NCLEX Neuro

You have a patient who has a brain tumor and is at risk for seizures. In the patient's plan of care you incorporate seizure precautions. Select below all the proper steps to take in initiating seizure precautions: A. Oxygen and suction at bedside B. Bed in highest position C. Remove all pillows from the patient's head D. Have restraints on stand-by E. Padded bed rails F. Remove restrictive objects or clothing from patient's body G. IV access

A. Oxygen and suction at bedside E. Padded bed rails F. Remove restrictive objects or clothing from patient's body G. IV access

True or False: Patients with multiple sclerosis have different signs and symptoms because this disease can affect various areas of the peripheral nervous system.

False: Yes, patients with MS have different signs and symptoms because lesions can present at different locations in the CENTRAL NERVOUS SYSTEM....hence the brain and spinal cord (not the peripheral nervous system).

A client with narcolepsy tells the primary healthcare provider, "I often feel drowsy and fall asleep at inappropriate times." Which medication should the nurse anticipate being prescribed by the primary healthcare provider for this client? A. Modafinil B. Ramelteon C. Eszopiclone D. Pramipexole

A. Modafinil

What clinical indicators should the nurse expect when interviewing and assessing a client with Meniere disease? Select all that apply. A. Nausea B. Dizziness C. Decreased pulse rate D. Increased temperature E. Jerky lateral eye movements

A. Nausea B. Dizziness E. Jerky lateral eye movements

The nurse is caring for a client who had a brain attack (cerebrovascular accident) and who has varying moods. The moods range from anger to depression to concern about the aphasia, hemiparesis, and the gavage feedings. Which behavior best indicates the client's acceptance of physical limitations? A. Performs tube feedings without assistance B. Allows family members to assist with care C. Smiles and becomes more extroverted D. Walks in the hall and sits in the lounge

A. Performs tube feedings without assistance

A client with glaucoma is receiving a carbonic anhydrase inhibitor. Which statement made by the client will require the nurse to notify the primary healthcare provider? A. "I have asthma." B. "I use contact lenses." C. "I am allergic to sulfonamides." D. "I have been taking phenelzine medication for three months."

C. "I am allergic to sulfonamides."

A client is awaiting surgery for a ruptured lumbar nucleus pulposus. Which activities should the nurse inform the client will most likely increase pain? Select all that apply. A. Lying on the side B. Flexing the knees C. Coughing excessively D. Sitting for long periods of time E. Bearing down when having a bowel movement

C. Coughing excessively E. Bearing down when having a bowel movement

Which medications below can help treat muscle spasms in a patient with multiple sclerosis? Select all that apply: A. Propranolol B. Isoniazid C. Baclofen D. Diazepam E. Modafinil

C. Baclofen D. Diazepam

What should the nurse instruct the client to do to limit triggering the pain associated with trigeminal neuralgia? A. Drink iced liquids. B. Avoid oral hygiene. C. Apply warm compresses. D. Chew on the unaffected side.

D. Chew on the unaffected side.

The nurse is providing preoperative teaching for a client who is to have cataract surgery. Which is appropriate for the nurse to include concerning what the client should do after surgery? Select all that apply. A. Do not blow your nose. B. Remain flat for three hours. C. Eat a soft diet for two days. D. Breathe and cough deeply. E. Avoid bending from the waist.

A. Do not blow your nose. E. Avoid bending from the waist

A client who had a cerebrovascular accident (also known as a "brain attack") becomes incontinent of feces. What is the most important nursing action to support the success of a bowel training program? A. Using medication to induce elimination B. Adhering to a definite time for attempted evacuations C. Considering previous habits associated with defecation D. Timing of elimination to take advantage of the gastrocolic reflex

B. Adhering to a definite time for attempted evacuations

A client is admitted to the hospital with weakness in the right extremities and a slight difficulty with speech. Vital signs are within expected limits. What is the priority nursing action during the first 24 hours? A.Taking the client's temperature B. Evaluating the client's motor status C. Obtaining the client's urine for a urinalysis D. Monitoring the client's blood pressure for hypertension

