ATI Neuro questions

A nurse is obtaining a health history from a client who is being evaluated for the cause of frequent headaches. Which of the following questions should the nurse ask to identify the aura type of migraine headaches? "Do the headaches occur multiple times each day?" "Does your headache occur on one side of your head?" "Is your headache accompanied by profuse facial sweating?" "Do you have the same manifestations each time the headache occurs?"

"Do you have the same manifestations each time the headache occurs?" Clients who have aura type migraines typically have the same manifestations each time the headache occurs.

A nurse is teaching a client who is scheduled for a cerebral angiography. Which of the following statements by the client indicates understanding? "I can eat as usual prior to the procedure." "I will be standing up during the procedure." "After the procedure, the urinary catheter will be removed." "I will feel warm after that dye is injected."

"I will feel warm after that dye is injected." When evaluating outcomes after providing teaching with a client about cerebral angiography procedure, the nurse should identify the client understands teaching when the statement is made about feeling warm when the dye is injected. This is an expected reaction that is experienced after the injection of contrast dye.

A nurse is providing education to a client who is scheduled for an electroencephalogram (EEG) the next day. Which of the following statements should the nurse make? "You should wash your hair prior to the procedure." "You cannot eat or drink for at least 6 hours prior to the procedure." "The procedure takes about 15 minutes to complete." "They will apply small electrodes to your chest during the procedure."

"You should wash your hair prior to the procedure." An EEG is a procedure that analyzes electrical activity of the brain. Therefore, the nurse should inform the client to ensure that their hair is washed prior to the procedure which will remove oils, gels, or sprays and allow for the placement of the scalp electrodes.

A nurse is providing nonpharmacologic methods of pain relief to a client. Identify the type of nonpharmacologic therapy to the example provided. A Cognitive behavioral methods B Movement therapy C Biologically based therapies D Physical modalities 1. Imagery 2. Aromatherapy 3. Yoga 4. Ice application

A1 B3 C2 D4 These are the different types of nonpharmacologic pain management. Cognitive and behavioral methods include relaxation breathing, music, distraction, and pet therapy. Movement therapy includes Yoga and T'ai chi. Biologically based therapies include herbs, change in diet, and increasing protein. Physical modalities include changes in position, heat or cold application, TENS unit, and other associated therapies.

A nurse is caring for a client who has meningitis and is at risk for SIADH. Which of the following findings should the nurse monitor for? Dilute urine Bounding pulse Change in level of consciousness Weight loss Hypernatremia

Bounding pulse Change in level of consciousness When recognizing cues to determine the presence of SIADH for a client who has meningitis, the nurse should monitor for a bounding pulse and change in the client's level of consciousness.

A nurse is caring for a client who has increased ICP and a new prescription for mannitol. For which of the following adverse effects should the nurse monitor? Hyperglycemia Hyponatremia Hypervolemia Oliguria

Hyponatremia Mannitol is a powerful osmotic diuretic. Adverse effects include electrolyte imbalances, such as hyponatremia. Hypovolemia is an adverse effect of mannitol and should be monitored. Polyuria is an adverse of mannitol and should be monitored.

A nurse is caring for a client who has global aphasia (both receptive and expressive). Which of the following interventions should the nurse implement? ​​​​​​​ Speak slowly to the client Assist the client to use cards with pictures Speak to the client in a loud voice Complete sentences the client cant finish Give instructions to the client one step at a time

Speak slowly to the client Assist the client to use cards with pictures Give instructions to the client one step at a time

A nurse in a clinic is teaching a client who has a history of migraine headaches about a new prescription for zolmitriptan. Which of the following statements by the client indicates understanding of the teaching? "This medication will relieve my symptoms by causing my blood vessels to dilate." "I should take this medication daily to prevent the headache from occurring." "I should expect facial flushing when I take this medication." "This medication will lower my sensitivity to food triggers."

