Exam 6 Neuro

Which of the following indicates that the pt has had a right-hemispheric stroke?

Paralysis on left side of body

A nurse is caring for a 10-year-old admitted to the pediatric unit after being diagnosed with a concussion. Which of the following findings would the nurse immediately report to the healthcare provider?

Vomiting

The nurse who is caring for a patient with a head injury recognizes which of the following as a late sign of increased intracranial pressure?

Widening pulse pressure

A nurse is teaching a parent how to instill eye drops into the eyes of a 12-year-old. Which of the following statements made by the parent best illustrates teaching was effective?

"I will tilt my child's head slightly back."

A nurse is providing teaching to the parents of a child who is to have an electroencephalogram (EEG). Which of the following statements, by a parent indicates teaching was effective?

"My child should remain quiet and still during this procedure."

A nurse is providing teaching to the partner of a client who has Alzheimer's disease and has a new X prescription for donepezil. Which of the following statements by the partner indicates the teaching is effective?

"This medication should help my husband's daily functions."

A nurse is providing education to a client who is to undergo an electroencephalogram (EEG) the next day. Which of the following information should the nurse include in the teaching? (Select all that apply)

-"Try to stay awake most of the night prior to the procedure" -"You will need to avoid coffee, tea, chocolate and cola from your meal before the procedure." -"Your anticonvulsant medication will be withheld 24 hours before the procedure."

When the nurse reviews the physician's diagnosis for a patient who has sustained a basal skull fracture, the nurse knows that the patient should be observed for which of the following? (Select all that apply)

-An area of bruising over the mastoid bone -Otorrhea -Positive halo sign on drainage on dressing

An elderly patient is admitted with the diagnosis of retinal detachment and is scheduled for laser surgery and scleral buckling procedure. The nurse anticipates which of the following symptoms to be exhibited in this patient? (Select all that apply)

-Flashing lights -Cobwebs in vision fields

A nurse is assessing a patient who has a seizure disorder. The patient tells the nurse, "I am about to have a seizure." Which of the following actions should the nurse implement? (Select all that apply)

-Provide privacy -Ease the patient to the floor if standing -Move furniture away from the patient -Protect the patient's head with a pillow

Which of the following are effective actions in preventing acute otitis media? (Select all that apply)

-Routine scheduled immunizations -Hand hygiene -Eliminate secondhand smoke -Avoid propping the formula bottle -Discontinue pacifier after 6 months

A nurse is comparing the neurological status of a patient who suffered a head injury with the status on the previous shift. Using the Glasgow Coma Scale, the nurse determines that the patient's score has changed from 11 to 15. Which of the following responses did the nurse assess in this patient? (Select all that apply)

-Spontaneous eye opening -Orientation to person, place, and time

A nurse is caring for a patient who just experienced a seizure. While doing follow-up documentation, the nurse would be certain to include which of the following items in the nurse's note? (Select all that apply)

-The time the seizure began -Incontinence of urine or stool -Type of movements in the body part involved -Pupil size and whether the eyes are open or not

The nurse is assessing the patient's pupils following a sports injury. Which of the following assessment findings indicates a neurological concern? (Select all that apply)

-Unequal pupils -pinpoint pupils -Absence of pupillary response

The healthcare provider prescribes sumatriptan 4,000 mcg subcutaneously stat for a patient with a severe postprocedural headache following a lumbar puncture. The sumatriptan is in a vial labeled 6 mg per 0.5 mL. Calculate the volume of the drug the nurse will administer.

0.33 mL

A nurse is preparing a dose of amoxicillin for a 3-year-old with acute otitis media. The child weighs 33 lb. The dosage prescribed is 50 mg/kg/day in divided doses for every 8 hours. The concentration of the drug is 250 mg per 5 mL. For one dose, the nurse will administer:

5 mL

Prescription: Ancef 1 gram in 100 mL D5W IVPB to be infused in 45 minutes. What is the infusion rate?

133 mL/hr

The healthcare provider has prescribed phenytoin 0.2 Grams po BID. The nurse has available Dilantin 100 mg capsules. The nurse will administer:

2 tabs

A patient is to receive 500 mL of dextrose 5% in normal saline solution over 8 hours. At what rate will the nurse set the infusion pump?

63 mL

The nurse observes clear fluid is draining from the nose of a client who had a head trauma 3 hours ago. Which condition does the nurse suspect from this observation?

Basilar skill fracture

Which of the following patients is at a greater risk for an ischemic stroke?

