Neuro Practice questions

A nurse knows that, for a patient with an ischemic stroke, tPA is contraindicated if the blood pressure reading is higher than

185 mm Hg/110 mm Hg Elevated blood pressure (systolic >185; diastolic >110 mm Hg) is a contraindication to tPA.

A 33-year-old client presents at the clinic with reports of weakness, incoordination, dizziness, and loss of balance. The client is hospitalized and diagnosed with MS. What sign or symptom, revealed during the initial assessment, is typical of MS?

Blurred vision, intention tremor, and urinary hesitancy Optic neuritis, leading to blurred vision, is a common early sign of MS, as is intention tremor (tremor when performing an activity). Nerve damage can cause urinary hesitancy. In MS, deep tendon reflexes are increased or hyperactive. A positive Babinski reflex is found in MS. Abdominal reflexes are absent with MS.

Which statement reflects nursing management of the client with expressive aphasia?

Encourage the client to repeat sounds of the alphabet Nursing management of the client with expressive aphasia includes encouraging the client to repeat sounds of the alphabet. Nursing management of the client with global aphasia includes speaking clearly to the client in simple sentences and using gestures or pictures when able. Nursing management of the client with receptive aphasia includes speaking slowing and clearly to assist the client in forming the sounds. Nursing management of the client with cognitive deficits, such as memory loss, includes frequently reorienting the client to time, place, and situation.

The nurse is educating a patient with a seizure disorder. What nutritional approach for seizure management would be beneficial for this patient?

High in protein and low in carbohydrate A dietary intervention, referred to as the ketogenic diet, may be helpful for control of seizures in some patients. This high-protein, low-carbohydrate, high-fat diet is most effective in children whose seizures have not been controlled with two antiseizure medications, but it is sometimes used for adults who have had poor seizure control (Mosek, Natour, Neufeld, et al., 2009).

The nurse is creating a plan of care for a client who has a recent diagnosis of MS. Which of the following should the nurse include in the client's care plan?

Instruct the client on daily muscle stretching. A client diagnosed with MS should be encouraged to increase the fiber in his or her diet and void 30 minutes after drinking to help train the bladder. The client should participate in daily muscle stretching to help alleviate and relax muscle spasms.

Which of the following drugs may be used after a seizure to maintain a seizure-free state?

Phenobarbital IV diazepam (Valium), lorazepam (Ativan), or fosphenytoin (Cerebyx) are administered slowly in an attempt to halt seizures immediately. Other medications (phenytoin, phenobarbital) are administered later to maintain a seizure-free state. In general, a single drug is used to control the seizures.

The client with a cerebral aneurysm asks the nurse, "What's the big fuss over a headache?" Which is the best response from the nurse regarding to a cerebral aneurysm?

"Your physician wants to evaluate the location and condition of the aneurysm." Keeping the client calm and quiet is an important aspect of care. Explaining the need for further evaluation is factual. The nurse should avoid saying "don't worry" or telling a client how to feel—this is not a therapeutic response. The aneurysm is growing or leaking are both inappropriate responses from a nurse and can lead to increased concern and anxiety for the client.

Which are contraindications for the administration of tissue plasminogen activator (t-PA)? Select all that apply. 1. Intracranial hemorrhage 2. Ischemic stroke 3. Age 18 years or older 4. Systolic BP less than or equal to 185 mm Hg 5. Major abdominal surgery within 10 days

1 & 5 Intracranial hemorrhage, neoplasm, aneurysm, and major surgical procedures within 14 days are contraindications to t-PA. Clinical diagnosis of ischemic stroke, being 18 years of age or older, and a systolic BP less than or equal to 185 mm Hg are eligibility criteria.

The nurse knows that symptoms associated with a TIA, usually a precursor of a future stroke, usually subside in what period of time?

1 hour A transient ischemic attack (TIA) is a neurologic deficit typically lasting less than 1 hour. A TIA is manifested by a sudden loss of motor, sensory, or visual function. The symptoms result from temporary ischemia (impairment of blood flow) to a specific region of the brain; however, when brain imaging is performed, there is no evidence of ischemia.

