Med Surg Exam 3

अब Quizwiz के साथ अपने होमवर्क और परीक्षाओं को एस करें!

*A nurse is beginning a physical assessment of 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 movement C. Alopecia D. Increased salivation E. Ataxia

A B E

Indicate whether the following manifestations of a stroke are more likely to occur with right brain damage or left brain damage. A. Aphasia B. Impaired judgment C. Quick, impulsive behavior D. Inability to remember words E. Left homonymous hemianopia F. Neglect of the left side of the body G. Hemiplegia of the right side of the body

A. Aphasia-Left B. Impaired judgment- Right C. Quick, impulsive behavior- Right D. Inability to remember words- Left E. Left homonymous hemianopia - Right F. Neglect of the left side of the body - Right G. Hemiplegia of the right side of the body - Left

*A nurse is assessing 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 expressions

B C D F

*A nurse is preparing to administer a medication to a client who has absence seizures. The nurse should expect to administer which of the following medications to the client?* (Select all that apply.) A. Phenytoin B. Ethosuximide C. Gabapentin D. Carbamazepine E. Valproic acid F. Lamotrigine

B E F

*In a patient with a disease that affects the myelin sheath of nerves, such as multiple sclerosis, the glial cells affected are the* a. microglia. b. astrocytes. c. ependymal cells. d. oligodendrocytes.

*The factor related to cerebral blood flow that most often determines the extent of cerebral damage from a stroke is the* a. O2 content of the blood. b. amount of cardiac output. c. level of CO2 in the blood. d. degree of collateral circulation.

A patient has ICP monitoring with an intraventricular catheter. What is a priority nursing intervention for the patient? a. Aseptic technique to prevent infection b. Constant monitoring of ICP waveforms c. Removal of CSF to maintain normal ICP d. Sampling CSF to determine abnormalities

The patellar tendon is struck and the leg extends with contraction of the quadriceps. what grade should this response be given? a. 1/5 b. 2/5 c. 3/5 d. 4/5

he patient is being monitored long-term with a brain tissue oxygenation catheter. What range for the pressure of oxygen in brain tissue (PbtO2) will maintain cerebral oxygen supply and demand? a. 55% to 75% b. 20 to 40 mm Hg c. 70 to 150 mm Hg d. 80 to 100 mm Hg

During care of a patient in myasthenic crisis, maintenance of what is the nurse's first priority for the patient? a. Maintaining Mobility b. Adequate Nutrition c. Maintaining Respiratory function d. Maintaining Verbal communication

On physical examination of a patient with headache and fever, the nurse should suspect a brain abscess when the patient has a. seizures. b. nuchal rigidity. c. focal symptoms. d. signs of increased ICP.

Which type of macroglial cells myelinate peripheral nerve fibers? a. neurons b. astrocytes c. schwann cells d. ependymal cells

the patient is receiving donepezil (Aricept), lorazepam (Ativan), risperidone (Risperdal), and sertraline (Zoloft) for the management of AD. What benzodiazepine medication is being used to help manage this patient's behavior? a. Sertraline (Zoloft) b. Donepezil (Aricept) c. Lorazepam (Ativan) d. Risperidone (Risperdal)

What methods are used to assess the facial nerve? (select all that apply) a. gag reflex b. confrontation c. corneal reflex test d. light touch to the face e. smile, frown, and close eyes f. salt and sugar discrimination

c e f

A patient is admitted to the hospital with possible bacterial meningitis. During the initial assessment, the nurse questions the patient about a recent history of what? a. Mosquito or tick bites b. Chickenpox or measles c. Cold sores or fever blisters d. An upper respiratory infection

How do generalized seizures differ from focal seizures? a. Focal seizures are confined to one side of the brain and remain focal in nature. b. Generalized seizures result in loss of consciousness whereas focal seizures do not. c. Generalized seizures result in temporary residual deficits during the postictal phase. d. Generalized seizures have bilateral synchronous epileptic discharges affecting the whole brain at onset of the seizure.

What is the most important method of diagnosing functional headaches? a. CT scan b. Electromyography (EMG) c. Cerebral blood flow studies d. Thorough history of the headache

what N-methyl-D-aspartate (NMDA) receptor antagonist is frequently used for a patient with AD who is experiencing decreased memory and cognition? a. Zolpidem (Ambien) b. Olanzapine (Zyprexa) c. Rivastigmine (Exelon) d. Memantine (Namenda)

*A 50-year-old man complains of recurring headaches. He describes them as sharp, stabbing and around his left eye. He says his left eye seems to swell and get teary when these headaches occur. Based on this history, you suspect that he has* a. cluster headaches. b. tension headaches. c. migraine headaches. d. medication overuse headaches.

*A nurse in the post‑anesthesia recovery unit is caring for a client who received a nondepolarizing neuromuscular blocking agent and has muscle weakness. The nurse should expect a prescription for which of the following medications?* A. Neostigmine B. Naloxone C. Dantrolene D. Vecuronium

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

*A nurse is providing information to a client who has early Parkinson's disease and a new prescription for pramipexole. The nurse should instruct the client to monitor for which of the following adverse effects of this medication?* A. Hallucinations B. Increased salivation C. Diarrhea D. Discoloration of urine

*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 that contain tyramine D. Report any skin discolorations

*A patient is suspected of having a brain tumor. The signs and symptoms include memory deficits, visual changes, weakness of right upper and lower extremities, and personality changes. The nurse recognizes that the tumor is most likely located in the* a. frontal lobe. b. parietal lobe. c. occipital lobe. d. temporal lobe.

*A patient's eyes jerk while the patient looks to the left. The nurse will record this finding as* a. nystagmus. b. CN VI palsy. c. ophthalmic dyskinesia. d. oculocephalic response.

*A priority goal of treatment for the patient with Alzheimer's disease is to* a. maintain patient safety. b. maintain or increase body weight. c. return to a higher level of self-care. d. enhance functional ability over time.

*During admission of a patient with a severe head injury to the emergency department, the nurse places the highest priority on assessment for* a. patency of airway. b. presence of a neck injury. c. neurologic status with the Glasgow Coma Scale. d. cerebrospinal fluid leakage from the ears or nose.

*Social effects of a chronic neurologic disease include* (Select all that apply) a. divorce. b. job loss. c. depression. d. role changes. e. loss of self-esteem.

A B C D E

*A nurse in the post anesthesia care unit is caring for a client who is experiencing malignant hyperthermia. Which of the following actions should the nurse take?* (Select all that apply) A. Place a cooling blanket on the client B. Administer oxygen at 100% C. Administer iced 0.9% sodium chloride D. Administer potassium chloride IV E. Monitor core body temperature

A B C E

*A nurse is caring for 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. Situational awareness

A B C E

*A nurse is completing an assessment of a client who has increased intracranial pressure (ICP). 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 mmHg 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 liquids C. Place food on the unaffected side of mouth. D. Assign an assistive personnel to feed the client slowly E. Teach the client to swallow with the neck flexed

A B C E

*Stimulation of the parasympathetic nervous system results in* (Select all that apply) a. constriction of the bronchi. b. dilation of skin blood vessels. c. increased secretion of insulin. d. increased blood glucose levels. e. relaxation of the urinary sphincters.

A B C E

*A nurse in the critical care unit is completing an admission assessment of a client who has a gunshot wound to the head. Which of the following assessment findings are indicative of increased ICP?* (Select all that apply) A. Headache B. Dilated pupils C. Tachycardia D. Decorticate posturing E. Hypotension

A B D

*A nurse is developing a plan of care for a client who is scheduled for cerebral angiography with contrast media. Which of the following statements by the client should the nurse report to the provider?* (Select all that apply) A. "I think I might be pregnant." B. "I take warfarin." C. "I take antihypertensive medication." D. "I am allergic to shrimp." E. "I ate a light breakfast this morning."

A B D E

*A nurse is reviewing a new prescription for oxcarbazepine with a female client who has partial seizures. Which of the following instructions should the nurse include?* (Select all that apply.) A. "Use caution if given a prescription for a diuretic medication." B. "Consider using an alternate form of contraception if you are using oral contraceptives." C. "Chew gum to increase saliva production." D. "Avoid driving until you see how the medication affects you." E. "Notify your provider if you develop a skin rash."

