Cox Neuro EAQ

A client who had a brain attack (stroke) is admitted to the hospital with right-sided hemiplegia. For what reason does the nurse recognize the importance of identifying restrictions of mobility or neuromuscular abnormalities? A. Shortening and eventual atrophy of the muscles will occur. B. Hypertrophy of the muscles eventually will result from disuse. C. Rigid extension can occur, making therapy painful and difficult. D. Decreased movement on the affected side predisposes the client to infection.

A- Shortening and eventual atrophy of muscles occur, resulting in contractures. Muscles will atrophy, not hypertrophy, from disuse. Flexion contractions, not extension rigidity, occur. Hemiplegia does not predispose to infection but to atrophy and contractures.

A client is diagnosed with the genetic disorder osteogenesis imperfecta. Which condition can be anticipated in the client at an age of 30? A. Loss of auditory acuity B. Loss of visual acuity C. Loss of smell perception D. Loss of touch perception

A- Some genetic disorders, such as osteogenesis imperfecta and Down syndrome, lead to progressive hearing loss in adults. Familial tendency and some genetic conditions may cause visual impairment. Osteogenesis imperfecta typically does not cause loss of smell or touch perception.

When helping a client with Parkinson disease to ambulate, what instructions should the nurse give the client? A. Avoid leaning forward. B. Hesitate between steps. C. Rest when tremors are experienced. D. Keep arms close to the center of gravity.

A- The client with Parkinson disease often has a stooped posture [1] [1] [2] because of the tendency of the head and neck to be drawn down; this shift away from the center of gravity causes instability. Hesitation is part of the disease; clients may use a marching rhythm to help maintain a more fluid gait. The tremors of Parkinson disease occur at rest (resting tremors). The client must consciously attempt to maintain a natural arm swing for balance.

Which structure is a component of the auditory ossicles? A. Malleus B. Vestibule C. Tympanic membrane D. External acoustic meatus

A- The malleus along with the incus and stapes constitutes the auditory ossicles. The vestibule is present in the inner ear and is an organ of balance. The tympanic membrane (eardrum) is a part of the middle ear. The external acoustic meatus is a component of the external ear.

A nurse is performing the history and physical examination of a client with Parkinson disease. Which assessments identified by the nurse support this diagnosis? A. Nonintention tremors B. Frequent bouts of diarrhea C. Masklike facial expression D. Hyperextension of the neck E. Rigidity to passive movement

A, C, E- Nonintentional tremors associated with Parkinson disease result from degeneration of the dopaminergic pathways and excess cholinergic activity in the feedback circuit. A masklike facial expression results from nigral and basal ganglial depletion of dopamine, an inhibitory neurotransmitter. Cogwheel rigidity is increased resistance to passive motion and is a classic sign of Parkinson. Constipation, not diarrhea, is a common problem because of a weakness of muscles used in defecation. The tendency is for the head and neck to be drawn forward, not hyperextended, because of loss of basal ganglial control.

The nurse is caring for a client with a spinal cord injury who has paraplegia. The nurse can expect which major problem early in the recovery period? A. Bladder control B. Nutritional intake C. Quadriceps setting D. Use of aids for ambulation

A- Because of the location of the micturition reflex center (in the sacral region of the spinal cord), bladder function may be impaired with lower spinal cord injuries. This client's ability to ingest, digest, or metabolize food is not affected; therefore nutrition is less of a problem than bladder control. Quadriceps settings require motor control, which the client does not have. Because there is no voluntary control over the lower extremities, mobility usually is accomplished through the use of a wheelchair rather than ambulation.

Which lobe of the cerebrum includes the client's Broca's speech center? A. Frontal lobe B. Parietal lobe C. Occipital lobe D. Temporal lobe

A- Broca's speech center is located in the frontal lobe and is responsible for the formation of words into speech. The parietal lobe aids in processing of spatial awareness and receiving and processing information about temperature, taste, and touch. The primary visual center is in the occipital lobe. The auditory center for interpreting sound is present in the temporal lobe.

The primary healthcare provider prescribes an adrenergic agonist to a client with increased intraocular pressure. Which question is priority that the nurse should ask the client? A. "Do you take antidepressants?" B. "Do you have any respiratory disorders?" C. "Do you wear contact lens?" D. "Do you have allergies to sulfonamides?"