B. Evaluating the client's motor status

The nurse is ordered to administer Lorazepam to a patient experiencing status epilepticus. As a precautionary measure, the nurse will also have what reversal agent on standby? A. Narcan B. Flumazenil C. Calcium Chloride D. Idarucizumab

B. Flumazenil

During your discharge teaching to a patient with multiple sclerosis, you educate the patient on how to avoid increasing symptoms and relapses. You tell the patient to avoid: A. Cold temperatures B. Infection C. Overexertion D. Salt F. Stress

B. Infection C. Overexertion F. Stress

A client with Meniere disease is advised to eat a sodium-restricted diet to reduce endolymphatic fluid. Which food selection provides evidence that the nurse's teaching was effective? A. Cake B. Macaroni C. Baked clams D. Grilled cheese

B. Macaroni

Your patient has a history of epilepsy. While helping the patient to the restroom, the patient reports having this feeling of déjà vu and seeing spots in their visual field. Your next nursing action is to? A. Continue assisting the patient to the restroom and let them sit down. B. Initiate the emergency response system. C. Lay the patient down on their side with a pillow underneath the head. D. Assess the patient's medication history.

C. Lay the patient down on their side with a pillow underneath the head.

A male client with a brain attack (cerebrovascular accident) has regained control of bowel movements but still is incontinent of urine. To help reestablish bladder control, what should the nurse encourage the client to do? A. Assume a standing position for voiding. B. Void every four hours and attempt to hold urine between set times. C. Attempt to void more frequently in the afternoon than in the morning. D. Drink a minimum of 4 L of fluid daily and divide it equally among the hours while awake.

A. Assume a standing position for voiding.

A patient is receiving Interferon Beta for treatment of multiple sclerosis. As the nurse you will stress the importance of? A. Physical exercise to improve fatigue B. Low fat diet C. Hand hygiene and avoiding infection D. Reporting ideation of suicide

C. Hand hygiene and avoiding infection

A patient is taking Phenytoin for treatment of seizures. Which statement by the patient requires you to re-educate the patient about this medication? A. "Every morning I take this medication with a full glass of milk with my breakfast." B. "I know it is important to have my drug levels checked regularly." C. "I will report a skin rash immediately to my doctor." D. "This medication can lower my body's ability to clot and fight infection."

A. "Every morning I take this medication with a full glass of milk with my breakfast."

You're assessing a patient who recently experienced a focal type seizure (partial seizure). As the nurse, you know that which statement by the patient indicates the patient may have experienced a focal impaired awareness (complex partial) seizure? A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this." B. "I remember having vision changes, but it didn't last long." C. "I woke up on the floor with my mouth bleeding." D. "After the seizure I was very sleepy, and I had a headache for several hours."

A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this."

A client with a history of stabbing pain in the eyes and blurring and gradual loss of vision is examined by an ophthalmologist, a neurologist, and an internist, all of whom find no organic cause. When eye complaints increase, the client is admitted to a mental health unit. What is the priority nursing intervention? A. Encouraging involvement in group activities B. Requesting a description of the eye discomfort C. Exploring feelings about possible impending blindness D. Focusing on daily activities while avoiding discussion of the eye discomfort

D. Focusing on daily activities while avoiding discussion of the eye discomfort

True or False: A patient who is experiencing a tonic-clonic seizure is experiencing a focal (partial) seizure.

False

True or False: Guillain-Barré Syndrome occurs when the body's immune system attacks the myelin sheath on the nerves in the central nervous system.

False, GBS attacks the peripheral nervous system

True or False: Multiple Sclerosis tends to affect men more than women and occurs during the ages of 50-70 years.

False: MS affects WOMEN more than men and shows up during the ages of 20-40 years.