"I should expect facial flushing when I take this medication." Zolmitriptan can cause facial flushing, tingling, and warmth. Zolmitriptan causes cranial arteries, the basilar arteries, and blood vessels in the dura mater to constrict. Zolmitriptan is used for abortive therapy in treating migraine headaches. It is not used for headache prevention.

A nurse is providing teaching with a client who has MS. Which of the following client statements indicates understanding? "I will plan to group my activities." "I won't be able to perform self-care." "I should have my partner do all of the housework." "I will perform vigorous exercising three times per day."

"I will plan to group my activities." A client who has MS should balance activity and rest and conserve their energy by grouping care and planning rest periods. Clients who are not in an acute MS flare should be able to perform self-care, participate in activities such as light housework, and mild exercise. They should avoid fatigue and overexertion; therefore, vigorous exercising is not recommended.

A nurse is teaching a client who has multiple sclerosis and a new prescription for baclofen. Which of the following statements should the nurse include in the teaching? "This medication will help you with your tremors." "This medication will help you with your bladder function." "This medication can cause your skin to bruise easily." "This medication can cause you to experience dizziness." "Nasal congestion and drainage occur."

"This medication will help you with your bladder function." "This medication can cause you to experience dizziness." "Nasal congestion and drainage occur." Propranolol is a beta blocker and clonazepam is a benzodiazepine given to clients who have MS to treat tremors. Propantheline is an anticholinergic medication that is given to clients who have MS to treat bladder dysfunction and baclofen can assist with improving bowel and bladder function. Prednisone is a corticosteroid medication that is given to clients who have MS to treat inflammation. An adverse effect of this medication is bruising of the skin. Baclofen is an antispasmodic medication that is given to clients who have MS to treat muscle spasms. An adverse effect of this medication is drowsiness, dizziness, weakness, and nausea. Instruct the client to monitor for these findings, as they can lead to impaired safety. The client should be instructed not to discontinue baclofen abruptly.

A nurse is providing teaching with a newly licensed nurse about the manifestations of stroke. Match the findings of stroke to the corresponding term. A. Difficulty writing B. Inability to perform simple commands C. Loss of balance or coordination D. Inability to recognize familiar objects by sight, hearing or touch E. Inability to speak or understand language 1. Agnosia 2. Aphasia 3. Agraphia 4. Ataxia 5. Apraxia

A3 B5 C4 D1 E2

A nurse is assessing a client who had abdominal surgery. The client reports pain in the abdomen at 9 on a 0 to 10 scale. What type of pain is the client experiencing? Acute Nociceptive Chronic Neuropathic

Acute Postoperative pain is acute pain and must be managed to prevent long-term/chronic pain.

A nurse is providing discharge instructions to a client who has a new diagnosis of migraine headaches. Which of the following instructions should the nurse include? Use music therapy for relaxation with the onset of the headache. Increase physical activity when a headache is present. Drink beverages that contain artificial sweeteners to prevent headaches. Apply a cool cloth to the face during a headache.

Apply a cool cloth to the face during a headache. A cool cloth placed over the client's eyes can provide comfort and relieve pain. A quiet, dark environment can provide comfort during a migraine headache. Increasing physical activity during a migraine headache can worsen the pain. Artificial sweeteners contain tyramine, which can trigger a migraine headache

A nurse in a clinic is caring for a client who has frequent migraine headaches. The client asks about foods that can cause headaches. The nurse should recommend that the client avoid which of the following foods? Baked salmon Chocolate Frozen strawberries Fresh asparagus

Chocolate The nurse understands that chocolate contains tyramine, which can trigger migraine headaches. The client should avoid fish that is smoked because it contains tyramine. Baked salmon does not contain tyramine and is not a trigger for migraine headaches.

A nurse in a provider's office is obtaining a health history from a client who has cluster headaches. Which of the following are expected findings? Pain is bilateral across the posterior occipital area. Client experiences altered sleep-wake cycle. Headache occurs approximately 1 to 8 times daily. Client describes headache pain as dull and throbbing. Nasal congestion and drainage occur.

