Medical Surgical Nursing- Neuro
The nurse knows the patient understands teaching about an angiogram when the patient makes which of the following statements?
"A catheter will be placed in an artery in my groin, and dye will be injected that will make my vessels show up on x-ray."
A patient with amyotrophic lateral sclerosis expresses concern about not having enough breath to sing anymore. Which explanation by the nurse is best?
"Amyotrophic lateral sclerosis may be affecting the nerves that go to your respiratory muscles, making them weak."
A patient with trigeminal neuralgia asks the nurse why carbamazepine (Tegretol) has been ordered. Which response is best?
"Carbamazepine is used to help relieve nerve pain."
Which instruction would the nurse provide for the patient when testing the trigeminal nerve?
"Close your eyes and tell me where you feel the cotton touching your face."
A patient makes an appointment to see a health care provider for recurrent severe headaches. Which instruction by the nurse will help gather the best additional data before the appointment?
"Keep a diary of your headaches, recording symptoms, timing, and headache triggers."
How soon after symptom onset must a person who is having a stroke receive thrombolytic therapy?
4.5 hours
A college student is admitted to the hospital with a severe headache. Which finding in the student's history is consistent with the diagnosis of meningitis?
A sore throat for 3 days
Which nursing interventions are appropriate for the patient with Bell palsy? Select all that apply.
Administer moisturizing eye drops. Apply an eye patch. Apply warm compresses. Provide facial massage.
Which of the following nursing interventions should be included in the plan of care for a patient at risk for foot drop?
Apply high-top tennis shoes.
A patient who is newly diagnosed with amyotrophic lateral sclerosis says to the nurse, "I do not want to be kept alive on machines." Which nursing action is best in response?
Ask the patient whether advance directives have been prepared and provide information if indicated.
A nurse is doing an afternoon assessment on a patient transferred to a medical unit from intensive care following a subarachnoid hemorrhage. The patient was alert and oriented during the morning assessment but reported being very tired. Now the patient is difficult to arouse. What action should the nurse take?
Call the registered nurse immediately.
A patient is admitted following a T4 spinal injury. When taking morning vital signs, the nurse notes that the patient appears restless and that blood pressure is elevated. Which of the following actions by the nurse is appropriate?
Check for a full bladder or bowel.
A patient with meningitis has photophobia and a severe headache. Which nursing interventions will be most helpful to relieve symptoms?
Darken the room and administer analgesics.
When performing a neurologic assessment, which of the following is a symptom of increasing intracranial pressure that the nurse should immediately to the primary care provider?
Decreasing level of consciousness
Which of the following are modifiable risk factors that should be taught to patients at risk for stroke? Select all that apply.
Diabetes. High cholesterol. Obesity.
A patient has returned from having a computed tomography scan with contrast. Which of the following should be a priority in the hours after the scan?
Drinking fluids
What interventions can help prevent aspiration in a post-stroke patient with dysphagia? Select all that apply.
Ensure that the patient is fully alert before feeding. Place the patient in high-Fowler position or chair for meals. Use a thickening agent.
What assessments are included in the FOUR score coma scale? Select all that apply.
Eye response. Motor response. Brainstem reflexes. Respiration.
Which nursing interventions are appropriate for the patient with a neurodegenerative disorder who has difficulty swallowing?
Have the patient tuck his or her chin down during swallowing.
When caring for a patient admitted with Guillain-Barré syndrome, which nursing diagnosis should take priority?
Impaired Gas Exchange
Which of the following actions should the nurse take to help prevent increased intracranial pressure in a patient following a traumatic brain injury?
Keep the head of the bed elevated at 30 degrees.
A patient who has had a generalized tonic-clonic seizure is sound asleep 30 minutes after the seizure. Meals are about to be delivered. Which nursing action is most appropriate?
Let the patient sleep during the postictal state, and keep the meal warm.
Which meal would be the best choice for a patient with myasthenia gravis?
Meatloaf, mashed potatoes, canned green beans
A patient with a history of seizures reports experiencing an aura and is concerned about an impending seizure. Place the nurse's interventions in the correct order.
Protect the patient from injury during the seizure. Document the events of the seizure. Help the patient lie down in a safe place. Turn the patient on his or her side to sleep.
The nurse identifies which of the following as normal effects of aging on the central nervous system? Select all that apply.
Reduced blood flow to the brain. Impaired short-term memory. Sleep disturbances. Decrease in acetylcholine.
A resident of a long-term care facility who has Alzheimer disease is sitting in a corner, crying loudly that no one is paying attention. Several staff members have tried to find out what's wrong, but the patient won't answer and just keeps rocking back and forth and crying. Which approach by the nurse might best help the patient?
Sit quietly by the patient and say, "I'm here. You aren't alone."
Which patients should be closely monitored by the nurse for symptoms of increased intracranial pressure? Select all that apply.
The patient admitted with a high fever and severe headache The patient in the postanesthesia care unit following craniectomy The patient with a brain tumor who is admitted for radiation therapy
How will the home health care nurse caring for a patient with myasthenia gravis and severe muscle weakness know if interventions have been effective?
The patient is able to perform activities of daily living with oxygen saturation remaining at 95%.
A nurse is caring for a patient who is recovering from an ischemic stroke. Upon entering the room to pick up the supper tray, the nurse notes that the patient has only eaten food on the left side of the tray. What should the nurse do?
Turn the plate 180 degrees and observe the patient's response.
Which is the best method for the nurse to use to communicate with the patient experiencing receptive aphasia?
Use gestures, standing where the patient can see.