A- Clients prescribed adrenergic agonists should be asked whether they are taking any antidepressants, such as phenezeline, because these medications increase blood pressure as do the adrenergic agonists; hence, this may lead to a hypertensive crisis. Clients prescribed beta-adrenergic blockers should be asked about any respiratory disorders, such as asthma, because the drug causes constriction of pulmonary smooth muscle which may lead to narrowing of the airway. Carbonic anhydrase inhibitors are similar to sulfonamides. Therefore, they should not be prescribed to clients who are allergic to sulfonamides. While asking about contact lensesis appropriate, this is not the priority for adrenergic agonist; discoloration of lens is not a critical as hypertensive crisis.

The family members of a client with the diagnosis of cerebrovascular accident (CVA, also known as "brain attack") express concern that the client often becomes uncontrollably tearful during their visits. What should the nurse include in a response? A. Emotional lability is associated with brain trauma. B. Their presence allows the client to express feelings. C. The client is depressed about the loss of functional abilities. D. Nonverbal expressions of feelings are more accurate than verbal ones.

A- Emotional lability is associated with brain trauma from ischemia or injury. The frontal lobe, hypothalamus, thalamus, and cortical limbic system are involved in expression of emotions. Emotional lability is not limited to interactions with family. Although the client may be depressed, the uncontrollable tearfulness is because of the disease process. Although nonverbal messages are often helpful in determining emotional response, these emotional outbursts may be unrelated to feelings.

What action should the nurse take when caring for a client who has a possible skull fracture as a result of trauma? A. Monitor the client for signs of brain injury. B. Check for hemorrhaging from the oral and nasal cavities. C. Elevate the foot of the bed if the client develops symptoms of shock. D. Observe for clinical indicators of decreased intracranial pressure and temperature.

A- Head injuries can cause trauma to the brain, and the client should be monitored for symptoms of increased intracranial pressure (e.g., headache, dizziness, and visual disturbances). Checking for hemorrhaging from the oral and nasal cavities is not indicated in this situation. Elevating the lower extremities should be avoided because it will increase intracranial pressure. The intracranial pressure may increase after trauma because of bleeding and edema. The temperature may increase because of injury to or pressure on the hypothalamus.

What is the maximum amount of time the nurse should allow an older adult with a cerebrovascular accident (also known as "brain attack") to remain in one position? A. 1 to 2 hours B. 3 to 4 hours C. 15 to 20 minutes D. 30 to 40 minutes

A-Change of position at least every 1 or 2 hours helps prevent the respiratory, urinary, and cutaneous complications of immobility [1] [2]. Too protracted a period of time in one position, such as every 3 to 4 hours, increases the potential for respiratory, urinary, and neuromuscular impairment. Prolonged physical pressure increases the possibility of skin breakdown. Fifteen to 20 minutes and 30 to 40 minutes are unnecessarily short time intervals- too frequent repositioning may interfere with the client's rest.

The nurse is assessing a client for recall memory. Which statements made by the client indicate that the client's recall memory is intact? A. "I was born in New York city." B. "I came to the hospital in a car." C. "You asked me to repeat the words apple, street, and chair." D. "I was admitted on the 24 th of September at 5 in the evening." E. "I had an appointment with a neurophysician last month."

B, C, D, E- Recall memory can be tested by asking questions related to the recent past, such as mode of transportation to the hospital, time and date of admission, and history of appointments with healthcare providers. Asking the client to repeat words tests recall memory. Remote memory is tested by asking the client about the city of birth or birth date.

While assessing the client, the nurse observes abnormal eye movement. The client reports dizziness when standing or walking. Which structure of the auditory system might be affected in this client? A. tympanic membrane B. vestibular system C. auditory tube D. cochlea

B- Abnormal eye movement is seen in nystagmus. Dizziness when standing or walking may indicate vertigo in the client. These both are manifested due to problems with balance, which is maintained by the vestibular system marked by B. The structure represented as A is the tympanic membrane, a part of the middle ear. Conductive hearing loss may occur if the tympanic membrane is affected. The structure represented as C is the auditory tube, which helps to equalize atmospheric air pressure between the middle ear and throat and allows the tympanic membrane to move freely. Structure C is not associated with vertigo and nystagmus. The structure represented as D is the cochlea and is involved in the transmission of sounds. Hearing impairment may result if the cochlea is affected.

A client is being evaluated based on client reports of an impairment of a portion of the peripheral vision. After testing is completed, a diagnosis of retinal detachment is made, and a cryosurgical procedure is scheduled. As part of the preoperative teaching, the nurse provides information about what the client can expect and includes which information? A. An explanation that the surgery will be brief B. A description of the surgical suite environment C. The procedure and risks of the repair of the retina D. The importance of postoperative coughing and deep-breathing exercises

B- Because vision will be limited somewhat after surgery, it is important to familiarize the client with vital aspects of the environment, which provides for physical and emotional safety. Surgery usually takes approximately two hours, followed by a stay in the postanesthesia care unit. The healthcare provider should discuss the procedure and risks; informed consent is the primary healthcare provider's responsibility not the nurse's. Coughing or other activity that increases intraocular pressure should be avoided.