A B D E

*A nurse is caring for a client who has global aphasia (both expressive and receptive). Which of the following should the nurse include in the client's plan of care?* (Select all that apply) A. Speak to client at 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 instruction one step at a time.

A B E

*A nurse is assessing for the presence of Brudzinski's sign in a client who has suspected meningitis. Which of the following actions should the nurse take when performing this technique?* (Select all that apply) A. Place the client in supine position B. Flex client's hip & knee C. Place hands behind the client's neck D. Bend client's head toward chest E. Straighten the client's flexed leg at knee

A C D

*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, unsteady on his feet, 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 bathrooms E. Place the mattress on the floor

A C D E

*A nurse is caring for 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 may notice weight gain" D. "Tumor growth will be delayed" E. "It can cause you to retain fluid"

A C E

*Common psychosocial reactions the patient may have post stroke include* (Select all that apply) a. depression. b. disassociation. c. sleep problems. d. intellectualization. e. denial of severity of stroke.

A C E

*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 herpes infection

A D E

*A nurse is planning 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 per day C. Administer morphine for the report of neck and general pain D. Turn off room lights & TV E. Monitor for impaired extraocular movement F. Encourage the client to cough frequently

A D E

*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 caffeine products from diet C. Limit looking at flash lights D. Perform aerobic exercise E. Limit episodes of hypoventilations F. Use of aerosol hairspray is recommended

A b C

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

*A nurse is assessing a client for changes in the level of consciousness using the Glasgow Coma Scale. The client opens his eyes when spoken to, speaks incoherently, and moves his extremities when pain is applied. Which of the following GCS scores should the nurse document?* A. E2 + V3 + M5= 10 B. E3 + V4 + M4= 11 C. E4 + V5 + M6= 15 D. E2 + V2 + M4= 8

*A nurse is assessing a client who reports severe headache and stiff neck. The nurse's assessment reveals positive Kernig's and Brudzinski's signs. Which of the following actions should the nurse perform first?* A. Admin antibiotics B. Implement droplet precautions C. Initiate IV access D. Decrease bright lights

*A nurse is caring for a client who experienced a traumatic head injury and has a intraventricular catheter (ventriculostomy) for ICP monitoring. The nurse should monitor the patient for which of the following complications related to the ventriculostomy?* A. Headache B. Infection C. Aphasia D. Hypertension

*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 near the nurse's station C. Encourage the client to ask for assistance D. Remind the client to walk with someone for support

*A nurse is caring for a client who has a left homonymous hemianopsia. Which of the following is an appropriate nursing intervention?* A. Teach the client to scan to the right to see object o 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 her plate using the clock method. D. Place the wheelchair on the client's left side

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

*A nurse is caring for a client who has just undergone a craniotomy for a supratentorial tumor 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 2 mg IV bolus prn q2hr for pain C. Ondansetron 4 mg IV bolus PRN q4-6hr for nausea D. Phenytoin 100 mg IV bolus TID

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

*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?* A. "Do not wash your hair the morning of the procedure." B. "Try to stay awake most of the night prior to the procedure." C. "The procedure will take approximately 15 minutes." D. "You will need to lie flat for 4 hours after the procedure."

*A nurse plans care for the patient with increased intracranial pressure with the knowledge that the best way to position the patient is to* a. keep the head of the bed flat. b. elevate the head of the bed to 30 degrees. c. maintain patient on the left side with the head supported on a pillow. d. use a continuous-rotation bed to continuously change patient position.

*A nursing measure that is indicated to reduce the potential for seizures and increased intracranial pressure in the patient with bacterial meningitis is* a. administering codeine for relief of head and neck pain. b. controlling fever with prescribed drugs and cooling techniques. c. maintaining strict bed rest with the head of the bed slightly elevated. d. keeping the room dark and quiet to minimize environmental stimulation.

*A patient is seen in the emergency department after diving into the pool and hitting the bottom with a blow to the face that hyperextended the neck and scraped the skin off the nose. The patient also described "having double vision" when looking down. During the neurologic exam, the nurse finds the patient is unable to abduct either eye. The nurse recognizes this finding is related to* a. a basal skull fracture. b. an injury to bilateral CN VI. c. a stiff neck from the hyperextension injury. d. facial swelling from the scrape on the bottom of the pool.

*Bladder training in a male patient who has urinary incontinence after a stroke includes* a. limiting fluid intake. b. helping the patient to stand to void. c. keeping a urinal in place at all times. d. catheterizing the patient every 4 hours.

*During the admitting neurologic examination, the nurse determines the patient has speech difficulties with weakness of the right arm and lower face. The nurse would expect a CT scan to show pathology in the distribution of the* a. basilar artery. b. left middle cerebral artery. c. right anterior cerebral artery. d. left posterior communicating artery.

*For a patient who is suspected of having a stroke, one of the most important pieces of information that the nurse can obtain is* a. time of the patient's last meal. b. time at which stroke symptoms first appeared. c. patient's hypertension history and management. d. family history of stroke and other cardiovascular diseases.

*The nurse is assessing the muscle strength of an older adult patient. The nurse knows the findings cannot be compared with those of a younger adult because* a. nutritional status is better in young adults. b. muscle bulk and strength decrease in older adults. c. muscle strength should be the same for all adults. d. most young adults exercise more than older adults.

*Vasogenic cerebral edema increases intracranial pressure by* a. shifting fluid in the gray matter. b. altering the endothelial lining of cerebral capillaries. c. leaking molecules from the intracellular fluid to the capillaries. d. altering the osmotic gradient flow into the intravascular component.

*Which patient has the highest risk for having a stroke?* a. obese 45-yr-old Native American. b. 65-yr-old African American man with hypertension. c. 35-yr-old Asian American woman who smokes. d. 32-yr-old white woman taking oral contraceptives.

*A nurse is planning 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. Admin antipyretic medication D. Perform skin assessment E. Keep the head of bed flat

B C D

*A nurse is teaching a client who has a new prescription for baclofen to treat muscle spasms. Which of the following statements by the client indicates an understanding of the teaching?* (Select all that apply) A. "I will stop taking this medication right away if I develop dizziness." B. "I know the doctor will gradually increase my dose of this medication for a while." C. "I should increase fiber to prevent constipation from this medication." D. "I won't be able to drink alcohol while I'm taking this medication." E. "I should take this medication on an empty stomach each morning."

B C D

*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 C E

*Which statement(s) accurately describe(s) mild cognitive impairment?* (Select all that apply) a. Cannot be detected by screening tests b. The person may appear normal to the casual observer c. Family members may see changes in the patient's abilities d. Problems that the person is experiencing interfere with daily activities e. The person is usually aware that there is a problem with his or her memory

B C E

*A nurse is caring for a client who has a closed-headed injury with ICP readings ranging from 16-22 mmHg. Which of the following actions should the nurse take to decrease the potential for raising the client's ICP?* (Select all that apply) A. Suction the endotracheal tube frequently B. Decrease the noise level in the client's room C. Elevate the client's head on 2 pillows D. Administer stool softener E. Keep the client well hydrated

B D

*A nurse is developing a plan of care for the nutritional needs of a client who has stage IV Parkinson's disease. Which of the following actions should the nurse include?* (Select all that apply) A. Provide three large balanced meals daily B. Record diet and fluid intake daily C. Document weight every other week D. Offer cold fluids such as milkshakes E. Offer nutritional supplements between meals

B D E

*A 65-year-old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is* a. searching the Internet for educational videos. b. helping the caregiver explore respite care options. c. promoting physical exercise and a well-balanced diet. d. teaching about the benefits and risks of ablation therapy.

*A nurse in a clinic is teaching a client who has a history of migraine headaches about a new prescription for zolmitriptan. Which of the following statements by the client indicates understanding of the teaching?* 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."

*A nurse in the operating room is caring for a client who received a dose of succinylcholine. During operation, the client suddenly develop rigidity and a rise in body temperature. The nurse should expect a prescription for which of the following medications?* A. Neostigmine B. Naloxone C. Dantrolene D. Vecuronium

*A nurse is assessing 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

*A nurse is caring for a client who displays manifestations of stage III Parkinson's disease. Which of the following actions should the nurse include in the plan of care?* A. Recommend a community support group. B. Integrate a daily exercise routine C. Provide a walker for ambulation D. Perform ADLs for the client

*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 his body. Which of the following responses should the nurse make?* A. "It can spread to breast and kidneys." B. "It can develop in your GI tract." C. "It is limited to brain tissue." D. "It probably started in another area of your body and spread to your brain."

