressure should be positioned so the head is in a neutral midline position. The nurse should avoid flexing or extending the client's neck or turning the head side to side. The head of the bed should be raised to 30 to 45 degrees. Use of proper positions promotes venous drainage from the cranium to keep intracranial pressure down.

A client has sustained a right tibia fracture and has just had a cast applied. Which instruction should the nurse provide in his cast care? A. "Cover the cast with a blanket until the cast dries." B. "Keep your right leg elevated above heart level." C. "Use a knitting needle to scratch itches inside the cast." D. "A foul smell from the cast is normal.

Answer: B Rationale: The leg should be elevated to promote venous return and prevent edema. The cast shouldn't be covered while drying because this will cause heat buildup and prevent air circulation. No foreign object should be inserted inside the cast because of the risk of cutting the skin and causing infection A foul smell from a cast is never normal and may indicate an infection.

A client has a herniated disk in the region of the third and fourth lumbar vertebrae. On assessment, the nurse expects to note: A. hypoactive bowel sounds B. severe low back pain C. sensory deficits in one arm. D. weakness and atrophy of the arm muscles

Answer: B Rationale: The most common finding in a client with a herniated lumbar disk is severe low back pain, which radiates to the buttocks, legs, and feet — usually unilaterally. A herniated disk also may cause sensory and motor loss (such as footdrop) in the area innervated by the compressed spinal nerve root. During later stages, it may cause weakness and atrophy of leg muscles. The condition doesn't affect bowel sounds or the arms.

The nurse is caring for five clients on the orthopedic unit with the help of a nursing assistant. Which task can the nurse safely delegate to the tech? A. Notifying the physician of a change in a client's blood pressure B. Assisting a client to the bathroom and recording the output in the medical record C. Auscultating and recording breath sounds in the medical record D. Taking a verbal report from the emergency department for a client being admitted to the orthopedic unit

Answer: B Rationale: The nurse can safely delegate activities of daily living such as assisting the client to the bathroom to the nursing assistant. Notifying the physician, auscultating breath sounds, and taking report are all responsibilities that must be performed by a registered nurse

After surgery to treat a hip fracture, a client returns from the post anesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?' A. With the affected hip flexed B. With the leg on the affected side abducted C. With the leg on the affected side adducted D. With the affected hip rotated externally

Answer: B Rationale: The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.

A client has pins with skeletal traction in place to stabilize a fracture. Protocol dictates that pin care should be performed each shift. When providing pin care for the client, which finding should the nurse report to the physician? A. Crust around the pin insertion site B. A small amount of yellow drainage at the left pin insertion site C. A slight reddening of the skin surrounding the insertion site D. Pain at the insertion site

Answer: B Rationale: The nurse should report the presence of yellow drainage, which indicates the presence of infection, at the left pin insertion site. Crust formation around the pin site is a natural response to the trauma caused by the pin insertion. Redness at the insertion site may be an early sign of infection; the nurse should continue to monitor the area. The client may experience pain at the pin insertion sites ineffective.

A client is diagnosed with gout. Which foods should the nurse instruct the client to avoid? Select all that apply. A. Green, leafy vegetables B. Liver C. Red wine D. Chocolate E. Sardines F. Eggs

Answer: B, C, E Rationale: Clients with gout should avoid foods that are high in purines, such as liver, cod, and sardines. They should also avoid anchovies, kidneys, sweetbreads, lentils, and alcoholic beverages — especially beer and wine. Green, leafy vegetables; chocolate; and eggs aren't high in purines.

A client is in the emergency department with a suspected fracture of the right hip. Which assessment findings would the nurse expect? A. The right leg is longer than the left leg. B. The right leg is shorter than the left leg. C. The right leg is abducted. D. The right leg is adducted. E. The right leg is externally rotated. F. The right leg is internally rotated.

Answer: B, D, E Rationale: In a hip fracture, the affected leg is shorter, adducted, and externally rotated.

The nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? A. Keep the affected leg in a position of adduction. B. Use measures other than turning to prevent pressure ulcers. C. Prevent internal rotation of the affected leg. D. Keep the hip flexed by placing pillows under the client's knee.

