Ch 54: Care of the Patient with a Neurologic Disorder

Why is the patient with suspected Guillain- Barre Syndrome hospitalized immediately? The brain may swell quickly causing seizures I hydration is needed to prevent fatal hypotension The disease can rapidly progress into respiratory failure

The disease can rapidly progress into respiratory failure

How are results recorded for The FOUR score coma scale? Sum all of the results from each category Results are collected over a 24 hour period and averaged The results are kept separate for each categon As part of the Glasgow coma scale

The results are kept separate for each categon

A patient has a seizure accompanied by incontinence. Which type of seizure did they likely have Dartial Focal Absence Tonic-clonic

Tonic-clonic

What is most helofu when assisting a patient to swallow safelv after a left sided stroke? Tuck chin when swallowing Take a sip of liguid with each bite Turn head to the left

Tuck chin when swallowing

A patient presents to the ER with a closed head injury. Which finding is reported immediately? Headache Tremors Vomiting Pruritus

Vomiting

A male patient is diagnosed with Parkinson disease. What info is correct about this disease? itis more common in women. bradykinesia, rigidity, tremor & impaired postural reflexes Symptoms appear when there is an increase of dopamine. The tremor is more prominent with movement

bradykinesia, rigidity, tremor & impaired postural reflexes

Which of the following is not a normal effect of aging on the nervous system? Loss of neurons the age pigment: Lipofuscin increase of cerebral blood flow Decrease in oxvaen use

increase of cerebral blood flow

After performing the Glasgow Coma Scale, the patients score is a 13 revealing.... a light comatose state disorientation normal neurological functioning a deep comatose state

normal neurological functioning

In times of stress, what takes over to prepare the body for "fight or flight?" sympathetic nervous system parasympathetic nervous system somatic nervous system central nervous system

sympathetic nervous system

The nurse is aware that t-PA (activase) must be given within. _ hours of onset of symptoms. 4 hours 6 hours hours 3 hours

3 hours

Glasgow Coma Scale- doesn't open eyes, no verbal response, & withdraws in response to pain 8 7 5 6

6

A nurse is collecting data from a client who has increased intracranial pressure (IC). Which of the following are expected findings? (Select all that apply.) A. Disoriented to time and place B. Restlessness and irritability C. Unequal pupils D. ICP 15 mm Hg E. Headache

A B C E

A nurse is planning care for a client who has dysphagia and a new dietary prescription. Which of the following should the nurse include in the plan of care? (Select all that apply.) A. Have suction equipment available for use. B. Feed the client thickened liguids. C. Place food on the unaffected side of the client's mouth. D. Assign an assistive personnel to feed the client slowly. E. Reinforce to the client to swallow with the neck flexed.

A B C E

A nurse is caring for a client who has global aphasia (both receptive and expressive). Which of the following should the nurse include in the client's plan of care? (Select all that apply.) A. Speak to the client at a slower rate. B. Assist the client to use cards with pictures." C. Speak to the client in a loud voice. D. Complete sentences that the client cannot finish. E. Give instructions one step at a time!

A, B, E

A nurse is checking 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? (Select all that apply.) A Place client in supine position B. Flex client's hip and knee. C. Place hands behind the client's neck. D. Bend client's head toward chest. E. Straighten the client's flexed leg at the knee.

A, C, D

A nurse is assisting with the care of a client who is having surgery for the removal of an encapsulated acoustic tumor. Which of the following potential complications should the nurse monitor for postoperatively? (Select all that apply.) A. Increased intracranial pressure B. Hemorrhagic shock C. Hydrocephalus D. Hypoglycemia E. Seizures

A, C, E

A nurse is reviewing a prescription for dexamethasone with a client who has an expanding brain tumor. Which of the following are appropriate statements by the nurse? (Select all that apply.) A. "It is given to reduce swelling of the brain." B. "You will need to monitor for low blood sugar." C. "You might notice weight gain." D. "Tumor growth will be delayed." E. "It can cause you to retain fluids.

A. "It is given to reduce swelling of the brain." C. "You might notice weight gain." E. "It can cause you to retain fluids."