You're patient is scheduled for an EEG (electroencephalogram). As the nurse you will: A. Keep the patient nothing by mouth. B. Hold seizure medications until after the test. C. Allow the patient to have coffee, milk, and juice only. D. Wash the patient's hair prior to the test. E. Administer a sedative prior to the test.

B. Hold seizure medications until after the test. D. Wash the patient's hair prior to the test.

A patient with a history of epilepsy is taking Phenytoin. The patient's morning labs are back, and the patient's Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will? A. Assess the patient for a rash B. Initiate seizure precautions C. Hold the next dose of Phenytoin D. Continue to monitor the patient

B. Initiate seizure precautions (10-20 mcg/mL is normal)

You're developing a plan of care for a patient with multiple sclerosis who presents with Uhthoff's Sign. What interventions will you include in the patient's plan of care? Select all that apply: A. Avoid movements of the head and neck downward B. Keep room temperature cool C. Encourage patient to use warm packs and heating pads for symptoms D. Educate the patient on three ways to avoid overheating during exercise

B. Keep room temperature cool D. Educate the patient on three ways to avoid overheating during exercise

Your patient is back from having a lumbar puncture. Select all the correct nursing interventions for this patient? A. Place the patient in lateral recumbent position. B. Keep the patient flat. C. Remind the patient to refrain from eating or drinking for 4 hours. D. Encourage the patient to consume liquids regularly.

B. Keep the patient flat. D. Encourage the patient to consume liquids regularly.

You're performing a head-to-toe assessment on a patient with multiple sclerosis. When you ask the patient to move the head and neck downward the patient reports an "electric shock" sensation that travels down the body. You would report your finding to the doctor that the patient is experiencing: A. Romberg's Sign B. Lhermitte's Sign C. Uhthoff's Sign D. Homan's Sign

B. Lhermitte's Sign

After three months of rehabilitation following a craniotomy, a client still is having some motor speech difficulty. What should the nurse do to promote the client's use of speech? A. Correct the client's mistakes immediately B. Respond to the client's rudimentary efforts of speaking C. Use simple sentences when interacting with the client D. Explain again why the client is having difficulty communicating

B. Respond to the client's rudimentary efforts of speaking

A client has sustained a spinal cord injury at the T2 level. The nurse assesses for signs of autonomic hyperreflexia (autonomic dysreflexia). What is the rationale for the nurse's assessment? A. The injury results in loss of the reflex arc. B. The injury is above the sixth thoracic vertebra. C. There has been a partial transection of the cord. D. There is a flaccid paralysis of the lower extremities.

B. The injury is above the sixth thoracic vertebra.

A 25 year-old presents to the ER with unexplained paralysis from the hips downward. The patient explains that a few days ago her feet were feeling weird and she had trouble walking and now she is unable to move her lower extremities. The patient reports suffering an illness about 2 weeks ago, but has no other health history. The physician suspects Guillain-Barré Syndrome and orders some diagnostic tests. Which finding below during your assessment requires immediate nursing action? A. The patient reports a headache. B. The patient has a weak cough. C. The patient has absent reflexes in the lower extremities. D. The patient reports paresthesia in the upper extremities.

B. The patient has a weak cough.

An 8-year-old child, who is not responding to anti-seizure medications, is prescribed to start a ketogenic diet. This diet will include: A. High carbohydrates and high fat B. Low fat, high salt, and high carbohydrates C. High fat and low carbohydrates D. High glucose, high fat, and low carbohydrates

C. High fat and low carbohydrates

Keeping the previous question in mind, the patient is now experiencing characteristics of a tonic-clonic seizure. The seizure started at 1402 and it is now 1408, and the patient is still experiencing a seizure. The nurse should? A. Continue to monitor the patient B. Suction the patient C. Initiate the emergency response system D. Restrain the patient to prevent further injury

C. Initiate the emergency response system

After surgery to repair a retinal detachment, an older adult client is transferred to the postanesthesia care unit with the affected eye patched. During the first four hours after surgery, the nurse should plan to notify the primary healthcare provider if the client reports which information? A. Has not voided B. Cannot open the eye C. Cannot remember the date D. Has sharp pain in the affected eye