Answer: C Rationale: External rotation and abduction of the hip will help prevent dislocation of a new hip joint. Internal rotation and adduction should be avoided. Postoperative total hip replacement clients may be turned onto the unaffected side. While the hip may be flexed slightly, it shouldn't exceed90 degrees and maintenance of flexion is not necessary

The nurse is performing an admission assessment on a client admitted with a pelvic fracture. Which statement by the client requires the nurse to seek more information from a legal standpoint? A. "I'm so clumsy. B. "I'm afraid I'll lose my job because I'm going to miss so much work." C. "Sometimes my husband gets so angry with me." D. "I'm going to need help at home after I'm discharged."

Answer: C Rationale: Legally, the nurse must further investigate the client's statement concerning the husband's anger. This statement suggests that the client's injury might be caused by domestic abuse. The other statements are common and don't require further investigation from a legal standpoint by the nurse.

Which nursing intervention is essential in caring for a client with compartment syndrome? A. Keeping the affected extremity below the level of the heart B. Wrapping the affected extremity with a compression dressing to help decrease the swelling C. Removing all external sources of pressure, such as clothing and jewelry D. Starting an I.V. line in the affected extremity in anticipation of venogram studies

Answer: C Rationale: Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity

A patient is about to undergo a lumbar puncture and expresses fear and anxiety about the procedure. Which of the following is the most effective nursing response? A. Warn the patient to stay very still because the smallest movement will increase her pain. B. Encourage the family to stay in the room for the procedure. C. Stay with the patient and focus on slow, deep breathing for relaxation. D. Delay the procedure to allow the patient to deal with her feelings.

Answer: C Rationale: Slow, deep breathing is the most effective method of reducing anxiety and stress. It reduces the level of carbon dioxide in the brain to increase calm and relaxation. Warning the patient to remain still will likely increase her anxiety. Encouraging family members to stay with the patient may make her worry about their anxiety as well as her own. Delaying the procedure is unlikely to allay her fears.

The nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which of the following findings should the nurse consider abnormal? A. More back pain than the first postoperative day B. Paresthesia in the dermatomes near the wounds C. Urine retention or incontinenced. D. Temperature of 99.2° F (37.3° C)

Answer: C Rationale: Urine retention or incontinence may indicate cauda equina syndrome, which requires immediate surgery. An increase in pain on the second postoperative day is common because the long-acting local anesthetic, which may have been injected during surgery, will wear off. While paresthesia is common after surgery, progressive weakness or paralysis may indicate spinal nerve compression. A mild fever is also common after surgery but is considered significant only if it reaches 101° F (38.3° C).

The nurse is teaching a client with a left fractured tibia how to walk with crutches. Which instruction is appropriate? A. "Use the axillae to help carry the weight." B. "All weight should be on the hands." C. "Keep feet apart to provide stability and a wide base of support." D. "Take long strides to maintain maximum mobility."

Answer: C Rationale: When using crutches, all weight should be on the hands. Constant pressure on the axillae from weight bearing can damage thebrachial plexus nerve and produce crutch paralysis. Feet should be 6″ to 8″ (15 to 20 cm) apart to provide stability and support. Short strides, not long ones, provide safety and maximum mobility.

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? A. "Do all your chores in the morning, when pain and stiffness are least pronounced." B. "Do all your chores after performing morning exercises to loosen up." C. "Pace yourself and rest frequently, especially after activities." D. "Do all your chores in the evening, when pain and stiffness are least pronounced."

Answer: C: Rationale: A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace herself during daily activities.