*A nurse is caring for a client who has just been admitted following surgical evacuation of a subdermal hematoma. Which of the following is the priority assessment?* A. Glasgow Coma Scale B. Cranial nerve function C. Oxygen saturation D. Pupillary response

*A nurse is completing discharge teaching to a client who has seizures and received a vagal nerve stimulator to decrease seizure activity. Which of the following statements should the nurse include in the teaching?* A. "It is safe to use microwaves that are 1,200 watts or less." B. "You should avoid the use of CT scans with contrast." C. "You should place a magnet over the implantable device when you feel an aura occurring." D. "It is recommended that you use ultrasound diathermy for pain management."

*A nurse is providing discharge instructions to a female 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 this med C. Take the medication at the same time every day D. Provide a urine sample to determine therapeutic levels of the medication

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

*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 for 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.

*A nurse is teaching a client who has a new prescription for levodopa/carbidopa for Parkinson's disease. Which of the following instructions should the nurse include?* A. Increase intake of protein‑rich foods. B. Expect muscle twitching to occur. C. Take this medication with food. D. Anticipate relief of manifestations in 24 hr.

*A patient having TIAs is scheduled for a carotid endarterectomy. The nurse explains that this procedure is done to* a. decrease cerebral edema. b. reduce the brain damage that occurs during a stroke in evolution. c. prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow. d. provide a circulatory bypass around thrombotic plaques obstructing cranial circulation.

*A patient is admitted with a headache, fever, and general malaise. The HCP has asked that the patient be prepared for a lumbar puncture. What is a priority nursing action to avoid complications?* a. Assess laboratory results for changes in the white cell count. b. Give acetaminophen for the headache and fever before the procedure. c. Notify the provider if signs of increased intracranial pressure are present. d. Administer antibiotics before the procedure to treat the potential meningitis.

*A patient is having word finding difficulty and weakness in his right arm. What area of the brain is most likely involved?* a. brainstem. b. vertebral artery. c. left middle cerebral artery. d. right middle cerebral artery.

*Dementia with Lewy bodies (DLB) is characterized by* a. remissions with exacerbations over many years. b. memory impairment, muscle jerks, and blindness. c. parkinsonian symptoms, including muscle ridigity. d. increased intracranial pressure from decreased CSF drainage.

*During neurologic testing, the patient is able to perceive pain elicited by pinprick. Based on this finding, the nurse may omit testing for* a. position sense. b. patellar reflexes. c. temperature perception. d. heel-to-shin movements.

*The nurse explains to the patient with a stroke who is scheduled for angiography that this test is used to determine the* a. presence of increased ICP. b. site and size of the infarction. c. patency of the cerebral blood vessels. d. presence of blood in the cerebrospinal fluid.

*The nurse is alerted to a possible acute subdural hematoma in the patient who* a. has a linear skull fracture crossing a major artery. b. has focal symptoms of brain damage with no recollection of a head injury. c. develops decreased level of consciousness and a headache within 48 hours of a head injury. d. has an immediate loss of consciousness with a brief lucid interval followed by decreasing level of consciousness.

*The nurse is caring for a client who has a prescription for bethanechol to treat urinary retention. The nurse should identify that which of the following findings is a manifestation of muscarinic stimulation?* A. Dry mouth B. Hypertension C. Excessive perspiration D. Fecal impaction

*The nurse on the clinical unit is assigned to four patients. Which patient should she assess first?* a. Patient with a skull fracture whose nose is bleeding b. Older patient with a stroke who is confused and whose daughter is present c. Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0-to-10 scale d. Patient 2 days postoperative after a craniotomy for a brain tumor who has had continued vomiting

*Vascular dementia is associated with* a. transient ischemic attacks. b. bacterial or viral infection of neuronal tissue. c. cognitive changes secondary to cerebral ischemia. d. abrupt changes in cognitive function that are irreversible.

*Nursing management of a patient with a brain tumor includes* (Select all that apply) a. discussing with the patient methods to control inappropriate behavior. b. using diversion techniques to keep the patient stimulated and motivated. c. assisting and supporting the family in understanding any changes in behavior. d. limiting self-care activities until the patient has regained maximum physical functioning. e. planning for seizure precautions and teaching the patient and the caregiver about antiseizure drugs.

C E

*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. Teach 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

*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?"

*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 onset of headache B. Increase physical activity when a headache is present C. Drink beverages that contain artificial sweeteners to prevent headaches D. Apply cool cloth to the face during a headache

*A nurse is reviewing the health record of a client who has a malignant brain tumor and notes the client has a positive Romberg sign. Which of the following actions should the nurse take to assess for this sign?* A. Stroke the later aspect of the sole of the foot B. Ask the client to blink his eye C. Observe for facial drooping D. Have the client stand erect with eyes closed

*A nurse is reviewing the healthcare record of a client who reports urinary incontinence and asks about a prescription for oxybutynin. The nurse should recognize that oxybutynin is contraindicated in the presence of which of the following conditions?* A. Bursitis B. Sinusitis C. Depression D. Glaucoma

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

*A nurse working in a long-term care facility is planning care for a client who has moderate Alzheimer's disease. Which of the following intervention should be included in the plan of care?* A. Use gait belt for ambulation B. Thicken all liquids C. Provide protective undergarments D. Assist with ADLs

*A patient with intracranial pressure monitoring has a pressure of 12 mm Hg. The nurse understands that this pressure reflects* a. a severe decrease in cerebral perfusion pressure. b. an alteration in the production of cerebrospinal fluid. c. the loss of autoregulatory control of intracranial pressure. d. a normal balance between brain tissue, blood, and cerebrospinal fluid.

*Dementia is defined as a* a. syndrome that results only in memory loss. b. disease associated with abrupt changes in behavior. c. disease that is always due to reduced blood flow to the brain. d. syndrome characterized by cognitive dysfunction and loss of memory.

*Drugs or diseases that impair the function of the extrapyramidal system may cause loss of* a. sensations of pain and temperature. b. regulation of the autonomic nervous system. c. integration of somatic and special sensory inputs. d. automatic movements associated with skeletal muscle activity.

*Information provided by the patient that would help distinguish a hemorrhagic stroke from a thrombotic stroke includes* a. sensory changes. b. a history of hypertension. c. presence of motor weakness. d. sudden onset of severe headache.

*The clinical diagnosis of dementia is based on* a. CT or MRS. b. brain biopsy. c. electroencephalogram. d. patient history and cognitive assessment.

*The nurse finds that an 87-year-old patient is continually rubbing, flexing, and kicking her legs throughout the day. The night shift reports that this same behavior escalates at night, preventing her from obtaining sleep. The next step the nurse should take is to* a. ask the physician for a daytime sedative for the patient. b. request soft restraints to prevent her from falling out of her bed. c. ask the physician for a nighttime sleep medication for the patient. d. perform an assessment, suspecting a disorder such as restless legs syndrome.

*The nurse is caring for a patient with peripheral neuropathy who is scheduled for EMG studies tomorrow morning. The nurse should* a. ensure the patient has an empty bladder. b. instruct the patient about the risk of electric shock. c. ensure the patient has no metallic jewelry or metal fragments. d. instruct the patient that pain may be experienced during the study.

*The nurse is reinforcing teaching with a newly diagnosed patient with amyotrophic lateral sclerosis (ALS). Which statement would be appropriate to include in the teaching?* a. "Even though the symptoms you have are severe, most people recover with treatment." b. "ALS results from excess chemicals in the brain, so symptoms can be controlled with medication." c. "You need to consider advance directives now, because you will lose cognitive function as the disease progresses." d. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."