A school nurse is called to the playground where a 6-year-old girl has been found sitting unresponsive and "staring into space," according to the playground supervisor. How would the nurse document the girl's activity in her chart at school?

Absence seizure Staring episodes characterize an absence seizure, whereas focal seizures, generalized seizures, and unclassified seizures involve uncontrolled motor activity.

A middle-aged client has sought care from the primary provider and undergone diagnostic testing that has resulted in a diagnosis of MS. What sign or symptom is most likely to have prompted the client to seek care?

Difficulty in coordination The symptoms of MS most commonly reported are fatigue, depression, weakness, numbness, difficulty in coordination, loss of balance, spasticity, and pain. Cognitive changes and contractures usually occur later in the disease.

A family member comes to the clinic to talk to the nurse about a client who has had a stroke on the right side of the brain. The family member is concerned because of the deficits the client is exhibiting. The nurse knows that when a client experiences a stroke on the right side of the brain, common deficits include what? Select all that apply. 1- Left-sided hemiplegia 2- Tendency to distractibility 3- Impairment of long-term memory 4- Hyperaware of deficits 5- Neglect of objects and people on the left side

1,2, & 5 Left-sided hemiplegia (stroke on right side of brain) may have the following neurologic deficits: spatial-perceptual defects; disregard for the deficits of the affected side require special safety considerations; tendency to distractibility; impulsive behavior, unaware of deficits; poor judgment; defects in left visual fields; misjudge distances; difficulty distinguishing upside-down and right-side up; impairment of short-term memory; and neglect left side of body, objects and people on left side.

The nurse is caring for a client with aphasia. Which action will the nurse take when communicating with the client? Select all that apply. 1. Pause between phrases 2. Use gestures when talking 3. Face the client when talking 4. Talk over the television volume 5. Speak in a normal tone of voice

1,2,3,5 Communicating with a client with aphasia can be challenging. Actions to improve communication include pausing between phrases, using gestures when talking, facing the client when talking, and speaking in a normal tone of voice. Extraneous background noise should be kept to a minimum. Turning off the sound on the television would be beneficial to improve communication.

A client with a neurological disorder has difficulty swallowing. The nurse should take special care with the client's diet because of a potential risk of imbalanced nutrition. Which measure may be taken by the nurse to ensure that the client's diet allows for easy swallowing?

Help the client sit upright when eating and feed slowly A client who has impaired swallowing should be helped to eat foods with texture. The nurse should help such a client sit upright, flex the client's chin toward the chest, and feed slowly. These measures promote easy swallowing of food and reduce the risk of aspiration or airway obstruction. The client should be allowed to rest before meals because fatigue may interfere with coordination and following instructions. Liquids should be offered frequently but in small quantities.

A nurse is teaching about ischemic stroke prevention to a community group and emphasizes that control of hypertension, which is the major risk factor for stroke, is key to prevention. Ways to control hypertension include the Dietary Approaches to Stop Hypertension (DASH) diet. This diet includes which of the following?

Moderate amounts of low-fat dairy products The DASH diet is high in fruits and vegetables, moderate in low-fat dairy products, and low in animal protein.

After having a stroke, a patient has cognitive deficits. What are the cognitive deficits the nurse recognizes the patient has as a result of the stroke? Select all that apply. 1. Poor abstract reasoning 2. Decreased attention span 3. Short- and long-term memory loss 4. Expressive aphasia 5. Paresthesias

1, 2, 3 Cognitive deficits associated with stroke include short- and long-term memory loss, decreased attention span, and poor abstract reasoning. Expressive aphasia is a verbal deficit, not a cognitive deficit. Paresthesias are sensory deficits, not cognitive deficits.

Which nursing interventions might need to be considered in a care plan for a client with advanced multiple sclerosis? Select all that apply. 1- Ensure access to a language board when communicating with the client. 2- Obtain daily weights to monitor weight gain. 3- Establish a voiding time schedule. 4- Encourage the client to walk with feet wide apart.

1, 3, & 4 Language assistive devices may be needed if communication is severely affected. Occasional bladder incontinence may lead to total incontinence. A voiding time schedule will allow the client greater independence. If motor dysfunction causes problems of incoordination and clumsiness, the patient is at risk for falling. As the disease progresses, nutritional deficiencies may develop. Weight should be assessed to ensure that there is no significant weight loss. Weight gain should not be an issue.