A patient with uncontrolled hypertension

Which of the following would the nurse not expect to see in a pt who has multiple sclerosis (MS)?

Alopecia

A nurse is assisting in the care of a patient who is being evaluated for possible myasthenia gravis. The health care provider gives a test dose of edrophonium (Tensilon). The nurse recalls that the patient would have which of the following reactions if the patient does actually have the disease?

An increase in muscle strength within 1-5 minutes

Which medication that a pt is taking would be of most concern for the pt with a head injury?

Aspirin

Betaxolol HCL eyedrops are prescribed for a pt with glaucoma. Which VS should the nurse monitor for adverse effects?

BP

A patient is admitted with a head injury. Which vital sign assessment would be most indicative of increased intracranial pressure?

BP 180/88, pulse 50, respirations 26

Which VS assessment would be most indicative of increased intracranial pressure (ICP)?

BP elevated, Bradycardia, Resp low

The nurse should anticipate the administration of which of these medications for a patient with Parkinson's disease?

Carbidopa-levodopa

The nurse is caring for a patient experiencing hearing loss. The nurse uses the otoscope to assess the ear canal and tympanic membrane and notes a significant accumulation of cerumen. Which documentation of hearing loss type would be most accurate?

Conductive

Miotic eye solutions are often ordered in the treatment of glaucoma. Which is the best nursing rationale for the use of this medication?

Constricts pupils

The nurse performs a neurologic assessment on a patient with a head injury from a car accident. Adduction of the arms at the shoulders, flexion of the arms on the chest, wrists flexed, hands in fists, and extension and adduction of the lower extremities are all present. The nurse recognizes these findings as indicating that the patient has which of the following?

Decorticate posturing

Which of the following would not be seen in a pt who has Bell's palsy?

Dry eyes

The patient with spinal cord injury resulting in paraplegia suddenly complains of severe pounding headache and nausea. The patient is profusely diaphoretic, with piloerection and flushing of the skin. Which is the nurse's first best intervention?

Elevate head of bed

A nurse is caring for a child newly diagnosed with cerebral palsy. Which of the following is the priority action for the nurse to take?

Engage the parents in the plan of care

Pts with Sundowner Syndrome should complete complex tasks in the evening instead of the morning.

False

The nurse is working in the triage section of a walk-in clinic. Which triad of common symptoms, when placed together, indicate Ménière's syndrome?

Hearing loss, vertigo, tinnitus

Which medication would the nurse expect to administer to reduce the cerebral edema following a craniotomy?

Mannitol

A nurse is caring for a child who just experienced a generalized seizure. Which of the following is the priority action?

Position the child in a side-lying position

A patient is complaining of a headache. The nurse notes that the patient is guarding his neck and complaining of stiffness in the neck area. The nurse suspects the patient may have meningitis. What is another well recognized sign of this infection?

Positive Kernig's sign

The nurse is preparing to administer ear drops to an adult. The nurse will use which technique?

Pull pinna up and back

To address the problems associated with dysphagia in the patient who has had a brain attack (stroke); the nurse should anticipate implementing which of these nutritional prescriptions?

Puree or soft diet

Which of the following S/S may result in at pt, experiencing a myasthenic crisis?

Respiratory distress

The patient who experienced a spinal cord injury two days ago has a sudden depression of reflex activity in the spinal cord below the level of injury resulting in flaccid paralysis. The nurse suspects which of the following?

Spinal shock

A patient has sustained a head injury and is unconscious in the emergency department. What details of the patient's medical history is of most concern to the nurse?

The patients medications include warfarin

During a pharmacology class, the students are told that some drugs need to be closely monitored. What aspect should the nurse closely monitor for in patients who have been administered salicylates, loop diuretics, quinidine, quinine, or aminoglycosides?

Tinnitus and sensorineural hearing loss

A patient with Parkinson's disease is seen in the clinic for adjustment of her medication and is experiencing worsening of her symptoms. The nurse anticipates which triad of symptoms related to Parkinson's disease?

Tremor, rigidity, bradykinesia

A patient with uncontrolled HTN is at a greater risk for an ischemic stroke

True

Ototoxic medication cause ringing in the ears

True

The priority nursing concern for a pt experiencing a migraine is pain

True

To assist with controlling vertigo, the nurse instructs the pt, to avoid sudden head movements.

True

Which of the following nursing actions would be contraindicated when performing mouth care for an unconscious patient?

Use an alcohol-based product for better cleaning

Trigeminal neuralgia (tic douloureux) is characterized by the presence of

severe facial pain