*Which patient is most at risk for developing delirium?* a. A 50-year-old woman with cholecystitis b. A 19-year-old man with a fractured femur c. A 42-year-old woman having an elective total hysterectomy d. A 78-year-old man admitted to the medical unit with complications related to heart failure

*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 the side-lying position B. Document the duration of the seizure C. Reorient the client to the environment D. Provide client hygiene

A 38-year-old woman has newly diagnosed multiple sclerosis (MS) and asks the nurse what is going to happen to her. What is the best response by the nurse? a. "You will have either periods of attacks and remissions or progression of nerve damage over time." b. "You need to plan for a continuous loss of movement, sensory functions, and mental capabilities." c. "You will most likely have a steady course of chronic progressive nerve damage that will change your personality." d. "It is common for people with MS to have an acute attack of weakness and then not to have any other symptoms for years."

A 54-year-old man is recovering from a skull fracture with a subacute subdural hematoma that caused unconsciousness. He has return of motor control and orientation but appears apathetic and has reduced awareness of his environment. When planning discharge of the patient, what should the nurse explain to the patient and the family? a. The patient is likely to have long-term emotional and mental changes that may require professional help. b. Continuous improvement in the patient's condition should occur until he has returned to pretrauma status. c. The patient's complete recovery may take years and the family should plan for his long-term dependent care. d. Role changes in family members will be necessary because the patient will be dependent on his family for care and support.

A newly admitted patient who has suffered a right sided brain stroke has a nursing diagnosis of disturbed visual sensory perception related to homonymous hemianopsia. Early in the care of the patient, the nurse should: a. place objects on the right side within the patient's field of vision b. approach the patient from the left side to encourage the patient to turn the head c. place objects on the patient's left side to assess the patient's ability to compensate d. patch the affected eye to encourage the patient to turn the head to scan the environment

A patient has a nursing diagnosis of risk for ineffective cerebral tissue perfusion related to cerebral edema. What is an appropriate nursing intervention for the patient? a. Avoid positioning the patient with neck and hip flexion. b. Maintain hyperventilation to a PaCO2 of 15 to 20 mm Hg. c. Cluster nursing activities to provide periods of uninterrupted rest. d. Routinely suction to prevent accumulation of respiratory secretions.

During the acute phase of a stroke, the nurse assesses the patient's vital signs and neurologic status every 4 hours. A cardiovascular sign that the nurse would see as the body attempts to increase cerebral blood flow is: a. hypertension b. fluid overload c. cardiac dysrhythmias d. S3 and S4 sounds

Following a lumbar puncture, what should the nurse assess the patient for? a. headache b. lower limb paralysis c. allergic reaction to the dye d. hemorrhage from the puncture site

For the patient undergoing a craniotomy, when should the nurse provide information about the use of wigs and hairpieces or other methods to disguise hair loss? a. During preoperative teaching b. If the patient asks about their use c. In the immediate postoperative period d. When the patient expresses negative feelings about his or her appearance

Four days following a stroke, a patient is to start oral fluids and feedings. Before feeding the patient, the nurse should first: a. check the patient's gag reflex b. order a soft diet for the patient c. raise the head of the bed to a sitting position d. assess the patient's ability to swallow tiny amounts of crushed ice

The patient is admitted to the emergency department having difficulty with respiratory, vasomotor, and cardiac function. The nurse should recognize that which portion of the brain is affected to cause these manifestations? a. medulla b. cerebellum c. parietal lobe d. Wernicke's area

To promote communication during rehabilitation of the patient with aphasia, an appropriate nursing intervention is to: a. allow time for the individual to complete his/her thoughts b. use gestures, pictures, and music to stimulate patient responses c. structure statements so that the patient does not have to respond verbally d. use flashcards with simple words and pictures to promote recall of language

What is a nursing intervention that is appropriate for the patient with a nursing diagnosis of anxiety related to lack of knowledge of the etiology and treatment of headache? a. Help the patient to examine lifestyle patterns and precipitating factors. b. Administer medications as ordered to relieve pain and promote relaxation. c. Provide a quiet, dimly lit environment to reduce stimuli that increase muscle tension and anxiety. d. Support the patient's use of counseling or psychotherapy to enhance conflict resolution and stress reduction.

What is the effect when a lesion occurs in a lower motor neuron compared to in an upper motor neuron? a.) cause hyporeflexia and flaccidity b.) affect motor control of the lower body c.) arise in structures above the spinal cord d.) interfere with reflex arcs in the spinal cord

When a patient is admitted to the ED following a head injury, what should be the nurse's first priority in management of the patient once a patent airway is confirmed? a. Maintain cervical spine precautions. b. Monitor for changes in neurologic status. c. Determine the presence of increased ICP. d. Establish IV access with a large-bore catheter.

Which type of stroke is associated with endocardial disorders, has a rapid onset, and is unrelated to activity? A. Embolic B. Thrombotic C. Intracerebral hemorrhage D. Subarachnoid hemorrhage

Why is the Glasgow Coma Scale (GCS) used? a. To quickly assess the LOC b. To assess the patient's ability to communicate c. To assess the patient's ability to respond to commands d. To assess the patient's coordination with motor responses

a patient with Alzheimer's disease (AD) dementia has manifestations of depression. The nurse knows that treatment of the patient with antidepressants will most likely do what? a. improve cognitive function b. not alter the course of either condition c. cause interactions with the drugs used to treat the dementia d. be contraindicated because of the CNS-depressant effect of antidepressants

the son of a patient with early onset AD asks if he will get AD. What should the nurse tell this man about the genetics of AD? a. the risk for it is higher for the children of parents of early onset AD b. women get AD more often than men do, so his chances of getting AD are slim c. the blood test for the ApoE gene to identify this type of AD can predict who will develop it d. this type of AD is not as complex as regular AD, so he does not need to worry about getting AD

the wife of a man with moderate AD has a nursing diagnosis of social isolation. What is a nursing intervention that would be appropriate to provide respite care and allow the wife to have satisfactory contact with significant others? a. help the wife to arrange for adult day care for the patient b. encourage permanent placement of the patient in the Alzheimer's unit of a long-term care facility c. refer the wife to a home health agency to arrange daily home nursing visits to assist with the patient's care d. arrange for hospitalization of the patient for 3 or 4 days so that the wife can visit out-of-town friends and relatives

The nurse finds a patient in bed having a generalized tonic-clonic seizure. During the seizure activity, what actions should the nurse take (select all that apply)? a. Loosen restrictive clothing. b. Turn the patient to the side. c. Protect the patient's head from injury. d. Place a padded tongue blade between the patient's teeth. e. Restrain the patient's extremities to prevent soft tissue and bone injury.

a b c

*A nurse is assessing a client who has seizure disorder. The client tells the nurse, "I am about to have a seizure." Which of the following actions should the nurse 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 b c d e

During the secondary assessment of the patient with a stroke, what should be included? (select all that apply) a. gaze b. sensation c. facial palsy d. proprioception e. current medications f. distal motor function

a b c d f

What are characteristics of a stroke caused by an intracerebral hemorrhage (select all that apply)? A. Carries a poor prognosis B. Caused by rupture of a vessel C. Strong association with hypertension D. Commonly occurs during or after sleep E. Creates a mass that compresses the brain

a b c e

Which events cause increased ICP (select all that apply)? a. Vasodilation b. Necrotic tissue edema d. Edema from initial brain insult c. Blood vessel compression e. Brainstem compression and herniation

a b d

the RN in charge at a long-term care facility could delegate which activities to UAP? (select all) a. assist the patient with eating b. provide personal hygiene and skin care c. check the environment for safety hazards d. assist the patient to the bathroom at regular intervals e. monitor for skin breakdown and swallowing difficulties

a b d

The nurse is monitoring a patient for increased ICP following a head injury. What are manifestations of increased ICP (select all that apply)? a. Fever b. Oriented to name only c. Narrowing pulse pressure d. Right pupil dilated greater than left pupil e. Decorticate posturing to painful stimulus

a b d e

the sister of a patient with AD asks the nurse whether prevention of the disease is possible. In responding, the nurse explains that there is no known way to prevent AD, but there are ways to keep the brain healthy. What is included in the ways to keep the brain healthy? (select all) a. avoid trauma to the brain b. recognize and treat depression early c. avoid social gatherings to avoid infections d. do not overtax the brain by trying to learn new skills e. daily wine intake will increase circulation to the brain f. exercise regularly to decrease the risk for cognitive decline

a b f

What factors should be considered when taking the history of a patient with a neurologic problem? (Select all that apply) a. Avoid suggesting symptoms b. Include the CN assessment as the first assessment c. Mental status must be accurately assessed to ensure that the reported history is factual d. do a focused assessment of the neurologic system, as other body systems will not be affected e. The mode of onset and course of illness are especially important aspects of the nursing history

a c e

Which components are able to change to adapt to small increases in intracranial pressure (ICP) (select all that apply)? a. Blood b. Skull bone c. Brain tissue d. Scalp tissue e. Cerebrospinal fluid (CSF)

a c e

Which factors decrease cerebral blood flow (select all that apply)? a. Increased ICP b. PaO2 of 45 mm Hg c. PaCO2 of 30 mm Hg d. Arterial blood pH of 7.3 e. Decreased mean arterial pressure (MAP)

a c e

what manifestations of cognitive impairment are primarily characteristic of delirium? (select all) a. reduced awareness b. impaired judgments c. words difficult to find d. sleep/wake cycle reversed e. distorted thinking and perception f. insidious onset with prolonged duration

a d e

A 28-year-old female patient has been diagnosed with occipital lobe damage after a car accident. What should the nurse expect the patient to need help with? a. Being able to feel heat b. Processing visual images c. Identifying smells appropriately d. Being able to say what she means