The nurse is preparing to assess a client with neurologic dysfunction. What does accurate and appropriate assessment require? Select all that apply. 1. The ability to select basic medications for the neurologic dysfunction 2. Understanding of the tests used to diagnose neurologic disorders 3. Knowledge of nursing interventions related to assessment and diagnostic testing 4. Knowledge of the anatomy of the nervous system 5. The ability to interpret the results of diagnostic tests

2,3 & 4 Assessment requires knowledge of the anatomy and physiology of the nervous system and an understanding of the array of tests and procedures used to diagnose neurologic disorders. Knowledge about the nursing implications and interventions related to assessment and diagnostic testing is also essential. Selecting medications and interpreting diagnostic tests are beyond the normal scope of the nurse.

A patient suffering a stroke is having a difficult time swallowing. What would the nurse document this finding as?

Dysphagia Stroke can result in dysphagia (difficulty swallowing) due to impaired function of the mouth, tongue, palate, larynx, pharynx, or upper esophagus. Patients must be observed for paroxysms of coughing, food dribbling out of or pooling in one side of the mouth, food retained for long periods in the mouth, or nasal regurgitation when swallowing liquids. Swallowing difficulties place the patient at risk for aspiration, pneumonia, dehydration, and malnutrition.

A nurse is communicating with a client who has aphasia after having a stroke. Which action should the nurse take?

Face the client and establish eye contact When speaking with a client who has aphasia, the nurse should face the client and establish eye contact. The nurse should use short phrases, not one long sentence, and give the client time between phrases to understand what is being said. Keeping extraneous and background noise such as the television to a minimum helps the client concentrate on what is being said. It isn't necessary to speak in a louder or softer voice than normal.

Which is often the most disabling clinical manifestation of multiple sclerosis?

Fatigue Fatigue affects 87% of people with MS, and 40% of that group indicate that fatigue is the most disabling symptom. Pain, spasticity, and ataxia are other clinical manifestations of MS, but are not the most disabling.

Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of small patches of demyelination in the brain and spinal cord?

Multiple sclerosis The cause of MS is not known, and the disease affects twice as many women as men. Parkinson disease is associated with decreased levels of dopamine caused by destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia of the brain. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia. Creutzfeldt-Jakob disease is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain.

A hospital client has experienced a seizure. In the immediate recovery period, what action best protects the client's safety?

Place the client in a side-lying position. To prevent complications, the client is placed in the side-lying position to facilitate drainage of oral secretions. Suctioning is performed, if needed, to maintain a patent airway and prevent aspiration. None of the other listed actions promotes safety during the immediate recovery period.

A nurse is planning care for a client who experienced a stroke in the right hemisphere of his brain. What should the nurse do?

Provide close supervision because of the client's impulsiveness and poor judgment. The primary symptoms of a client who experiences a right-sided stroke are left-sided weakness, impulsiveness, and poor judgment. Aphasia is more commonly present when the dominant or left hemisphere is damaged. When a client has one-sided weakness, the nurse should place the wheelchair on the client's unaffected side. Because a right-sided stroke causes left-sided paralysis, the right side of the body should remain unaffected.

The nurse is caring for a client with multiple sclerosis (MS). The client tells the nurse the hardest thing to deal with is the fatigue. When teaching the client how to reduce fatigue, what action should the nurse suggest?

Resting in an air-conditioned room whenever possible Fatigue is a common symptom of clients with MS. Lowering the body temperature by resting in an air-conditioned room may relieve fatigue; however, extreme cold should be avoided. A hot bath or shower can increase body temperature, producing fatigue. Muscle relaxants, prescribed to reduce spasticity, can cause drowsiness and fatigue. Planning for frequent rest periods and naps can relieve fatigue. Other measures to reduce fatigue in the client with MS include treating depression, using occupational therapy to learn energy conservation techniques, and reducing spasticity.

The nurse is caring for a client diagnosed with an ischemic stroke and knows that effective positioning of the client is important. Which of the following should be integrated into the client's plan of care?