A nurse is collecting data from a client who has a new diagnosis of multiple sclerosis. Which of the following findings should the nurse expect? (Select all that apply.) A. Areas of paresthesia B. Involuntary eye movements C. Alopecia D. Increased salivation E. Ataxia

A. Areas of paresthesia B. Involuntary eye movements E. Ataxia

A nurse is reviewing trigger factors that can cause seizures with a client who has a new diagnosis of generalized seizures. Which of the following information should the nurse include in this review? (Select all that apply.) A. Avoid overwhelming fatigue. B. Remove caffeinated products from the diet. C. Limit looking at flashing lights. D. Perform aerobic exercise. E. Limit episodes of hypoventilation. F. Use of aerosol hairspray is recommended

A. CORRECT: The nurse should instruct the client to avoid overwhelming fatigue, which can trigger a seizure by stimulating abnormal electrical neuron activity. B. CORRECT: The nurse should instruct the client to remove caffeinated products from the diet, which can trigger a seizure by stimulating abnormal electrical neuron activity. C. CORRECT: The nurse should instruct the client to refrain from looking at flashing lights, which can trigger a seizure by stimulating abnormal electrical neuron activity.

Anurse is caring for a client who has just undergone a craniotomy and has a respiratory rate of 12. Which of the following postoperative prescriptions should the nurse clarify with the provider? A. Dexamethasone 30 mg IV bolus BID B. Morphine sulfate 2 mg IV bolus PRN every 2 hr for pain C. Ondansetron 4 mg IV bolus PRN every 4 to 6 hr for nausea D. Phenytoin 100 mg IV bolus TID

B.

The peripheral nervous system contains which two divisions? Somatic and Autonomic Cranial and Autonomic Central and Somatic Autonomic and Central

Somatic and Autonomic

A nurse is contributing to the plan of care for a client who has meningitis and is at risk for increased intracranial pressure (ICP). Which of the following actions should the nurse plan to take? (Select all that apply.) A. Implement seizure precautions. B. Perform neurologic checks four times a day. C. Administer morphine for the report of neck and generalized pain. D. Turn off room lights and television. E. Monitor for impaired extraocular movements. F. Encourage the client to cough frequently.

A. Implement seizure precautions. D. Turn off room lights and television. E. Monitor for impaired extraocular movements.

A nurse is assisting with the care of a client who has experienced a right-hemispheric stroke. The nurse should expect the client to have difficulty with which of the following? (Select all that apply) A. Impulse control B. Moving the left side C. Depth perception D. Speaking E. Writing

A. Impulse control B. Moving the left side C. Depth perception

A nurse is caring for a client who just experienced a generalized seizure. Which of the following actions should the nurse perform first? A. Keep the client in a side-lying position. B. Document the duration of the seizure. C. Reorient the client to the environment. D. Provide client hygiene.

A. Keep the client in a side-lying position. Rationale: The greatest risk to the client is aspiration during the postictal phase. Therefore the priority intervention is to keep the client in a side-lying position so secretions can drain from the mouth keeping the airway patent.

A nurse is caring for a client who has a seizure disorder. The client tells the nurse, "I am about to have a seizure." Which of the following actions should the nurse plan to implement? (Select all that apply.) A. Provide privacy. B. Ease the client to the floor if standing. C. Move furniture away from the client. D. Loosen the client's clothing. E. Protect the client's head with padding. F. Restrain the client.

A. Provide privacy. B. Ease the client to the floor if standing. C. Move furniture away from the client. D. Loosen the client's clothing. E. Protect the client's head with padding.

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? (Select all that apply.) A. Remove floor rugs. B. Have door locks that can be easily opened C. Provide increased lighting in stairwells. D. Install handrails in the bathroom. E. Place the mattress on the floor.

A. Remove floor rugs C. Provide increased lighting in stairwells D. Install handrails in the bathroom E. Place the mattress on the floor

A nurse is reinforcing teaching with a client who has Parkinson's disease and has a new prescription for bromocriptine. Which of the following instructions should the nurse include? A. Rise slowly when standing. B. Expect urine to become dark-colored. C. Avoid foods containing tyramine. D. Report any skin discoloration.

A. Rise slowly when standing

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 should be included in the nurse's response? (Select all that apply.) A. Exposure to metal waste products B. Long-term estrogen therapy C. Sustained use of vitamin E D. Previous head injury E. History of exposure to toxins

A. exposure to metal waste products D. previous head injury E. history of exposure to toxins.

The nurse will implement which of these interventions for increased intracranial pressure? Place neck in neutral postion Teach pt to avoid Valsalva maneuver. Position patient to avoid flexion of hips, waist and neck. Suction only as necessary, but no longer than 20 sec.