Client experiences altered sleep-wake cycle. Headache occurs approximately 1 to 8 times daily. Nasal congestion and drainage occur. Cluster headaches can be due to a lack of continuity in the sleep-wake cycle .Cluster headaches occur approximately 1 to 8 times daily. Cluster headaches are described as unilateral, intense, and nonthrobbing. A client can have a runny nose and nasal congestion with a cluster headache. Cluster headaches typically cause pain on one side of the head and radiate to the forehead, temple, or cheek.

A nurse is preparing to collect data for a client who has multiple sclerosis (MS). Which of the following findings should the nurse expect? Elevated BP Client report of fatigue Client report of rhinitis Muscle rigidity

Client report of fatigue When recognizing cues, the nurse should identify that the client report of fatigue is a common finding for a client who has MS.

A nurse is caring for a client who reports pain at 10 on a 0 to 10 scale. The nurse plans to administer morphine. Which of the following adverse effects should the nurse monitor for in the client? Select all that apply Confusion Diarrhea Constipation Hypertension Bradypnea

Confusion Constipation Bradypnea A client receiving morphine is at risk for confusion, sedation, respiratory depression, hypotension, constipation, nausea, vomiting and urinary retention.

A nursing is caring for a client who has a closed-head injury with ICP readings ranging from 16 to 22 mm Hg. Which of the following actions should the nurse take to decrease the potential for raising the client's ICP? Suction the endotracheal tube frequently. Decrease the noise level in the client's room. Elevate the client's head on two pillows. Administer a stool softener. Keep the client well hydrated.

Decrease the noise level in the client's room. Administer a stool softener. Decreasing the noise level and restricting the number of people in the client's room can help prevent increases in ICP. Administration of a stool softener will decrease the need to bear down (Valsalva maneuver) during bowel movements, which can increase ICP. Suctioning increases ICP and should be performed only when indicated. Hyperflexion of the client's neck with pillows carries the risk of increasing ICP and should be avoided. The head of the bed should be raised to at least 30°, but the head should be maintained in an upright, neutral position. Overhydration carries the risk of increasing ICP and should be avoided. Monitor fluid and electrolyte levels closely for the client who has increased ICP.

A nurse is caring for a client who is taking benztropine and is reporting tremors and rigidity in the left hand and arm. Which of the following findings should the nurse identify as an adverse effect of benztropine? ​​​​​​​ Aspiration Dry mouth Diarrhea Dark urine Orthostatic hypotension

Dry mouth When analyzing cues, the nurse should identify that anticholinergic effects, such as dry mouth, are anticipated in clients who take benztropine.

A nurse in a neurology clinic is caring for clients who have seizure disorders. Match each manifestation the nurse observes with the type of seizure each client is experiencing. A. Myoclonic seizure B. Tonic-clonic seizure C. Absence seizure D. Simple partial seizure E. Atonic seizure 1. Client experienced loss of muscle tone 2. The client repeatedly experienced loss of consciousness with no motor activity 3. The client experienced incontinence 4. The seizure lasted for several seconds 5. The client experienced flushing and an offensive smell

E1 C2 B3 A4 D5

A nurse is caring for a client immediately following a lumbar puncture. Which of the following actions should the nurse take? Encourage increased fluid intake Administer analgesic for pain Encourage to cough and deep breathe Monitor the puncture site for drainage

Encourage increased fluid intake Administer analgesic for pain

A nurse is caring for a client who is scheduled for a cerebral computed tomography scan with contrast. Which of the following actions should the nurse take? Hold the client in a left lateral position during the procedure. Insert indwelling urinary catheter prior to procedure. Ensure the client is not wearing any metal objects prior to procedure. Administer an analgesic for pain after the procedure.

Ensure the client is not wearing any metal objects prior to procedure. A cerebral computed tomography scan with contrast requires the nurse to inform the client to remove any metal objects such as jewelry, hair accessories, hair clips, or belts from their body because these items can interfere with the scanning machine.