A diagnosis of a ruptured cerebral aneurysm has been made in a patient with manifestations of a stroke. The nurse anticipates which treatment option that would be considered for the patient? A. Hyperventilation therapy B. Surgical clipping of the aneurysm C. Administration of hyperosmotic agents D. Administration of thrombolytic therapy

A patient has a lesion involving the fasciculus gracilis and fasciculus cuneatus of the spinal cord. The nurse would expect the patient to experience loss of: a.) pain and temperature sensations. b.) touch, deep pressure, vibration, and position sense. c.) unconscious information about body position and muscle tension. d.) voluntary muscle control from the cerebral cortex to the peripheral nerves.

A patient with a head injury has bloody drainage from the ear. What should the nurse do to determine if CSF is present in the drainage? a. Examine the tympanic membrane for a tear. b. Test the fluid for a halo sign on a white dressing. c. Test the fluid with a glucose-identifying strip or stick. d. Collect 5 mL of fluid in a test tube and send it to the laboratory for analysis.

A patient with a seizure disorder is being evaluated for surgical treatment of the seizures. The nurse recognizes that what is one of the requirements for surgical treatment? a. Identification of scar tissue that is able to be removed b. An adequate trial of drug therapy that had unsatisfactory results c. Development of toxic syndromes from long-term use of antiseizure drugs d. The presence of symptoms of cerebral degeneration from repeated seizures

A patient with a tremor is being evaluated for Parkinson's disease. The nurse explains to the patient that Parkinson's disease can be confirmed by a. CT and MRI scans. b. relief of symptoms with administration of dopaminergic agents. c. the presence of tremors that increase during voluntary movement. d. cerebral angiogram that reveals the presence of cerebral atherosclerosis.

A patient with an intracranial problem does not open his eyes to any stimulus, has no verbal response except moaning and muttering when stimulated, and flexes his arm in response to painful stimuli. What should the nurse record as the patient's GCS score? a. 6 b. 7 c. 9 d. 11

A patient with myasthenia gravis is admitted to the hospital with respiratory insufficiency and severe weakness. What should the nurse recognize will confirm a diagnosis of myasthenia gravis? a. History and physical examination reveal weakness b. serum acetylcholine receptor antibodies are present c. the patient's respiratory function is impaired because of muscle weakness d. EMG reveals an increased response with repeated stimulation of muscles

A patient with newly diagnosed MS has been hospitalized for evaluation and initial treatment of the disease. Following discharge teaching, the nurse realizes that additional instruction is needed when the patient says what? a. "It is important for me to avoid exposure to people with upper respiratory infections." b. "When I begin to feel better, I should stop taking the prednisone to prevent side effects." c. "I plan to use vitamin supplements and a high-protein diet to help manage my condition." d. "I must plan with my family how we are going to manage my care if I become more incapacitated."

After talking with the healthcare provider, the patient asks what the blood-brain barrier does. what is the best description the nurse can give the patient? a. protects the brain from external trauma b. protects against harmful blood-borne agents c. provides for flexibility while protecting the spinal cord d. forms the outer layer of protective membranes around the brain and spinal cord

Assisting the family to understand what is happening to the patient is an especially important role of the nurse when the patient has a tumor in which part of the brain? a. Ventricles b. Frontal lobe c. Parietal lobe d. Occipital lobe

During the diagnosis and long-term management of a seizure disorder, what should the nurse recognize as one of the major needs of the patient? a. Managing the complicated drug regimen of seizure control b. Coping with the effects of negative social attitudes toward epilepsy c. Adjusting to the very restricted lifestyle required by a diagnosis of epilepsy d. Learning to minimize the effect of the condition in order to obtain employment

Following a generalized tonic-clonic seizure, the patient is tired and sleepy. What care should the nurse provide? a. Suction the patient before allowing him to rest. b. Allow the patient to sleep as long as he feels sleepy. c. Stimulate the patient to increase his level of consciousness. d. Check the patient's level of consciousness every 15 minutes for an hour.

Mitoxantrone (Novantrone) is being considered as treatment for a patient with progressive-relapsing MS. The nurse explains that a disadvantage of this drug compared with other drugs used for MS is what? a. It must be given subcutaneously every day. b. It has a lifetime dose limit because of cardiac toxicity. c. It is an anticholinergic agent that causes urinary incontinence. d. It is an immunosuppressant agent that increases the risk for infection.

The patient has just had a myelogram. What should be included in the nursing care for this patient? a. restrict fluids until the patient is ambulatory b. keep the patient flat in the bed for several hours. c. position the patient with the head of the bed elevated 30 degrees d. provide mild analgesics for pain associated with the insertion of needles

The wife of a patient who is manifesting deterioration in memory asks the nurse whether her husband has AD. The nurse explains that a diagnosis of AD is usually made when what happens? a. a urine test indicates elevated levels of isoprostanes b. all other possible causes of dementia have been eliminated c. blood analysis reveals increased amounts of B-amyloid protein d. a CT scan of the brain indicates brain atrophy

Vigorous control of fever in the patient with meningitis is required to prevent complications of increased cerebral edema, seizure frequency, neurologic damage, and fluid loss. What nursing care should be included? a. Administer analgesics as ordered. b. Monitor LOC related to increased brain metabolism. c. Rapidly decrease temperature with a cooling blanket. d. Assess for peripheral edema from rapid fluid infusion.

What are the key manifestations of bacterial meningitis? a. Papilledema and psychomotor seizures b. High fever, nuchal rigidity, and severe headache c. Behavioral changes with memory loss and lethargy d. Jerky eye movements, loss of corneal reflex, and hemiparesis

What is the best explanation of stereotactic radiosurgery? a. Radioactive seeds are implanted in the brain. b. Very precisely focused radiation destroys tumor cells. c. Tubes are placed to redirect CSF from one area to another. d. The cranium is opened with removal of a bone flap to open the dura.

What is the neurologic diagnostic test that has the highest risk of complications and requires frequent monitoring of neurologic and vital signs following following the procedure? a. electromyelogram b. cerebral angiography c. electroencephalogram d. transcranial doppler sonography

What is the normal response to striking the tendon with a reflex hammer? a. forearm pronation b. extension of the arm c. flexion of the arm at the elbow d. flexion and supination of the elbow

What is the purpose of dendrite? a. provides gap in peripheral nerve axons b. carries impulses to the nerve cell body c. carries impulses from the nerve cell body d. helps repair damage to peripheral axons

When providing care for a patient with ALS, the nurse recognizes what as one of the most distressing problems experienced by the patient? a. Painful spasticity of the face and extremities b. Retention of cognitive function with total degeneration of motor function c. Uncontrollable writhing and twisting movements of the face, limbs, and body d. Knowledge that there is a 50% chance the disease has been passed to any offspring

When the patient has a rapidly growing tumor, what slows the expansion of the cerebral brain tissue into the adjacent hemisphere? a. ventricles b. Falx cerebri c. arachnoid layer d. Tentorium cerebella

When using intraventricular ICP monitoring, what should the nurse be aware of to prevent inaccurate readings? a. The P2 wave is higher than the P1 wave. b. CSF is leaking around the monitoring device. c. The transducer of the ventriculostomy monitor is at the level of the upper ear. d. The stopcock of the drainage device is open to drain the CSF fluid