ALL

34. The avoidance of decreases the risk for lung cancer.

ANS: cigarette smoking The avoidance of cigarette smoking has been found to decrease the incidence of lung cancer. REF: Page 1892 TOP: Risk factors

35. A is a diagnostic procedure used to identify lesions by observing the flow of radiopaque dye through the subarachnoid space and is similar to a lumbar puncture.

ANS: myelogram Myelogram is commonly used to identify lesions in the intradural or extradural compartments of the spinal canal. REF: Page 1900 TOP: Anatomy and physiology Step: Planning

36. A female patient is diagnosed with myasthenia gravis. Upon physical assessment, the nurse notices her left eyelid is drooping. The nurse's notes would document this as of the eyelid.

ANS: ptosis Ptosis is a medical term for drooping eyelid. REF: Page 1928 TOP: Anatomy and physiology

17. A patient, age 23, has a comminuted fracture of T6-T7. She has a spinal cord injury resulting in paraplegia. She manifests signs and symptoms of autonomic dysreflexia, which is frequently triggered by a. bladder distention. b. nausea. c. food allergies. d. electrolyte imbalance.

ANS: A Autonomic dysreflexia occurs as a result of abnormal cardiovascular response to stimulation of the sympathetic division of the autonomic nervous system as a result of stimulation of the bladder, large intestine, or other visceral organs. The most common cause of this condition includes a distended bladder or fecal impaction. REF: Pages 1946, 1948, Figure 54-26 TOP: Spinal cord injury

38. Which foods may worsen headaches? (Select all that apply.) a. Yogurt b. Caffeine c. Beef d. Pears e. Marinated foods f. Milk

ANS: A, B, E Some foods may cause or worsen headaches. Foods that may provoke headaches include vinegar, chocolate, yogurt, alcohol, fermented or marinated foods, ripened cheese, cured sandwich meat, caffeine, and pork. REF: Page 1902 TOP: Headache

8. A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned for her with respect to this diagnostic test? a. Obtain an allergy history before the test. b. Ambulate the patient when she is returned to her room after the test. c. Warn her that paralysis could result from injection of the contrast medium. d. Keep her NPO for 6 to 8 hours after the test.

ANS: A Before the dye is injected, patients must be asked whether they have any allergies, specifically whether they have had any anaphylactic or hypotensive episodes from other dyes. REF: Page 1900 TOP: Diagnostic procedures Step: Planning

10. A patient's neurological status deteriorates over hours, and a craniotomy is performed to evacuate the hematoma. Which nursing intervention is indicated to help decrease the threat of increased intracranial pressure? a. Elevate the head of the bed 30 degrees. b. Cluster nursing interventions to provide uninterrupted periods of rest. c. Teach him to cough and deep breathe to prevent the necessity for suctioning. d. Teach him to hold his breath and bear down while repositioning in bed.

ANS: A Elevate the head of the bed to 30 to 45 degrees to promote venous return. REF: Page 1907 TOP: Hematoma Step: Planning

14. Before the patient undergoes computed tomographic (CT) scanning with a contrast medium, the nurse should a. verify that the patient is not allergic to seafood or iodine. b. explain that the patient will have to change position frequently during the procedure. c. maintain a safe distance from the patient to reduce the exposure to radiation. d. verify that the patient has no metal objects such as an implant or a pacemaker.

ANS: A It is important for the nurse to document and report to the physician any history of allergy to iodine and seafood because iodine is present in the contrast medium. REF: Page 1898 TOP: Diagnostic procedures

3. A patient has a head injury and is presenting with signs and symptoms of increased intracranial pressure. Which nursing intervention would be helpful in reducing this pressure? a. Place the neck in a neutral position to promote venous drainage. b. Suction hourly to stimulate the cough reflex. c. Add extra blankets to keep the patient warm. d. Turn the patient frequently to prevent skin impairment.