A nurse is caring for a client who is receiving an IV infusion of alteplase for the management of suspected ischemic stroke. Which of the following findings is an adverse effect of this medication? Hypertension Hypothermia Epistaxis Diplopia

Epistaxis When taking actions, the nurse should identify that alteplase is a thrombolytic agent that is administered IV for a client who is suspected of having an ischemic stroke. The nurse should monitor for adverse effects of bleeding (GI bleeding, epistaxis, hemoptysis, and intracranial hemorrhage).

A nurse is caring for a client who has Alzheimer's disease. A family member of the client asks the nurse about risk factors for the disease. Which of the following factors should be included in the nurse's response? Exposure to metal Long term estrogen therapy Sustained use of Vitamin E Previous head injury History of herpes infection

Exposure to metal Previous head injury History of herpes infection When taking actions, the nurse should identify that exposure to metal and toxic waste, a previous head injury, and a history of herpes infection are risk factors for Alzheimer's disease.

A nurse is planning care for a client who had a stroke and is experiencing dysphagia. Which of the following actions should the nurse include in the plan? ​​​​​​​ Have suction equipment available for use. Eliminate distractions during mealtime. Place food on the unaffected side of the client's mouth. Assign assistive personnel to provide initial feeding. Inform client to swallow with the neck flexed forward.

Have suction equipment available for use. Eliminate distractions during mealtime. Place food on the unaffected side of the client's mouth. Inform the client to swallow with the neck flexed forward When generating solutions, the nurse should identify a client who has dysphagia is at risk for aspiration. Therefore, it is important for the nurse to keep the client NPO until a swallowing evaluation has been performed by SLP. When planning care, the nurse should have suction equipment available, eliminate distractions during mealtime, place food on the unaffected side of mouth and inform client to swallow with neck flexed forward. These measures will reduce the risk for aspiration and decrease the risk of choking

A nurse in the critical care unit is completing an admission assessment of a client who has a gunshot wound to the head. Which of the following assessment findings are indicative of increased ICP? Headache Tachycardia Dilated pupils Hypotension Decorticate posturing

Headache Dilated pupils Decorticate posturing Headache and dilated pupils are findings associated with increased ICP. Decorticate or decerebrate posturing is also a finding associated with increased ICP. Bradycardia, not tachycardia, is a finding associated with increased ICP. Hypertension, not hypotension, is a finding associated with increased ICP.

A nurse is assessing a client who has meningitis. Which of the following findings should the nurse expect? Bradycardia Headache Nuchal rigidity Seizures Photophobia

Headache Nuchal rigidity Seizures Photophobia When recognizing cues, the nurse should expect a client who has meningitis to experience a headache which can be related to increased intracranial pressure. The client can also exhibit nuchal rigidity (stiff neck) as well as experience seizures due to fever and increased intracranial pressure along with photophobia who has meningitis.

A nurse is caring for a newly admitted client. The client has been identified as having bacterial meningitis. Which of the following is the priority action for the nurse to take? Isolate the patient Initiate seizure precautions Provide a quiet enviornment Start IV fluids

Isolate the patient The nurse should analyze the findings and determine that the priority hypothesis is that the client who has been identified as having bacterial meningitis is at greatest risk for transmitting the infection; therefore, the nurse should initiate droplet precautions and place the client in a private room.

A nurse is caring for a client who was recently admitted to the emergency department following a head-on motor vehicle crash. The client is unresponsive, has spontaneous respirations of 22/min, and has a laceration on the forehead that is bleeding. Which of the following is the priority nursing action at this time? Keep neck stabilized Insert nasogastric tube Monitor pulse and BP frequently Establish IV access and start fluid replacement

Keep neck stabilized The greatest risk to the client is permanent damage to the spinal cord if a cervical injury does exist. The priority nursing intervention is to keep the neck immobile until damage to the cervical spine can be ruled out.

A nurse is caring for a client who is experiencing an acute exacerbation of MS. Which of the following actions should the nurse take? ​​​​​​​ Assist with ambulation 6 times daily. Monitor for dysphagia. Check skin integrity. Use a communication board. Encourage fluid intake.