The client should be placed in a prone position for 15 to 30 minutes several times a day. If possible, the clients placed in a prone position for 15 to 30 minutes several times a day. A small pillow or a support is placed under the pelvis, extending from the level of the umbilicus to the upper third of the thigh. This helps to promote hyperextension of the hip joints, which is essential for normal gait, and helps prevent knee and hip flexion contractures. The hip joints should not be maintained in flexion and the Trendelenburg position is not indicated.

A client with a neurologic deficit is feeling frustrated because it is very difficult to pronounce words since having a stroke. The client is struggling with:

dysarthria. Dysarthria is characterized by poor articulation of words due to muscle weakness or loss of muscle control. Dysphasia is characterized by the compromised ability to put words together meaningfully. Ataxia is a dysfunction of the parts of the nervous system that coordinate movement. Dysphagia is difficulty with swallowing.

A nurse is providing care to a client who has had a stroke. Which symptoms are consistent with left-sided stroke?

impulsive behavior, poor judgment, deficits in left visual fields Impulsive behavior, poor judgment, deficits in left visual fields are symptoms of right hemispheric stroke. Expressive aphasia, defects in the right visual fields, problems with abstract thinking are symptoms of left hemispheric stroke. Problems with abstract thinking, impairment of short-term memory, poor judgment are symptoms inconsistent with each other as some indicate left and others indicate right hemispheric stroke. Cautious behavior, deficits in left visual fields, misjudgment of distances are symptoms inconsistent with each other as some indicate left and others indicate right hemispheric stroke.

The nurse is providing care for a client who has limited mobility after a stroke. In order to assess the client for contractures, the nurse should assess the client's:

range of motion. Each joint of the body has a normal range of motion. To assess a client for contractures, the nurse should assess whether the client can complete the full range of motion. Assessing DTRs, muscle size, or joint pain does not reveal the presence or absence of contractures.

The nurse is called to attend to a patient having a seizure in the waiting area. What nursing care is provided for a patient who is experiencing a convulsive seizure? Select all that apply. 1. Loosening constrictive clothing 2. Opening the patient's jaw and inserting a mouth gag 3. Positioning the patient on his or her side with head flexed forward 4. Providing for privacy 5. Restraining the patient to avoid self injury

1, 3, 4 During a patient's seizure, the nurse should do the following. Loosen constrictive clothing. If possible, place the patient on one side with head flexed forward, which allows the tongue to fall forward and facilitates drainage of saliva and mucus. If suction is available, use it if necessary to clear secretions. Provide privacy, and protect the patient from curious onlookers. (The patient who has an aura [warning of an impending seizure] may have time to seek a safe, private place.) The nurse should not attempt to pry open jaws that are clenched in a spasm or attempt to insert anything. Broken teeth and injury to the lips and tongue may result from such an action. No attempt should be made to restrain the patient during the seizure, because muscular contractions are strong and restraint can produce injury.

The nurse is initiating a bladder-training schedule for a patient. What intervention can be provided for optimal success? (Select all that apply.) 1. Encourage the patient to wait 30 minutes after drinking a measured amount of fluid before attempting to void. 2. Give up to 3,000 mL of fluid daily. 3. Teach bladder massage to increase intra-abdominal pressure. 4. Require the patient to restrict fluid intake during the day to decrease voiding. 5. Administer a diuretic every morning.

1,2, 3 At no time should the fluid intake be restricted to decrease the frequency of urination. Sufficient fluid intake (2,000 to 3,000 mL per day, according to patient needs) must be ensured. To optimize the likelihood of voiding as scheduled, measured amounts of fluids may be administered about 30 minutes before voiding attempts. In addition, most of the fluids should be consumed before evening to minimize the need to void frequently during the night. Massage of the abdomen can be effective in increasing intra-abdominal pressure and thus promoting the urge to void. The goal of bladder training is to restore the bladder to normal function, so diuretics should not be used.