ANS: A Place the neck in a neutral position (not flexed or extended) to promote venous drainage. REF: Page 1907 TOP: Intracranial pressure (ICP) Step: Planning

31. In assessing a patient with suspected Bell's palsy, what clinical manifestations might be present? a. Inability to wrinkle forehead and pucker lips b. Inability to touch nose with finger with eyes closed c. Symmetric facial expressions d. Excruciating lightninglike shock in lips

ANS: A Unilateral weakness of the facial muscles usually occurs, resulting in a flaccidity of the affected side of the face with inability to wrinkle the forehead, close the eyelid, pucker the lips, smile, frown, whistle, or retract the mouth on that side. The face appears asymmetric. REF: Page 1938 TOP: Bell's palsy

27. A lumbar puncture is performed to obtain which specimen? a. Serum b. Cerebral spinal fluid (CSF) c. Urine d. Arterial blood gases

ANS: B A lumbar puncture is done to obtain CSF for examination, to relieve pressure, or to introduce dye or medication. REF: Page 1897 TOP: Lumbar puncture

12. A patient has been diagnosed with organic brain pathology. He is presenting with signs and symptoms of total or partial loss of the ability to recognize familiar objects or people through sensory stimulation. This condition is called a. apraxia. b. agnosia. c. aphasia. d. dysphagia.

ANS: B Agnosia is a total or partial loss of the ability to recognize familiar objects or people through sensory stimuli as a result of organic brain damage. REF: Page 1911 TOP: Organic brain pathology

23. An 83-year-old patient has had a stroke. He is right-handed and has a history of hypertension and "little" strokes. He presents with right hemiplegia. To afford him the best visual field, the nurse should approach him a. from the right side. b. from the left side. c. from the center. d. from either side.

ANS: B Another perceptual problem is hemianopia, which is characterized by defective vision or blindness in half of the visual field. If the patient has hemianopia, which is common, the patient should be approached from the nonparalyzed side for care. REF: Page 1933, Figure 54-19 TOP: Stroke

18. A patient, age 52, is brought to the emergency department by ambulance after she hit her head on her bathroom sink and fell unconscious to the floor. Which assessment should the nurse perform first? a. History of health problems b. Patency of airway c. Neurological status d. Status of bodily functions

ANS: B Nursing diagnosis and interventions for the patient with a severe head injury may include Ineffective breathing pattern related to neuromuscular impairment. Nursing interventions will be to maintain a patent airway. REF: Page 1945 TOP: Trauma

29. Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction characterized by the fluctuating weakness of certain skeletal muscle groups. The use of intravenous immune globulin a. increases anxiety and depression. b. reduces the production of acetylcholine antibodies. c. removes the antibodies produced by the autoimmune response. d. increases the production of acetylcholine antibodies.

ANS: B One treatment option is the administration of intravenous immune globulin to reduce the production of acetylcholine antibodies. Intravenous immune globulin is used for a severe relapse of myasthenia gravis. REF: Page 1928 TOP: Myasthenia gravis (MG)

22. A patient, age 27, has been admitted to the neurological department because of seizures of unknown cause. The nurse should take precautions by a. placing the patient in protective restraints. b. being certain padded side rails are present. c. suggesting that the family monitor the patient. d. placing the patient with one-on-one nursing service.

ANS: B Padded side rails may be used, especially if seizures often occur during sleep. REF: Page 1915 TOP: Seizures Step: Planning

20. A patient, age 69, is being evaluated by a neurologist for signs of muscle rigidity, masklike face (area from forehead to chin), and propulsive gait. These signs are often characteristic of a. multiple sclerosis. b. Parkinsonism. c. Alzheimer's disease. d. epilepsy.

ANS: B Parkinsonism is a syndrome that consists of a slowing down in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor, and impaired postural reflexes. REF: Page 1919 TOP: Parkinsonism

15. The Glasgow coma scale is a screening tool used to assess level of consciousness in three major areas. They are a. verbal, sensation, motor. b. eye, motor, verbal. c. verbal, pain, reflexes. d. eye, pain, verbal.

ANS: B The Glasgow coma scale was developed in 1974 and consists of three parts of the neurological assessment: eye opening, best motor response, and best verbal response. REF: Page 1695, Table 54-3, Table 54-4 TOP: Glasgow coma scale

9. A patient has recently suffered a stroke with left-sided weakness. She has problems with choking, especially when she drinks thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely? a. Having her avoid all liquids b. Instructing her to tuck her chin when swallowing c. Giving her sips of water with each bite d. Having her turn her head to the left

ANS: B The patient should sit at a 90-degree angle with the head up and chin slightly tucked. REF: Page 1910 TOP: Stroke

25. Which body system would the nurse choose to closely monitor in a patient diagnosed with Guillain-Barré syndrome? a. CNS b. GI c. Respiratory d. Cardiovascular

ANS: C The patient's condition can rapidly deteriorate into paralysis that affects the respiratory muscles. Close monitoring of respiratory function is important and necessary. REF: Page 1939 TOP: Guillain-Barré syndrome Step: Planning

32. The earliest sign of increased intracranial pressure is a. headache. b. dilated pupil. c. decreasing level of consciousness. d. diplopia (double vision).