A client has sustained a spinal cord injury at the T2 level. The nurse assesses for signs of autonomic hyperreflexia (autonomic dysreflexia). What is the rationale for the nurse's assessment? A. The injury results in loss of the reflex arc. B. The injury is above the sixth thoracic vertebra. C. There has been a partial transection of the cord. D. There is a flaccid paralysis of the lower extremities.

B- The T6 level is the sympathetic visceral outflow level. Because the client's injury is above this level (T2), autonomic hyperreflexia is expected. The reflex arc remains intact after spinal cord injury. The important point is not that the cord is transected, but the level at which the injury occurred. A flaccid paralysis of the lower extremities is not related to autonomic hyperreflexia. All cord injuries result in flaccid paralysis during the period of spinal shock. As the inflammation subsides, spasticity gradually increases.

The nurse is caring for a client with Parkinson disease. Which is a priority nursing concern? A. Decreased physical mobility related to stooped posture B. Risk for injury related to gait disturbances C. Impaired skin related to drooling D. Pain related to headache

B- The client with Parkinson disease may fall because of gait disturbances. Decreased mobility and impaired skin are problems but not the priority. Pain is usually not a manifestation of Parkinson disease.

Soon after admission to the hospital with a head injury, a client's temperature increases to 102.2° F (39° C). The nurse considers that the client has sustained injury to which structure? A. Thalamus B. Hypothalamus C. Temporal lobe D. Globus pallidus

B- The hypothalamus connects with the autonomic area for vasoconstriction, vasodilation, and perspiration and with the somatic centers for shivering. Therefore, it is an important area for regulating body temperature. The thalamus receives all sensory stimuli, except taste, for transmission to the cerebral cortex. It is also involved with emotions and instinctive activities. The temporal lobe is concerned with auditory stimuli. It also may be involved with the sense of smell. The globus pallidus is part of the basal ganglia, required for specific body movements.

A nurse is performing a neurologic assessment of a client. Which equipment is required when preparing to assess the vagus nerve (cranial nerve X) of the client? A. Tuning fork B. Ophthalmoscope C. Tongue depressor D. Cotton and a straight pin

C- A tongue depressor is used to depress the tongue to observe the pharynx and larynx, and to assess soft palate symmetry and the presence of the gag reflex. The information obtained provides data about cranial nerve X (vagus). A tuning fork is used to assess cranial nerve VIII (auditory). An ophthalmoscope is used to assess cranial nerve II (optic). Cotton and a straight pin are used to assess sensory function: light touch and pain.

A nurse uses the Glasgow Coma Scale to assess a client's status after a head injury. When the nurse applies pressure to the nail bed of a finger, which movement of the client's upper arm should cause the most concern? A. Flexing B. Localizing C. Extending D. Withdrawing

C- Abnormal upper arm extension receives a rate of 2 because it is characteristic of decerebrate (extension) posturing. Greater injury leads to less purposeful movement. Decerebrate posturing indicates severe brain injury; the only more serious response is total lack of response. Flexing, characteristic of decorticate (flexion) posturing associated with severe brain injury, receives a rate of 3. Localizing receives a rate of 5. The inability to withdraw from a painful stimulus indicates the greatest neurologic impairment. Withdrawing receives a rate of 4.

A client with a diagnosis of polyarteritis nodosa asks the nurse for information about this disorder. What information should the nurse include in the response? A. Clients with this disease have an excellent prognosis. B. The disorder affects males and females in equal numbers. C. The disorder is considered one of hypersensitivity, and the exact cause is unknown. D. Clients with this disease have problems with only the kidneys and the retina of the eyes.

C- An autoimmune response plays a role in the development of polyarteritis, although drugs and infections may precipitate it. The disorder often is fatal, usually as a result of heart or renal failure. Men are affected three times more often than women. Arteriolar pathology can affect any organ or system.

A nurse is monitoring a client who is having a computed tomography (CT) scan of the brain with contrast. Which response indicates that the client is having an untoward reaction to the contrast medium? A. Pelvic warmth B. Feeling flushed C. Shortness of breath D. Salty taste in the mouth

C- An untoward response to the iodinated dye used as a contrast is anaphylaxis, a life-threatening allergic response. Anaphylaxis is manifested by respiratory distress, hypotension, and shock; counteractive measures must be instituted. A feeling of warmth or flushing is an expected minor side effect. A salty taste is an expected minor side effect.