Monitor for dysphagia. Check skin integrity. Use a communication board. Encourage fluid intake. The client with an acute exacerbation of ms may experience dysarthria should be monitored for dysphagia, or difficulty swallowing. They may also need to utilize a communication board due to their dysarthria, or unclear speech. They are at risk of skin breakdown due to immobility, and this should be assessed frequently. The nurse should encourage fluid intake to assist with preventing UTI and constipation.

A nurse is caring for a client who has just been admitted following surgical evacuation of a subdural hematoma. Which of the following is the priority assessment? Glascow coma scale Cranial nerve function Oxygen saturation Pupillary response

Oxygen saturation Using the airway, breathing, and circulation (ABC) priority-setting framework, assessment of oxygen saturation is the priority action. Brain tissue can only survive without perfusion for 3 min before permanent damage occurs.

A nurse is assessing for the presence of Brudzinski's sign in a client who has suspected meningitis. Which of the following actions should the nurse take when performing this technique? Place client in supine position Place hands behind client's neck Flex client's hip and knee Bend client's head toward chest Straighten client's flexed leg at the knee

Place client in supine position Place hands behind client's neck Bend client's head toward chest When recognizing cues to determine the presence of Brudzinski's sign for a client who has suspected meningitis, the nurse should place the client in the supine position, place hands behind the client's neck while bending the client's head toward the chest. The lower extremities of the client will flex.

Lilly is caring for Mrs. Roberts who has Alzheimer's disease and fell at home prior to admission. Which of the following actions should the nurse take first to keep the client safe? Keep the call light near the patient Place the client in the room closest to the nurse's station Encourage the client to ask for assistance Remind the client to walk with someone for support

Place the client in the room closest to the nurse's station When prioritizing hypothesis, the nurse should identify that using the safety and risk reduction priority-setting framework, placing the client in close proximity to the nurses' station is the first action the nurse should take.

A nurse is caring for a client who has left homonymous hemianopsia. Which of the following actions should the nurse take? ​​​​​​​ Teach the client to scan to the right to see objects on the right side of the body. Place the client's bedside table on the right side of the bed. Orient the client to the food on the plate using the clock method. Place the wheelchair on the client's left side.

Place the client's bedside table on the right side of the bed You answered incorrectly. When taking actions, the nurse should identify that a client who has left homonymous hemianopsia has lost the left visual field of both eyes which causes vision impairment on their left side. Therefore, the nurse should place the bedside table and wheelchair on the client's right side of the bed for visualization of the items on the table and instruct the client. o turn their head to the left to visualize the entire field of vision.

A nurse is caring for a client who has stage IV Parkinson's disease and has lost 20 lbs since their last checkup one month ago. The client presents with akinesia and rigidity. A nurse is developing a plan of care for the nutritional needs. Which of the following actions should the nurse include? Provide 3 large balanced meals a day Record intake and output daily Document weight every other week Offer cold fluids such as milkshakes Offer nutritional supplements between meals

Record intake and output daily Offer cold fluids such as milkshakes Offer nutritional supplements between meals The nurse should offer nutritional supplements between meals to maintain the client's weight and provide small, frequent meals during the day to maintain adequate nutrition. The nurse should plan to provide cold fluids such as milkshakes. Thick and cold fluids are tolerated easier by the client. When generating solutions, the nurse should record the client's diet and fluid intake daily to assess for dietary needs and to maintain adequate nutrition and hydration Document the client's weight weekly to identify weight loss and intervene to maintain the client's weight.

A nurse is making a home visit to a client who has AD. The client's partner states that the client is often disoriented to time and place, is unsteady, and has a history of wandering. Which of the following safety measures should the nurse review with the partner? Remove floor rugs Have door locks that can be easily opened Provide increased lighting in the stairwell Install handrails in the bathroom Place the mattress on the floor

Remove floor rugs Provide increased lighting in the stairwell Install handrails in the bathroom Place the mattress on the floor When taking actions, the nurse should identify that removing floor rugs, providing good lighting, especially in dark areas, such as stairways, installing handrails in the client's bathroom, and placing the client's mattress on the floor, reduces the risk of falling or tripping.