ANS: C A decreasing level of consciousness is the earliest sign of increased intracranial pressure. REF: Pages 1894, 1905 TOP: Increased intracranial pressure

6. The patient, injured in an automobile accident, is being evaluated in the emergency department for possible head injury. Which test should not be done if there is an indication of increased intracranial pressure? a. CT scan b. MRI scan c. Lumbar puncture d. Electroencephalogram

ANS: C A lumbar puncture is contraindicated in patients who might have increased intracranial pressure, because the withdrawal of fluid may cause the medulla oblongata to herniate downward into the foramen magnum. REF: Pages 1906, 1940 TOP: Trauma

30. The best nursing intervention for restlessness in a patient with a head injury is a. sedation with an available narcotic. b. restraints to prevent injury. c. assessing for pain or distended bladder. d. encouraging verbalization of the problem.

ANS: C Behavioral problems associated with a lack of judgment and restlessness may also occur. Restlessness in the head-injured patient may be caused by the need for a change of position, pain, or the need to empty the bladder. REF: Page 1945 TOP: Head injury

A nurse is contributing to the plan of care for a client who has bacterial meningitis. Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Monitor for bradycardia B. Provide an emesis basin at the bedside. C. Administer antipyretic medication, D. Perform skin data collection. E. Keep the head of the bed flat.

B, C, D

4. When obtaining a health history from a patient with a neurological problem, the nurse is likely to elicit the most valid response from the patient with which question? a. "Do you have any sensations of pins and needles in your feet?" b. "Does the pain radiate from your back into your legs?" c. "Can you describe the sensations you are having in your head?" d. "Do you ever have any nausea or dizziness?"

ANS: C For patients with suspected neurological conditions, the presence of many symptoms or subjective data may be significant. REF: Page 1893 TOP: Assessment

16. When the seriousness of craniocerebral trauma is assessed, it is important to remember that a. heavy scalp bleeding indicates serious trauma. b. open injuries are always more serious than closed injuries. c. signs and symptoms may not occur until several days after the trauma. d. trauma to the frontal lobe is more significant than to any other area.

ANS: C If a patient who has been conscious for several days after head injury loses consciousness or develops neurological signs and symptoms, a subdural hematoma should be suspected. REF: Page 1945 TOP: Trauma

26. A method of reducing a person's risk of becoming infected with the West Nile virus would be to a. wear shorts and short-sleeve shirts. b. apply baby lotion to all extremities. c. apply insect repellent that contains DEET. d. apply flea and tick repellent.

ANS: C One can reduce the risk of becoming infected with West Nile virus by applying insect repellent to exposed skin. Choose an insect repellant that contains diethyltoluamide (DEET) and one that provides protection for the amount of time you will be outdoors. REF: Page 1941 TOP: West Nile virus Step: Planning

33. A therapeutic measure to reduce increased intracranial pressure is a. suction the patient every 2 hours. b. place in a semiprone position. c. reduce fluid intake. d. keep the patient flat in bed.

ANS: C Restrict fluid intake. Elevate the head of the bed 30 to 45 degrees to promote venous return. Prevent hip flexion to prevent an increase in intra-abdominal and intrathoracic pressure. Perform suctioning only as necessary. REF: Page 1907 TOP: Increased intracranial pressure

A spinal cord injury patient has signs of autonomic dysreflexia. Which intervention is first? Assess vital signs Check for bladder distention. Give nitroprusside (Nipride) as ordered Sit the patient upright, if permitted.

Check for bladder distention.

24. If a patient with a head injury has drainage from the nose or ears, which nursing intervention would be appropriate? a. Cleanse ear or nose with a soft cotton-tipped swab. b. Gently suction the nasal cavity. c. Allow the patient to wipe the nose or ears, but not blow the nose or place anything in the external ear. d. Place a pressure dressing over the ear.