When using the heel-to-shin test, for what abnormality is the nurse assessing the patient? a. hypertonia b. lack of coordination c. extension of the toes d. loss of proprioception

Which type of headache is suspected when the headaches are unilateral and throbbing, preceded by a prodrome of photophobia, and associated with a family history of this type of headache? a. Cluster b. Migraine c. Frontal-type d. Tension-type

Which type of seizure occurs in children, is also known as a petit mal seizure, and consists of a staring spell that lasts for a few seconds? a. Atonic b. Typical absence c. Atypical absence d. focal impaired awareness

While the nurse performs range of motion (ROM) on an unconscious patient with increased ICP, the patient experiences severe decerebrate posturing reflexes. What should the nurse do first? a. Use restraints to protect the patient from injury. b. Perform the exercises less frequently because posturing can increase ICP. c. Administer central nervous system (CNS) depressants to lightly sedate the patient. d. Continue the exercises because they are necessary to maintain musculoskeletal function.

a patient with AD in a long-term care facility is wandering the halls very agitated, asking for her "mommy" and crying. What is the best response by the nurse? a. ask the patient, "why are you behaving this way?" b. tell the patient, "let's go get you a snack in the kitchen" c. ask the patient, "wouldn't you like to lie down now?" d. tell the patient, "just take some deep breaths and calm down"

a patient with moderate AD has a nursing diagnosis of impaired memory related to effects of dementia. What is an appropriate nursing intervention for this patient? a. post clocks and calendars in the patient's environment b. establish and consistently follow a daily schedule with the patient c. monitor the patient's activities to maintain a safe patient environment d. stimulate thought processes by asking the patient questions about recent activities

the family caregiver for a patient with AD expressed an inability to make decisions, concentrate, or sleep. The nurse determines what about the caregiver? a. the caregiver is also developing signs of AD b. the caregiver is manifesting symptoms of caregiver role strain c. the caregiver needs a period of respite from care of the patient d. the caregiver should ask other family members to participate in the patient's care

what is one focus of interprofessional care of patients with AD? a. replacement of deficient ACH in the brain b. drug therapy for cognitive problems and undesirable behaviors c. the use of memory-enhancing techniques to delay disease progression d. prevention of other chronic diseases that hasten the progression of AD

*A nurse is caring for a client who is postprocedure following lumbar puncture and reports a throbbing headache when sitting upright. Which of the following actions should the nurse take?* (Select all that apply) A. Use the Glasgow Coma Scale when assessing the client B. Assist the client to a supine position C. Administer an opioid medication D. Encourage the client to increase fluid intake E. Instruct the client to perform deep breathing and coughing exercises

b c d

A patient is diagnosed with cluster headaches. The nurse knows that which characteristics are associated with this type of headache (select all that apply)? a. Family history b. Alcohol is the only dietary trigger c. Abrupt onset lasting 5 to 180 minutes d. Severe, sharp, penetrating head pain e. Bilateral pressure or tightness sensation f. May be accompanied by unilateral ptosis or lacrimation

b c d f

Which CNs are involved with oblique eye movements? (select all that apply) a. optic b. trochlear c. trigeminal d. abducens e. oculomotor

b d e

What are causes of vasogenic cerebral edema (select all that apply)? a. Hydrocephalus b. Ingested toxins c. Destructive lesions or trauma d. Local disruption of cell membranes e. Fluid flowing from intravascular to extravascular space

b e

for a patient with moderate cognitive impairment, the HCP is trying to differentiate between a diagnosis of dementia and dementia with Lewy bodies (DLB). What observations by the nurse support a diagnosis of DLB? (select all) a. tremors b. fluctuating cognitive ability c. disturbed behavior, sleep, and personality d. symptoms of pneumonia, including congested lung sounds e. bradykinesia, rigidity, and postural instability without tremor

b e

A carotid endarterectomy is being considered as treatment for a patient who has had several TIAs. What should the nurse explain to the patient about this surgery? A. It involves intracranial surgery to join a superficial extracranial artery to an intracranial artery. B. It is used to restore blood circulation to the brain following an obstruction of a cerebral artery. C. It involves removing an atherosclerotic plaque in the carotid artery to prevent an impending stroke. D. It is used to open a stenosis in a carotid artery with a balloon and a stent to restore cerebral circulation.

A patient admitted to the hospital following a generalized tonic-clonic seizure asks the nurse what caused the seizure. What is the best response by the nurse? a. "So many factors can cause epilepsy that it is impossible to say what caused your seizure." b. "Epilepsy is an inherited disorder. Does anyone else in your family have a seizure disorder?" c. "In seizures, some type of trigger causes sudden, abnormal bursts of electrical brain activity." d. "Scar tissue in the brain alters the chemical balance, creating uncontrolled electrical discharges."

A patient at the clinic for a routine health examination mentions that she is exhausted because her legs bother her so much at night that she cannot sleep. The nurse questions the patient further about her leg symptoms with what knowledge about restless legs syndrome? a. The condition can be readily diagnosed with EMG. b. Other more serious nervous system dysfunctions may be present. c. Dopaminergic agents are often effective in managing the symptoms. d. Symptoms can be controlled by vigorous exercise of the legs during the day.

A patient is admitted to the hospital with a left hemiplegia. To determine the size and location and to ascertain whether a stroke is ischemic or hemorrhagic, the nurse anticipates that the health care provider will request a A. Lumbar puncture B. Cerebral arteriogram C. MRI D. Ct scan with contrast

A patient with MS has a nursing diagnosis of self-care deficit related to muscle spasticity and neuromuscular deficits. In providing care for the patient, what is most important for the nurse to do? a. Teach the family members how to care adequately for the patient's needs. b. Encourage the patient to maintain social interactions to prevent social isolation. c. Promote the use of assistive devices so the patient can participate in self-care activities. d. Perform all activities of daily living (ADLs) for the patient to conserve the patient's energy.

A patient with Parkinson's disease is started on levodopa. What should the nurse explain about this drug? a. It stimulates dopamine receptors in the basal ganglia. b. It promotes the release of dopamine from brain neurons. c. It is a precursor of dopamine that is converted to dopamine in the brain. d. It prevents the excessive breakdown of dopamine in the peripheral tissues.

A patient with a stroke has a right sided hemiplegia. The nurse prepares family members to help control behavior changes seen with this type of stroke by teaching them to: a. ignore undesirable behaviors manifested by the patient b. provide directions to the patient verbally in small steps c. distract the patient from inappropriate emotional responses d. supervise all activities before allowing the patient to do them independently

A patient with right hemisphere stroke has a nursing diagnosis of unilateral neglect related to sensory perceptual deficits. During the patient's rehabilitation, it is important for the nurse to: a. avoid positioning the patient on the affected side b. place all objects for care on the patient's unaffected side c. teach the patient to care consciously for the affected side d. protect the affected side from injury with pillows and supports

A thrombus that develops in a cerebral artery does not always cause a loss of neurologic function because A. The body can dissolve atherosclerotic plaques as they form. B. Some tissues of the brain do not require constant blood supply to prevent damage. C. Circulation via the Circle of Wills may provide blood supply to the affected area of the brain. D. Neurologic deficits occur only when major arteries are occluded by thrombus formation around atherosclerotic plaque.

An appropriate food for a patient with a stroke who has mild dysphagia is: a. fruit juices b. pureed meat c. scrambled eggs d. fortified milkshakes

An early sign of increased ICP that the nurse should assess for is a. Cushing's triad. c. decreasing level of consciousness (LOC). b. unexpected vomiting. d. dilated pupil with sluggish response to light.