D. Has sharp pain in the affected eye

A client underwent an external ear assessment and is diagnosed with hard nodules on the pinna. Which assessment finding indicates tophi? A. Ulcerative lesions at the site B. Crusted indurated lesions at the site C. Decreased calcium levels in the blood D. Increased uric acid levels in the blood

D. Increased uric acid levels in the blood

A client is scheduled for a labyrinthectomy to treat Meniere syndrome. Which expected outcome of the procedure should be included in preoperative teaching? A. Absence of pain B. Decreased cerumen C. Loss of sense of smell D. Permanent irreversible deafness

D. Permanent irreversible deafness

You're assessing a patient's health history for risk factors associated with developing Guillain-Barré Syndrome. Select all the risk factors below: A. Recent upper respiratory infection B. Patient's age: 3 years old C. Positive stool culture Campylobacter Jejuni D. Hyperthermia E. Epstein-Barr F. Diabetes G. Myasthenia Gravis

A. Recent upper respiratory infection C. Positive stool culture Campylobacter Jejuni E. Epstein-Barr

A patient who is having a tonic-clonic seizure is prescribed Phenobarbital. During administration of this drug, it is important the nurse monitors for: A. Respiratory depression B. Hypertension C. Disseminated intravascular clotting D. Hypotension E. Fever

A. Respiratory depression D. Hypotension

A nurse is caring for a client with Parkinson disease. Which clinical indicators does the nurse expect to find upon assessment? Select all that apply. A. Resting tremors B. Flattened affect C. Muscle flaccidity D. Tonic-clonic seizures E. Slow voluntary movements

A. Resting tremors B. Flattened affect E. Slow voluntary movements

A client with a cervical injury reports a severe headache and nasal congestion. What should the nurse assess for? A. Suprapubic distention B. Increased spinal reflexes C. Adventitious breath sounds D. Imminent development of shock

A. Suprapubic distention

You're developing discharge instructions to the parents of a child who experiences atonic seizures. What information below is important to include in the teaching? A. "This type of seizure is hard to detect because the child may appear like he or she is daydreaming." B. "Be sure your child wears a helmet daily." C. "It is common for the child to feel extremely tired after experiencing this type of seizure." D. "Avoid high fat and low carbohydrate diets."

B. "Be sure your child wears a helmet daily."

You're educating a 25-year-old female about possible triggers for seizures. Which statement requires you to re-educate the patient about the triggers? A. "I'm at risk for seizure activity during my menstrual cycle." B. "I will limit my alcohol intake to 2 glasses of wine per day." C. "It's important I get plenty of sleep." D. "I will be sure to stay hydrated, especially during hot weather."

B. "I will limit my alcohol intake to 2 glasses of wine per day."

You're educating a patient about treatment options for Guillain-Barré Syndrome. Which statement by the patient requires you to re-educate the patient about treatment? A. "Treatments available for this syndrome do not cure the condition but helps speed up recovery time." B. "Plasmapheresis or immunoglobin therapies are treatment options available for this syndrome but are most effective when given within 4 weeks of the onset of symptoms." C. "When I start plasmapheresis treatment a machine will filter my blood to remove the antibodies from my plasma that are attacking the myelin sheath." D. "Immunoglobulin therapy is where IV immunoglobulin from a donor is given to a patient to stop the antibodies that are damaging the nerves.

B. "Plasmapheresis or immunoglobin therapies are treatment options available for this syndrome but are most effective when given within 4 weeks of the onset of symptoms."

Select all the TRUE statements about the pathophysiology of multiple sclerosis: A. "The dendrites on the neuron are overstimulated leading to the destruction of the axon." B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon." C. "This disease affects the insulating structure found on the neuron in the central nervous system." D. "The dopaminergic neurons in the part of the brain called substantia nigra have started to die."