A health care provider has prescribed a standard electroencephalogram (EEG) test for the client. What general instructions should the nurse provide to the client? Select all that apply. 1. The procedure generally takes 45 to 60 minutes. 2. Please remove all jewelry and any metal objects prior to the procedure. 3. This procedure uses a water-soluble lubricant for electrode contact which can be easily wiped off and removed using shampoo. 4. If you feel nervous about the test I can provide you a light sedative medication to ease your anxiety. 5. Please refrain from drinking coffee and any caffeinated beverages the morning prior to the procedure. 6. It is required that you withhold taking your anticonvulsant medication 72 hours before the procedure.

1,3,5 A standard EEG usually takes 45 to 60 minutes. Typically, a water-soluble lubricant is used to aid electrode contact. This lubricant is easily removed with shampoo. Coffee, tea, chocolate, and cola drinks are omitted from the meal before the test because of their stimulating effect. Sedation is not considered because it may lower the seizure threshold in clients and it may alter brain activity. Stimulants, tranquilizers, anticonvulsants, and depressants are advised to be held 24 to 48 hours, not 72 hours, prior to the procedure because these medications can alter the EEG wave patterns or mask the abnormal wave patterns of seizure disorders. The client is instructed to eat before the test because keeping the client NPO (nothing by mouth) can alter blood glucose levels and cause changes in brain wave patterns. The client can wear jewelry during the test, although some facilities will request that earrings be removed.

A nurse is taking care of a client with swallowing difficulties after a stroke. What are some interventions the nurse can accomplish to prevent the client from aspirating while eating? Select all that apply. 1. Encourage the client to increase his/her intake of water and juice. 2. Assist the client out of bed and into the chair for meals. 3. Instruct the client to tuck his/her chin towards their chest when swallowing. 4. Request a swallowing assessment by a speech therapist before the client's discharge. 5. Recommend the insertion of a percutaneous endoscopic gastrostomy (PEG) tube.

2,3 If swallowing function is partially impaired, it may return over time, or the client may be educated in alternative swallowing techniques, advised to take smaller boluses of food, and educated about types of foods that are easier to swallow. The client may be started on a thick liquid or pureed diet, because these foods are easier to swallow than thin liquids. Having the client sit upright, preferably out of bed in a chair, and instructing them to tuck the chin toward the chest as they swallow will help prevent aspiration. Recommending the insertion of a percutaneous endoscopic gastrostomy (PEG) tube would not prevent the client from aspirating while eating. A PEG tube could be placed if the client was unable to tolerate or resume an oral intake. A swallowing assessment should be done before allowing any oral intake and preferably within 4 to 24 hours after a stroke. A nurse can also accomplish a swallowing study using a validated and reliable assessment tool.

While performing range-of-motion exercises for a patient, the nurse abducts the patient's shoulder. Which of the following images best depicts the nurse's action?

During abduction of the shoulder, the nurse moves the arm from the side of the body to above the head and then returns the arm to the side of the body (neutral position). With forward flexion of the shoulder (option B), the nurse moves the arm forward and upward until it is alongside the head. For flexion of the elbow (option C), the nurse bends the elbow, bringing the forearm and hand toward the shoulder, and then returns the forearm and hand to the neutral position. When internally rotating the shoulder (option D), the arm is at shoulder height, the elbow is bent at a 90-degree angle, and the palm is toward the feet. The nurse turns the upper arm until the palm and forearm point backward.

A client with a recent stroke history is admitted to a rehabilitation unit and placed on high fall risk precautions. The client is impulsive, easily distracted, frequently forgets his/her cane when walking, and the location of his/her room. What stroke conditions do these signs best indicate?

Right hemispheric stroke In right hemispheric stroke, signs include a client that is easily distracted and has impulsive behavior and poor judgment. The client can be unaware of deficits like motor weakness, as demonstrated by the client forgetting the cane. Clients can also have spatial or perceptual deficits. This means they can get lost in familiar and unfamiliar places. This client was unable to find his/her room. The client who has a right hemisphere stroke demonstrates weakness on the left side of the body. The client with left hemispheric stroke has signs such as paralysis or weakness in the right side of the body, right-sided visual deficits, and slow cautious behaviors. Ischemic and hemorrhagic strokes describe what caused the stroke rather than what side of the brain was affected. Signs and symptoms differ for each type of stroke. Ischemic strokes can include numbness to one side of the face. Headache, decreased level of consciousness, and seizures typically are signs of a hemorrhagic stroke.