An unconscious patient with increased ICP is on ventilatory support. The nurse notifies the health care provider when arterial blood gas (ABG) measurement results reveal what? a. pH of 7.43 b. SaO2 of 94% c. PaO2 of 70 mm Hg d. PaCO2 of 35 mm Hg

During an assessment of the motor system, the nurse finds that the patient has a staggering gait and an abnormal arm swing. What should the nurse use this information to do? a. assist the patient to cope with the disability b. plan a rehabilitation program for the patient c. protect the patient from an injury caused by falls d. help to establish a diagnosis of cerebellar dysfunction

During assessment of a patient admitted to the hospital with an acute exacerbation of MS, what should the nurse expect to find? a. Tremors, dysphasia, and ptosis b. Bowel and bladder incontinence and loss of memory c. Motor impairment, visual disturbances, and paresthesias d. Excessive involuntary movements, hearing loss, and ataxia

During neurologic assessment of the older adult, what should the nurse know is an effect of aging on the neurologic system? a. absent deep-tendon reflexes b. below-average intelligence score c. decreased sensation of touch and temperature d. decreased frequency of spontaneous awakening

How is cranial nerve (CN) III, originating in the midbrain, assessed by the nurse for an early indication of pressure on the brainstem? a. Assess for nystagmus b. Test the corneal reflex c. Test pupillary reaction to light d. Test for oculocephalic (doll's eyes) reflex

In noting the results of an analysis of CSF, what should the nurse identify as an abnormal finding? a. pH of 7.35 b. clear, colorless appearance c. glucose level of 30 mg/dl (1.7 mmol/L) d. WBC count of 5/mL (0.005/L)

In promoting health maintenance for prevention of strokes, the nurse understands that the highest risk for the most common type of stroke is present in which people? A. African Americans B. Women who smoke C. Individuals with hypertension and diabetes D. Those who are obese with high dietary fat intake

In providing care for patients with chronic, progressive neurologic disease, what is the major goal of treatment that the nurse works toward? a. Meet the patient's personal care needs. b. Return the patient to normal neurologic function. c. Maximize neurologic functioning for as long as possible. d. Prevent the development of additional chronic diseases.

Increased ICP in the left cerebral cortex caused by intracranial bleeding causes displacement of brain tissue to the right hemisphere beneath the falx cerebri. The nurse knows that this is referred to as what? a. Uncal herniation b. Tentorial herniation c. Cingulate herniation d. Temporal lobe herniation

The incidence of ischemic stroke in patients with TIAs and other risk factors is reduced with the administration of which medication? A. Furosemide (Lasix) B. Lovastatin (Mevacor) C. Daily low dose aspirin D. Nimodipine (Nimotop)

The nurse is preparing to admit a newly diagnosed patient experiencing tonic-clonic seizures. What could the nurse delegate to unlicensed assistive personnel (UAP)? a. Complete the admission assessment. b. Explain the call system to the patient. c. Obtain the suction equipment from the supply cabinet. d. Place a padded tongue blade on the wall above the patient's bed.

The nurse recognizes the presence of Cushing's triad in the patient with which vital sign changes? a. Increased pulse, irregular respiration, increased BP b. Decreased pulse, increased respiration, decreased systolic BP c. Decreased pulse, irregular respiration, widened pulse pressure d. Increased pulse, decreased respiration, widened pulse pressure

The nurse teaches the patient taking antiseizure drugs that this method is most commonly used to measure compliance and monitor for toxicity. a. A daily seizure log b. Urine testing for drug levels c. Blood testing for drug levels d. Monthly electroencephalography (EEG)

The patient comes to the emergency department (ED) with cortical blindness and visual field defects. Which type of head injury does the nurse suspect? a. Cerebral contusion b. Orbital skull fracture c. Posterior fossa fracture d. Frontal lobe skull fracture

The patient has a depressed skull fracture and scalp lacerations with communication to the intracranial cavity. Which type of injury should the nurse record? a. Linear skull fracture b. Depressed skull fracture c. Compound skull fracture d. Comminuted skull fracture

The patient has a lack of comprehension of both verbal and written language. Which type of communication difficulty does this patient have? A. Dysarthia B. Fluent dysphasia C. Receptive aphasia D. Expressive aphasia

To reduce the risk for falls in the patient with Parkinson's disease, what should the nurse teach the patient to do? a. Use an elevated toilet seat. b. Use a walker or cane for support. c. Consciously lift the toes when stepping. d. Rock side to side to initiate leg movements.

What functions does the thalamus have? a. registers auditory input b. integrates past experiences c. relays sensory and motor input to and from the cerebrum d. controls and facilitates learned and automatic movements

What happens at the synapse? a. The synapse physically joins 2 neurons b. The nerve impulse is transmitted only from 1 neuron to another neuron c. The presynaptic terminal submits a nerve impulse through the synaptic cleft to the receptor site on the postsynaptic cell d. When a presynaptic cell releases a excitatory neurotransmitters, the postsynaptic cell depolarizes enough to generate an action potential

What is demonstrated when the patient stands with the feet close together and eyes closed and the patient sways or falls? a. pronator drift b. absent patellar reflex c. positive Romberg test d. absence of two-point discrimination

What primarily determines the neurologic functions that are affected by the stroke? A. The amount of tissue area involved. B. The rapidity of onset of symptoms. C. The brain area perfused by the affected artery D. The presence of absence of collateral circulation

What should be included in the management of a patient with delirium? a. The use of restraints to protect the patient from injury b. The use of short-acting benzodiazepines to sedate the patient c. Identification and treatment of underlying causes when possible d. Administration of high doses of an antipsychotic drug, such as haloperidol (Haldol)

When teaching a patient with a seizure disorder about the medication regimen, what is it most important for the nurse to emphasize? a. The patient should increase the dosage of the medication if stress is increased. b. Most over-the-counter and prescription drugs are safe to take with antiseizure drugs. c. Stopping the medication abruptly may increase the intensity and frequency of seizures. d. If gingival hypertrophy occurs, the drug should be stopped and the health care provider notified.

Which CN is tested with tongue protrusion? a. vagus b. olfactory c. hypoglossal d. glossopharyngeal

Which CN responds to the corneal reflex test? a. optic b. vagus c. trigeminal d. spinal accessory

Which area of the brain regulates endocrine system and ANS functions? a. Basal Ganglia b. Temporal Lobe c. Hypothalamus d. Reticular activating system

Which chronic neurologic disorder involves a deficiency of the neurotransmitters acetylcholine and γ aminobutyric acid (GABA) in the basal ganglia and extrapyramidal system? a. Myasthenia gravis b. Parkinson's disease c. Huntington's disease d. Amyotrophic lateral sclerosis (ALS)

Which intervention should the nurse delegate to the LPN when caring for a patient following an acute stroke? a. assess the patient's neurologic status b. assess the patient's gag reflex before beginning feeding c. administer ordered antihypertensives and platelet inhibitors d. teach the patient's caregivers strategies to minimize unilateral neglect

Which observation of the patient made by the nurse is most indicative of Parkinson's disease? a. Large, embellished handwriting b. Weakness of one leg resulting in a limping walk c. Difficulty rising from a chair and beginning to walk d. Onset of muscle spasms occurring with voluntary movement

during assessment of a patient with dementia, the nurse determines that the condition is potentially reversible when finding out what about the patient? a. has long-standing abuse of alcohol b. has a history of Parkinson's disease c. recently developed symptoms of hypothyroidism d. was infected with HIV 15 yrs ago

for what purpose would the nurse use the Mini-Mental State Examination to evaluate a patient with cognitive impairment? a. it is a good tool to determine the etiology of dementia b. it is a good tool to evaluate mood and thought processes c. it can help to document the degree of cognitive impairment in delirium and dementia d. it is useful for initial evaluation of mental status, but additional tools are needed to evaluate changes in cognition over time

the newly admitted patient has moderate AD. What does the nurse know this patient will need help with? a. eating b. walking c. dressing d. self-care activities