ANS: C The patient's ear and nose are checked carefully for signs of blood and serous drainage, which indicate that the meninges are torn and spinal fluid is escaping. No attempt should be made to clean out the orifice. REF: Page 1945 TOP: Trauma

39. The three components of Cushing's response are: (Select all that apply.) a. Increased pulse rate b. Increased blood pressure c. Widened pulse pressure d. Bradycardia e. Increased systolic blood pressure f. Uncontrolled thermoregulation

ANS: C, D, E A widened pulse pressure, increased systolic blood pressure, and bradycardia are together called Cushing's response. It is considered an important diagnostic sign of late-stage brain herniation. REF: Page 1905 TOP: Increased intracranial pressure

40. Important nursing measures needed when feeding a hemiplegic patient include: (Select all that apply.) a. Mixing liquids and solid foods together b. Taking the patient's dentures out to prevent choking c. Checking the affected side of mouth for food accumulation d. Offering small bites of food e. Elevating the patient to no more than 30 degrees f. Adding a thickening agent to liquids

ANS: C, D, F Important nursing measures include avoiding foods that cause choking, checking the affected side of the mouth for accumulation of food and resultant poor hygiene, not mixing liquids and solid foods, and encouraging the patient to take small bites. REF: Page 1910 TOP: Hemiplegia Step: Planning

28. In the aging process, older adults are able to a. react to events immediately. b. master new material quickly. c. remember information from the immediate present (short-term memory). d. learn new skills.

ANS: D Most older people possess the ability to learn, but the speed of learning is slowed. Short-term memory is more affected by aging than is long-term memory. DIF: Cognitive Level: Knowledge REF: Page 1892, Life Span Considerations box TOP: Older adult considerations

11. A patient has a history of tonic-clonic seizures. She was admitted to the neurological unit after having had three tonic-clonic seizures in the past 2 days. Her husband reported that she had been sleeping for long periods after each seizure. The nurse explains to him that this rest period after a tonic-clonic seizure is called a a. convalescent period. b. post-status epilepticus period. c. post-tonic-clonic period. d. postictal period.

ANS: D Seizures are followed by a rest period of variable length, called a postictal period. REF: Page 1912 TOP: Seizures

5. A patient has been injured in a motorcycle accident and is presenting with signs and symptoms of increased intracranial pressure. What is the most significant sign or symptom of increased intracranial pressure? a. Pupil changes b. Ipsilateral paralysis c. Vomiting d. Decrease in the level of consciousness

ANS: D Collection of objective data includes a change in level of consciousness. A change in the level of consciousness is the earliest sign of increased intracranial pressure. REF: Pages 1897, 1905 TOP: Intracranial pressure (ICP)

19. A 39-year-old mother of four has a 6-year history of multiple sclerosis. During planning, the nurse remembers this is a degenerative neurological disease that a. occurs most often in tropical climates. b. occurs most often in the older adult. c. has classic signs and symptoms that are readily recognized. d. results from demyelination of the nerve sheath.

ANS: D In patients with multiple sclerosis, multiple foci of demyelination are distributed randomly in the white matter of the brain stem, spinal cord, optic nerves, and cerebrum. REF: Page 1916 TOP: Multiple sclerosis Step: Planning

21. When planning care for a patient with aphasia, the nurse should a. talk loudly so he or she can hear. b. refrain from giving explanations about procedures because the patient cannot understand them anyway. c. provide as much environmental stimuli as possible to prevent feelings of isolation. d. consider the type of aphasia that the patient has and adapt communication methods accordingly.

ANS: D Many stroke patients have communication problems, including dysarthria and aphasia. The nurse should wait for the patient to communicate, rather than prompting or finishing the sentence before the patient has a chance to find the appropriate word. REF: Page 1935 TOP: Aphasia Step: Planning

13. A patient has been complaining of headaches. If the headaches are migraine, the nurse would expect to assess that the headaches: a. They are observed during times of stress. b. They become worse toward evening. c. They have their onset when the person is in his or her twenties or thirties. d. They may cause unusual smells or sounds for the patient before the pain begins.

ANS: D Migraine headaches are unusual in that there are prodromal (early signs and symptoms of a developing condition or disease) signs and symptoms that occur before the acute attack. REF: Page 1901 TOP: Headache

1. The name of this area of the brain means "bridge." It is the origin of cranial nerves V through VIII and is responsible for sending impulses to the structures inferior and superior to it. It also contains a respiratory center that complements the part of the brain stem located inferior to it. It is called the a. medulla oblongata. b. diencephalon. c. cerebellum. d. pons.