The nurse is caring for a client with a spinal cord injury. The client exhibits signs of autonomic hyperreflexia. What does the nurse recall is the most common cause of this response? A. Hemodynamic changes related to tilt table positioning B. Deteriorating myelin sheath C. Distended large intestine D. Crushed spinal cord

C- Bowel or bladder distention causes autonomic nerve impulses to ascend via the cord to the point of injury. Here the reflex is completed, and autonomic outflow causes piloerection (goose bumps), sweating, and splanchnic vasoconstriction. Splanchnic vasoconstriction causes hypertension and a pounding headache. The client being upright on a tilt table is not involved in the autonomic hyperreflexia nerve impulses [1] phenomenon. The myelin sheath deteriorating is not involved in the autonomic hyperreflexia phenomenon. The spinal cord is crushed rather than severed and is not involved in the autonomic hyperreflexia phenomenon

A client with a cerebrovascular accident ("brain attack") has dysarthria. What should the nurse include in the plan of care to address this problem? A. Routine hygiene B. Liquid formula diet C. Prevention of aspiration D. Effective communication

C- Clients with dysarthria have difficulty communicating verbally, and an alternate means of communication may be indicated. Routine hygiene, liquid formula diet, and prevention of aspiration are important aspects of care, but they are not related to dysarthria. Dysphagia can lead to aspiration

A client who sustains a stroke has a loss of proprioception and fine touch. Which artery does the nurse suspect is damaged? A. Lateral cerebral B. Middle cerebral C. Anterior cerebral D. Posterior cerebral

C- Damage to the anterior cerebral artery can lead to a loss of proprioception and fine touch. Damage to the vertebral artery can cause dysphagia and dysarthria. Injury to the middle cerebral artery can cause motor and sensory deficits. Posterior cerebral artery damage can cause visual hallucinations and hemianopsia. There is no artery called lateral cerebral.

A client admitted with the diagnosis of subarachnoid hemorrhage exhibits aphasia and hemiparesis. The nurse concludes that these neurologic deficits are caused primarily by which response? A. Blood loss B. Tissue death C. Vascular spasms D. Electrolyte imbalance

C- In an attempt to stop the bleeding, adjacent arteries constrict (vasospasm). This in turn contributes to the ischemia responsible for the neurologic deficits. The volume of blood loss is not great enough to significantly alter the oxygen-carrying capability of the remaining blood supply. Although prolonged ischemia may cause necrosis, many of the manifestations of cerebral ischemia are reversed as pressure diminishes, and there may be no permanent damage. Severe electrolyte imbalance may cause generalized weakness. However, hemiparesis and aphasia are not the result of electrolyte loss.

A client is scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. The nurse explains to the client that the diagnosis of myasthenia gravis is confirmed if the administration of Tensilon produces which response? A. Brief exaggeration of symptoms B. Prolonged symptomatic improvement C. Rapid but brief symptomatic improvement D. Symptomatic improvement of only the ptosis

C- Tensilon acts systemically to increase muscle strength; it lasts several minutes. Tensilon produces a brief increase in muscle strength; with a negative response the client will demonstrate no change in symptoms. Tensilon may intensify muscle weakness in a cholinergic crisis. Tensilon does not cause lasting effects. Tensilon acts systemically on all muscles, rather than selectively on the eyelids.

A client is diagnosed with Parkinson disease and asks the nurse what causes the disease. On which underlying pathology does the nurse base a response? A. Disintegration of the myelin sheath B. Breakdown of upper and lower neurons C. Reduced acetylcholine receptors at synapses D. Degeneration of the neurons of the basal ganglia

D- Parkinson disease involves destruction of the neurons of the substantia nigra, reducing dopamine. The cause of this destruction is unknown. Disintegration of the myelin sheath is associated with multiple sclerosis. Breakdown of upper and lower motor neurons is associated with Lou Gehrig disease or amyotrophic lateral sclerosis. Reduced acetylcholine receptors at synapses are associated with myasthenia gravis.