Which of the following descriptions are characteristic of encephalitis (select all that apply)? a. CSF production is increased b. Almost always has a bacterial cause c. Is an inflammation of the brain d. Almost always has a viral cause e. May be transmitted by insect vectors f. Involves inflammation of tissues surrounding the brain and spinal cord

c d e

The patient is diagnosed with focal impaired awareness seizures. Which characteristics are related to focal impaired awareness seizures (select all that apply)? a. Formerly known as grand mal seizure b. Often accompanied by incontinence or tongue or cheek biting c. Psychomotor seizures with repetitive behaviors and lip smacking d. Altered memory, sexual sensations, and distortions of visual or auditory sensations e. Loss of consciousness and stiffening of the body with subsequent jerking of extremities f. Often involves behavioral, emotional, and cognitive functions with altered consciousness

c d f

The rehabilitation nurse assesses the patient, caregiver, and family before planning the rehabilitation program for this patient. What must be included in this assessment? (select all that apply) a. cognitive status of the family b. patient resources and support c. physical status of all body systems d. rehabilitation potential of the patient e. body strength remaining after the stroke f. patient and caregiver expectations of the rehabilitation

c d f

A 68 year old man is admitted to the ED with multiple blunt trauma wounds following a one-vehicle car accident. He is restless; disoriented to person, place, and time; and agitated. He resists attempts at examination and calls out the name "Janice." Why should the nurse suspect delirium rather than dementia in this patient? a. The fact that he should not have been allowed to drive if he had dementia b. His hyperactive behavior, which distinguishes his condition from the hypoactive behavior of dementia c. Emergency personnel reported he was noncommunicative when they arrived at the accident scene d. The report of his family that, although he has heart disease and is "very hard of hearing," this behavior is unlike him

A nursing intervention is indicated for the patient with hemiplegia is: a. the use of a footboard to prevent plantar flexion b. immobilization of the affected arm against the chest with a sling c. positioning the patient in bed with each joint lower than the joint proximal to it d. having the patient perform passive range of motion (ROM) of the affected limb with the unaffected limb

A patient comes to the emergency department immediately after experiencing numbness of the face and an inability to speak but while the patient awaits examination, the symptoms disappear and the patient requests discharge. Why should the nurse emphasize that it is important for the patient to be treated before leaving? A. The patient has probably experienced an asymptomatic lacunar stroke. B. The symptoms are likely to return and progress to worsening neurologic deficit in the next 24 hours. C. Neurologic deficits that are transient occur most often as a result from small hemorrhages that clot off. D. The patient has probably experienced a TIA, which is a sign of progressive cerebrovascular disease.

A patient's wife asks the nurse why her husband did not receive the clot busting medication (tPA) she has been reading about. Her husband is diagnosed with a hemorrhagic stroke. What should the nurse respond? a. "he didn't arrive within the time frame for that therapy" b. "not everyone is eligible for this drug. has he had surgery lately?" c. "you should discuss the treatment of your husband with his doctor" d. "the medication you are talking about dissolves clots and could cause more bleeding in your husband's brain"

How are the metabolic and nutritional needs of the patient with increased ICP best met? a. Enteral feedings that are low in sodium b. Simple glucose available in D5W IV solutions c. Fluid restriction that promotes a moderate dehydration d. Balanced, essential nutrition in a form that the patient can tolerate

How do spinal nerves of the PNS differ from cranial nerves? a. only spinal nerves occur in pairs b. CNs affect only the sensory and motor functions of the head and neck c. cell bodies of all CNs are located in the brain whereas cell bodies of spinal nerves are located in the spinal cord. d. all spinal nerves contain both afferent sensory and efferent motor fibers whereas CNs contain one or the other or both

In the neurologic nursing assessment of the patient, he is unable to hear a ticking watch. What neurologic problem could be the cause of this finding? a. the patient is distracted b. the patient is hard of hearing c. the vagus nerve is malfunctioning d. the cochlear branch of the acoustic nerve is damaged

Skull x-rays and a computed tomography (CT) scan provide evidence of a depressed parietal fracture with a subdural hematoma in a patient admitted to the ED following an automobile accident. In planning care for the patient, what should the nurse anticipate? a. The patient will receive life support measures until the condition stabilizes. b. Immediate burr holes will be made to rapidly decompress the intracranial cavity. c. The patient will be treated conservatively with close monitoring for changes in neurologic status. d. The patient will be taken to surgery for a craniotomy for evacuation of blood and decompression of the cranium.

Successful achievement of patient outcomes for the patient with cranial surgery would best be indicated by what? a. Ability to return home in 6 days b. Ability to meet all self-care needs c. Acceptance of residual neurologic deficits d. Absence of signs and symptoms of increased ICP

The classic triad of manifestations associated with Parkinson's disease is tremor, rigidity, and bradykinesia. What is a consequence related to rigidity? a. Shuffling gait b. Impaired handwriting c. Lack of postural stability d. Muscle soreness and pain

The nurse can assist the patient and the family in coping with the long term effects of a stroke by: a. informing family members that the patient will need assistance with almost all ADLs b. explaining that the patient's pre-stroke behavior will return as improvement progresses c. encouraging the patient and family members to seek assistance from family therapy or stroke support groups d. helping the patient and family understand the significance of residual stroke damage to promote problem solving and planning

The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by a. spinal x-ray findings. b. T-cell analysis of the blood. c. analysis of cerebrospinal fluid. d. history and clinical manifestations.

The nurse suspects the presence of an arterial epidural hematoma in the patient who experiences a. failure to regain consciousness following a head injury. b. a rapid deterioration of neurologic function within 24 to 48 hours following a head injury. c. nonspecific, nonlocalizing progression of alteration in LOC occurring over weeks or months. d. unconsciousness at the time of a head injury with a brief period of consciousness followed by a decrease in LOC.

The patient has been diagnosed with a cerebral concussion. What should the nurse expect to see in this patient? a. Deafness, loss of taste, and CSF otorrhea b. CSF otorrhea, vertigo, and Battle's sign with a dural tear c. Boggy temporal muscle because of extravasation of blood d. Headache, retrograde amnesia, and transient reduction in LOC

The patient is suspected of having a new brain tumor. Which test will the nurse expect to be ordered to detect a small tumor? a. CT scan b. Angiography c. Electroencephalography (EEG) d. Positron emission tomography (PET) scan

What drug therapy is included for acute migraine and cluster headaches that appears to alter the pathophysiologic process for these headaches? a. β-Adrenergic blockers such as propranolol (Inderal) b. Serotonin antagonists such as methysergide (Sansert) c. Tricyclic antidepressants such as amitriptyline (Elavil) d. Specific serotonin receptor agonists such as sumatriptan (Imitrex)

What is the priority intervention in the emergency department for the patient with a stroke? A. Intravenous fluid replacement B. Administration of osmotic diuretics to reduce cerebral edema C. Initiation of hypothermia to decrease the oxygen needs of the brain D. Maintenance of respiratory function with a patent airway and oxygen administration

What method is used to assess for extinction? a. cotton wisp b. sharp and dull end of a pin c. tuning fork to bony prominences d. Simultaneously stimulating both sides of the body

What should the nurse do to prepare a patient for a lumbar puncture? a. sedate the patient with medication b. withhold medications containing caffeine for 8 hours c. have tha patient sit on the side of the bed, leaning on a padded over-the-bed table d. position the patient in a lateral recumbent position with the hips, knees, and neck flexed.

When assessing the body functions of a patient with increased ICP, what should the nurse assess first? a. Corneal reflex testing b. Pupillary reaction to light c. Extremity strength testing d. Circulatory and respiratory status

When caring for a patient in the severe stage of AD, the nurse could use what diversion or distraction activities? a. Watching TV b. Books to read c. Playing games d. Mobiles or dangling ribbons

Which cranial surgery would require the patient to learn how to protect the surgical area from trauma? a. Burr holes b. Craniotomy c. Cranioplasty d. Craniectomy

Which drug treatment helps to decrease ICP by expanding plasma and the osmotic effect to move fluid? a. Dexamethasone (Decadron) b. Oxygen administration c. Pentobarbital (Nembutal) d. Mannitol (Osmitrol) (25%)

Which of the following protects the central nervous system (CNS)? a. synaptic cleft b. limbic system c. myelin sheath d. cerebrospinal fluid (CSF)

Which type of seizure is most likely to cause death for the patient? a. Subclinical seizures b. Myoclonic seizures c. Psychogenic seizures d. status epilepticus

the husband of a patient is complaining that his wife's memory has been decreasing lately. When asked for examples of her memory loss, the husband says that she is forgetting the neighbors' names and forgot their granddaughter's birthday. What kind of loss does the nurse recognize this to be? a. delirium b. memory loss in AD c. normal forgetfulness d. memory loss in mild cognitive impairment

which statement most accurately describes dementia? a. overproduction of B-amyloid protein causes all dementias b. dementia resulting from neurodegenerative causes can be prevented c. dementia caused by hepatic or renal encephalopathy cannot be reversed d. vascular dementia can be diagnosed by brain lesions identified with neuroimaging

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