Lilly is planning care for Mrs. Roberts, who has mild Alzheimer's disease. Which of the following interventions should be included in the plan of care? Apply a waist restraint to reduce the risk of falls Thicken all liquids Provide protective undergarments Reorient the client to self and current events

Reorient the client to self and current events When generating solutions, the nurse should identify that a client who has mild Alzheimer's can require reorientation to self and current events as cognitive function declines

A nurse is caring for a client who has Parkinson's disease. Which of the following findings should the nurse anticipate the client to exhibit? Decreased Vision Shuffling gait Drooling Pill-rolling tremor of the fingers Lack of facial expression

Shuffling gait Drooling Pill-rolling tremor of the fingers Lack of facial expression When recognizing cues, the nurse should identify that clients who have Parkinson's disease can manifest pill-rolling tremors of the fingers due to overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult. Clients can also manifest a shuffling gait. Lack of facial expressions are also common, making controlled movement difficult. The client who has Parkinson's disease can develop drooling, making the controlled movement of swallowing secretions difficult.

A nurse is providing discharge instructions to a client who has a prescription for phenytoin. Which of the following information should the nurse include? Discontinue the medication if there is no seizure activity for 6 months. Watch for receding gums when taking the medication. Take the medication at the same time every day. Provide a urine sample to determine therapeutic levels of the medication.

Take the medication at the same time every day. When taking actions to provide discharge instructions to a client who has a prescription for an antiseizure medication, the nurse should instruct the client to adhere to the medication schedule as prescribed to maintain therapeutic levels of the medication.

A nurse is assisting a client who is ambulating to the bathroom. The client begins to have a seizure. Which actions should the nurse take? The nurse should provide privacy Ease the client to the floor if standing Move furniture away from the client Loosen the client's clothing Protect the client's head Restrain the client

The nurse should provide privacy Ease the client to the floor if standing Move furniture away from the client Loosen the client's clothing Protect the client's head

A nurse is providing teaching to the partner of a client who has Alzheimer's disease and has a new prescription for donepezil. Which of the following statements by the partner indicates the teaching is effective? This medication should increase my spouse's appetite This medication should help my spouse sleep better This medication should help my spouse's daily function This medication should increase my spouse's energy levels

This medication should help my spouse's daily function When evaluating outcomes, the nurse should identify that donepezil slows the progression of AD and can improve behavior and daily functions.

A nurse is preparing information for a client about SUDEP and includes strategies to avoid seizure triggers and strategies to manage seizures. Sort each activity by whether the nurse should include it as a seizure trigger or a strategy for seizure management. Trigger or management: Aerosol air fresheners for aromatherapy Moderate exercise Hot tub baths for relaxation Caffeinated beverages throughout the day Flashing light therapy to regulate mood and promote relaxation

Triggers: Air freshener Hot tub baths Caffeinated beverages Flashing light therapy Management: Moderate exercise When generating solutions for education about prevention of SUDEP, the nurse should plan to instruct the client to avoid triggers such as chemical sprays, extreme temperatures, caffeine, and flashing lights. The nurse should plan to instruct the client to include moderate exercise in a temperature-controlled environment as a strategy for managing overall health and avoiding trigger such as extreme heat or hyperventilation.

A nurse is caring for a client who came into the emergency department after an injury to the right arm. The nurse is assessing the client's pain. Which question should the nurse ask first? Where is your pain? How does it change with time? What does it feel like? How severe is your pain?

Where is your pain? When performing a comprehensive pain assessment, it is important to first identify where the pain is located. The first question the nurse should ask is "where is your pain?" The second question the nurse should ask is "what does the pain feel like?" The third question is "how does the pain change with time?" The nurse should ask the client to rate the severity of the pain for the fourth question.