Which patient should NOT be prescribed alendronate (Fosamax) for osteoporosis? A. A female patient being treated for high blood pressure with an ACE inhibitor. B. A patient who is allergic to iodine/shellfish. C. A patient on a calorie restricted diet. D. A patient on bed rest who must maintain a supine position

Answer: D Rationale: Alendronate can cause significant gastrointestinal side effects, such as esophageal irritation, so it should not be taken if a patient must stay in supine position. It should be taken upon rising in the morning with 8 ounces of water on an empty stomach to increase absorption. The patient should not eat or drink for 30 minutes after administration and should not lie down. ACE inhibitors are not contraindicated with alendronate and there is no iodine allergy relationship

The nurse is giving instructions to a client who's going home with a cast on his leg. Which point is most critical? A. Using crutches properly B. Exercising joints above and below the cast, as ordered C. Avoiding walking on a leg cast without the physician's permission D. Reporting signs of impaired circulation

Answer: D Rationale: Although all of these interventions are important, reporting signs of impaired circulation is the most critical. Signs of impaired circulation must be reported to the physician immediately to prevent permanent damage. The other options reflect more long-term concerns. The client should learn to use his crutches properly to avoid nerve damage. The client may exercise above and below the cast, as the physician orders. The client should be told not to walk on the cast without the physician's permission

A fifty-year-old blind and deaf patient has been admitted to your floor. As the charge nurse your primary responsibility for this patient is? A: Let others know about the patient's deficits B: Communicate with your supervisor your concerns about the patient's deficits. C: Continuously update the patient on the social environment. D: Provide a secure environment for the patient

Answer: D Rationale: This patient's safety is your primary concern.

A client comes to the outpatient department with suspected carpal tunnel syndrome. When assessing the affected area, the nurse expects to find which abnormality typically associated with this syndrome? A. Positive Tinel's sign B. Negative Phalen's sign C. Positive Chvostek's sign D. Negative Trousseau's

Answer: A Rationale The nurse expects a client with carpal tunnel syndrome to exhibit a positive Tinel's sign — tingling or shock like pain in reaction to light percussion over the median nerve at the wrist. The client also may have a positive Phalen's sign, characterized by hand tingling with acute wrist flexion.

The client with a brain attack (stroke) has residual dysphagia. When a diet order is initiated, the nurse avoids doing which of the following? A. Giving the client thin liquids B. Thickening liquids to the consistency of oatmeal C. Placing food on the unaffected side of the mouth D. Allowing plenty of time for chewing and swallowing

Answer: A Rationale: Clients with dysphagia have difficulty swallowing, especially thin liquids. It may help to feed slowly and place food on the unaffected side of the mouth.

The nurse is caring for a client who recently underwent a total hip replacement. The nurse should: A. ease the client onto a low toilet seat. B. allow the client's legs to be crossed at the knees when out of bed. C. use soft chairs when the client is sitting out of bed. D. limit client hip flexion when sitting.

Answer: D Rationale: Instruct the client to limit hip flexion to 90 degrees while sitting. Supply an elevated toilet seat so that the client can sit without having to flex his hip more than 90 degrees. Instruct the client not to cross his legs to avoid dislodging or dislocating the prosthesis. Caution the client against sitting in chairs that are too low or too soft; these chairs increase flexion, which is undesirable.

For a client with osteoporosis, the nurse should provide which dietary instruction? A. "Decrease your intake of red meat." B. "Decrease your intake of popcorn, nuts, and seeds." C. "Eat more fruits to increase your potassium intake." D. "Eat more dairy products to increase your calcium intake."

Answer: D Rationale: Osteoporosis causes a severe, general reduction in skeletal bone mass. To offset this reduction, the nurse should advise the client to increase calcium intake by consuming more dairy products, which provide about 75% of the calcium in the average diet. None of the other options would stop osteoporosis from worsening

A nurse is caring for a patient who has had hip replacement. The nurse should be most concerned about which of the following findings? A. Complaints of pain during repositioning. B. Scant bloody discharge on the surgical dressing. C. Complaints of pain following physical therapy. D. Temperature of 101.8⁰ F (38.7⁰ C).

Answer: D Rationale: Post-surgical nursing assessment after hip replacement should be principally concerned with the risk of neurovascular complications and the development of infection. A temperature of 101.8⁰ F (38.7⁰ C) postoperatively is higher than the low grade that is to be expected and should raise concern. Some pain during repositioning and following physical therapy is to be expected and can be managed with analgesics. A small amount of bloody drainage on the surgical dressing is a result of normal healing.