The bed alarm is ringing because an older adult client is attempting to get out of bed. A nurse enters the room and finds the client agitated and confused. The family member is upset and states, "He has never been like this. I don't know what to do." After getting the client back into bed, which nursing action is most appropriate? A. Asking the family member to step out of the room so the client can rest B. Placing a vest restraint on the client to prevent the client from falling out of bed C. Explaining to the family that it is common for older clients to get confused while in the hospital D. Requesting the nursing assistant to stay with the client while the nurse calls the primary healthcare provider

D- Because this is new for the client, the nurse should notify the primary healthcare provider. The client should be monitored continually for a while to prevent falling or injuring himself. This is an appropriate task to delegate to a nursing assistant. Since this is new for the client, reassuring the family that older adult clients often get confused in the hospital is not helpful. Evidence-based practice has shown that having a family member with the client is helpful. Therefore, the family member should be encouraged to stay with the client. Placing a restraint on the client should be done as a last resort and not instituted without a primary healthcare provider's prescription

After an anterior fossa craniotomy, a client is placed on controlled mechanical ventilation. To ensure adequate cerebral blood flow, which action should the nurse take? A. Clear the ear of draining fluid. B. Discontinue anticonvulsant therapy. C. Elevate the head of the bed 30 degrees. D. Monitor serum carbon dioxide levels routinely.

D- Carbon dioxide levels must be maintained since carbon dioxide can cause vasodilation, increasing intracranial pressure, and decreasing blood flow. The fluid may be cerebrospinal fluid; clearing the ear may cause further damage. Because of manipulation during a craniotomy, anticonvulsants are given prophylactically to prevent seizures. Elevating the head of the bed 30 degrees will not increase cerebral blood flow.

A client is admitted to the hospital with a tentative diagnosis of a brain tumor. Which diagnostic test result will the nurse check for confirmation of this diagnosis? A. Myelography B. Lumbar puncture C. Electromyography D. Computed tomography

D- Computed tomography is the most definitive test for identifying unexpected structures in the brain. It provides a three-dimensional view of cranial contents and defines outlines of masses and other abnormalities. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans are also beneficial and in some cases are better. Myelography is an x-ray examination of the spinal cord and vertebral canal, not the cranium. A lumbar puncture is contraindicated- removal of cerebrospinal fluid in the presence of an increase in intracranial pressure, which usually accompanies a brain tumor, may cause compression of the brainstem. Electromyography measures electrical currents produced by skeletal muscles, not the cranium

The nurse is caring for a client who is suspected of having a brain tumor and is scheduled for a computed tomography (CT) scan. The nurse expects that the preprocedure plan of care will include which component? A. Withholding routine medications B. Administering the prescribed sedative C. Explaining that all metal must be removed D. Telling the client about what to expect during the examination

D- Knowing what to expect decreases anxiety. Routine medications are not withheld. A sedative is not necessary for a CT scan. Removing metal is for a magnetic resonance imaging (MRI) test.

The nursing is caring for four different clients with eye disorders. Which client should be assessed for asthma before prescribing beta-adrenergic blockers? A: Increased lens density, reduced visual sensory perception B: Increased tear secretion, blood shot eye appearance C: Degeneration of corneal tissue, severe visual impairment D: Reduced outflow of aqueous humor, increased intraocular pressure

D- Reduced outflow of aqueous humor and increased intraocular pressure causes glaucoma, which can be treated with different types of drugs. Before prescribing beta-adrenergic blockers, the client should be assessed for moderate to severe asthma because if these drugs are absorbed systematically, they constrict pulmonary smooth muscle and narrow airways. Increased lens density and reduced visual sensory perception indicates cataracts that can be treated only with cataract surgery. Increased tear secretion and blood shot eye appearance is observed in a client with conjuctivitis. This can be treated with ophthalmic antibiotics. Degeneration of corneal tissue indicates keratoconus, which can be cured by performing a surgery called keratoplasty (corneal transplant).

A client is admitted with paresis of the ciliary muscles of the left eye. What function should the nurse expect to be affected? A. Closing the eyelids B. Convergence of both eyes C. Ability to discriminate colors D. Focusing the lens on near objects

D- The contraction of the ciliary muscles permits the lens to return to its normal bulge and decreases focal length, promoting the ability to focus on near objects. The ciliary muscles are intrinsic (within the eyeball); the third cranial nerve (oculomotor), an extrinsic nerve, controls some movements of the eyelid. The rectus and oblique muscles of the eye are involved in convergence. Color blindness is an inherited trait.

An older client with macular degeneration comes to the eye clinic. Which response reported by the client does the nurse identify as consistent with the diagnosis? A. Sees best in dim light B. Sees halos around lights C. Cannot see objects in the periphery D. Cannot see objects in the center of the visual field

D- The macula is the central vision area of the retina. Therefore, macular degeneration affects central vision and makes it difficult to see objects within direct, central vision. Dim light will make vision more difficult for this client. Seeing halos around lights is related to glaucoma rather than to macular degeneration. An inability to see objects in the periphery is related to glaucoma rather than to macular degeneration.