ANS: D The pons connects the midbrain to the medulla oblongata. The word pons means "bridge." It is the origin of cranial nerves V and VIII. REF: Page 1890 TOP: Anatomy and physiology

2. The cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and also carries motor fibers to glands that produce digestive juices and other secretions is the a. somatic motor nerve. b. visceral sensory nerve. c. abducens nerve. d. vagus nerve.

ANS: D The vagus nerve extends from the throat, larynx, and organs in the thoracic and abdominal cavities. It is responsible for sensations and will accelerate peristalsis when stimulated. REF: Page 1891, Table 54-1 TOP: Anatomy and physiology

37. Involuntary rhythmic movement of the eyes, with oscillations that may be horizontal, vertical, or mixed movements, is called .

ANS: nystagmus REF: Page 1917 TOP: Anatomy and physiology

The RAS (Reticular Activating System) is responsible for: Concentration Attention Wakefulness Introspection

All

What term most accurately describes age-related changes of the neurological system? Becoming senile is an inevitable consequence of aging. Older people lose the ability to learn new things Long-term memory is more affected than short-term memory. As neurons are lost with aging. neuro function declines.

As neurons are lost with aging. neuro function declines.

What nursing action should be implemented in regards to a myeloaram? Keep patient NO for 6-8 hours Ask the patient about allergies prior to the procedure Ambulate patient after the test

Ask the patient about allergies prior to the procedure

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? (Select all that apply.) A. Pain is bilateral across the posterior occipital area. B. Client experiences altered sleep-wake cycle. C. Headache occurs approximately 1 to 8 times daily. D. Client describes headache pain as dull and throbbing. E. Nasal congestion and drainage occur.

B. Client experiences altered sleep-wake cycle C. Headache occurs approximately 1 to 8 times daily E. Nasal congestion and drainage occur

A nurse is monitoring a client who reports severe headache and a stiff neck. The nurse's data collection reveals positive Kernig's and Brudzinski's signs. Which of the following actions should the nurse perform first? A Administer antioiotics. B. Implement droplet precautions. C.Intiate IV access. D. Decrease bright lights.

B. Implement droplet precautions.

A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? A. Fluctuations in blood pressure B. Loss of cognitive function C. Ineffective cough D. Drooping eye lids

B. Loss of cognitive function

A nurse is collecting data on a client for manifestations of Parkinson's disease. Which of the following are expected findings? (Select all that apply.) A. Decreased vision B. Pill-rolling tremor of the fingers C. Shuffling gait D. Drooling E. Bilateral ankle edema F. Lack of facial expression

B. Pill-rolling tremor of the fingers C. Shuffling gait D. Drooling F. Lack of facial expression

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

B. Place the bedside table on the right side of the bed.

A nurse is caring for a client who has AD and falls frequently. Which of the following actions should the nurse take first to keep the client safe? A. Keep the call light near the client. B. Place the client in a room close to the nurses' station. C. Encourage the client to ask for assistance. D. Remind the client to walk with someone for support.

B. Place the client in a room close to the nurses' station.

A nurse is contributing to the plan of care for a client who has Parkinson's disease. Which of the following actions should the nurse include? A. Provide three large balanced meals daily. B. Record diet and fluid intake daily. C. Document weight every other week. D. Offer low-protein food choices.

B. Record diet and fluid intake daily.

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 instruct that which of the following foods can trigger a migraine headache? A. Baked salmon B. Salted peanuts C. Frozen strawberries D. Fresh asparagus

B. Salted peanuts

A nurse in a clinic is reinforcing teaching to 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 information provided? A. "This medication will relieve my symptoms by causing my blood vessels to dilate." B. "I should take this medication daily to prevent the headache from occurring." C. "I should expect facial flushing when I take this medication." D. "This medication will lower my sensitivity to food triggers."

C. "I should expect facial flushing when I take this medication."

A nurse is caring for a client who has a benign brain tumor. The client asks the nurse if this same type of tumor can occur in other areas of the body. Which of the following responses should the nurse make? A. "It can spread to breasts and kidneys." B. "It can develop in your gastrointestinal tract." C. "It is limited to brain tissue." D. "It probably started in another area of your body and spread to your brain."

C. "It is limited to brain tissue."

A nurse is reinforcing 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 instruction is effective? A. "This medication should increase my husband's appetite." B. "This medication should help my husband sleep better." C. "This medication should help my husband's daily function." D. "This medication should increase my husband's energy level."

C. "This medication should help my husband's daily function."

A nurse is collecting data on a client. Which of the following findings indicates that the client has experienced a left-hemispheric stroke? A. Impulse control difficulty B. Poor judgment C. Inability to recognize familiar objects D. Loss of depth perception

C. Inability to recognize familiar objects

A nurse is providing discharge instructions to a client who has a prescription for phenytoin. Which of the following information should the nurse include? A. Consider taking an antacid when on this medication. B. Watch for receding gums when taking the medication. C. Take the medication at the same time every day. D. Provide a urine sample to determine therapeutic levels of the medication.

C. Take the medication at the same time every day.

A nurse is reviewing the use of the meningococcal vaccine (MCV4) for the prevention of meningitis with a newly licensed nurse. Which of the following information should the nurse include? A. The vaccine is indicated to reduce the risk of respiratory infection. B. The vaccine is administered in a series of four doses. C. The vaccine is recommended for adolescents before starting college. D. The vaccine is initially given at 2 months of age.

C. The vaccine is recommended for adolescents before starting college.

What are the two division of the nervous system Cerebellum and brainstem Central and peripheral Somatic and Autonomic Ventricles and Cerebrum

Central and peripheral

What is the earliest sign of increased intracranial pressure? Widening pulse pressure Ipsilateral pupil dilation Change in level of consciousness (LOC) Ataxic breathing pattern

Change in level of consciousness (LOC)

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? A. "Do the headaches occur multiple times each day?" B. "Is your headache accompanied by profuse facial sweating?" C. "Does your headache occur on one side of your head?" D. "Do you have the same manifestations each time the headache occurs?"

D. "Do you have the same manifestations each time the headache occurs?"

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

D. "This medication can cause you to experience dizziness."

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? A. Use music therapy for relaxation with the onset of the headache. B. Increase physical activity when a headache is present. C.. Drink beverages that contain artificial sweeteners to prevent headaches. D. Apply a cool cloth to the face during a headache.

D. Apply a cool cloth to the face during a headache.

A nurse is caring for a client who has Parkinson's disease and is starting to display bradykinesia. Which of the following is an appropriate action by the nurse? A. Instruct the client to walk more quickly when ambulating. B. Complete passive range-of-motion exercises daily. C. Place the client on a low-protein, low-calorie diet. D. Give the client extra time to perform activities.

D. give the client extra time

A nurse working in a long-term care facility is contributing to the plan of care for a client who has moderate Alzheimer's (mild or moderate stage). Which of the following interventions should be included in the plan of care? A. Use a gait belt for ambulation. B. Thicken all liquids. C. Provide protective undergarments. D. Reorient the client to self and current events.

D. reorient the client to self and current events

What neurotransmitter mainly affects motor function & unconscious movement of skeletal muscles. Acetylcholine Norepinephrine Dopamine Serotonin

Dopamine

A patient cannot taste on the posterior 1/3rd of their tongue. Which cranial nerve is damaged? Facial Hypoglossal Glossopharyngeal Vagus

Glossopharyngeal

A patient with possible meningitis can't extend her legs without extreme pain. This IS the Brudzinski's sian Battle's sign Kernig's sign Cosgrow's sign

Kernig's sign

You would expect an order for what medication for a patient with increased ICP? Mannitol Neurontin Xanax Percocet

Mannitol

The autoimmune disease of the neuromuscular junction characterized by muscle weakness is... Mvasthenia gravis Amyotrophic lateral sclerosis Huntington disease Trigeminal neuralgia

Mvasthenia gravis

Prevention of neurological problems include all of the following except? Obesity is not defined as a risk factor cigarette smoking is defined as a risk factor high blood pressure increases risk nigh blood cholesterol increases likelihood

Obesity is not defined as a risk factor

You are taking care of a patient who suddenly begins to seize. What is appropriate response? Run to the telephone and call for help Place a padded tongue blade into the patients mouth. Apply soft restraints until the seizure activity ceases. Observe and record the seizure activitv.

Observe and record the seizure activitv.

A patient is not able to comprehend written or spoken word. Which term describes this condition 90 sec Receptive aphasia Global aphasia Expressive aphasia Anomia

Receptive aphasia