B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon." C. "This disease affects the insulating structure found on the neuron in the central nervous system."

Which finding below represents a positive Romberg Sign in a patient with multiple sclerosis? A. The patient report dark spots in the visual fields during the confrontation visual field test. B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth. C. The patient's sign and symptoms increase when expose to hot temperatures. D. The patient reports an electric shock feeling when the head and neck are moved downward.

B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth.

The patient's lumbar puncture results are back. Which finding below correlates with Guillain-Barré Syndrome? A. high glucose with normal white blood cells B. high protein with normal white blood cells C. high protein with low white blood cells D. low protein with high white blood cells

B. high protein with normal white blood cells

Your patient is scheduled for a lumbar puncture to help diagnose multiple sclerosis. The patient wants clarification about what will be found in the cerebrospinal fluid during the lumbar puncture to confirm the diagnosis of MS. You explain that ____________ will be present in the fluid if MS is present. A. high amounts of IgM B. oligoclonal bands C. low amounts of WBC D. oblong red blood cells and glucose

B. oligoclonal bands

A client with multiple sclerosis is informed that this is a chronic, progressive neurologic condition. The client asks the nurse, "Will I experience unbearable pain?" What is the nurse's best response? A. "Tell me about your fears regarding pain." B. "Analgesics will be prescribed to control the pain." C. "Some clients report feeling a tingling or burning sensation but not unbearable pain." D. "Let's make a list of the things you need to ask your healthcare provider."

C. "Some clients report feeling a tingling or burning sensation but not unbearable pain."

Which clinical indicators does the nurse identify that suggest a client is experiencing urinary retention and overflow after a cerebrovascular accident (also known as a "brain attack")? Select all that apply. A. Edema B. Oliguria C. Frequent voidings D. Suprapubic distention E. Continual incontinence

C. Frequent voidings D. Suprapubic distention

Neurons in the brain are tasked with handling and transmitting information. There are different types of neurons, such as excitatory and inhibitory. Excitatory neurons release the neurotransmitter _____________, while inhibitory neurons release the neurotransmitter ________________. A. GABA, glutamate B. Norepinephrine, GABA C. Glutamate, GABA D. Dopamine, glutamate

C. Glutamate, GABA

Which tests below can be ordered to help the physician diagnose Guillain-Barré Syndrome? Select all that apply: A. Edrophonium Test B. Sweat Test C. Lumbar puncture D. Electromyography E. Nerve Conduction Studies

C. Lumbar puncture D. Electromyography E. Nerve Conduction Studies

Your patient has entered the post ictus stage for seizures. The patient's seizure presented with an aura followed by body stiffening and then recurrent jerking. The patient had incontinence and bleeding in the mouth from injury to the tongue. What is an expected finding in this stage based on the type of seizure this patient experienced? A. Crying and anxiety B. Immediate return to baseline behavior C. Sleepy, headache, and soreness D. Unconsciousness

C. Sleepy, headache, and soreness

A client admitted with the diagnosis of subarachnoid hemorrhage exhibits aphasia and hemiparesis. The nurse concludes that these neurologic deficits are caused primarily by which response? A. Blood loss B. Tissue death C. Vascular spasms D. Electrolyte imbalance

C. Vascular spasms

You're about to send a patient for a lumbar puncture to help rule out Guillain-Barré Syndrome. Before sending the patient you will have the patient? A. Clean the back with antiseptic B. Drink contrast dye C. Void D. Wash their hair

C. Void

A 7-year-old male patient is being evaluated for seizures. While in the child's room talking with the child's parents, you notice that the child appears to be daydreaming. You time this event to be 10 seconds. After 10 seconds, the child appropriately responds and doesn't recall the event. This is known as what type of seizure? A. Focal Impaired Awareness (complex partial) B. Atonic C. Tonic-clonic D. Absence

D. Absence

A client who had a craniotomy is transferred to the intensive care unit from the postanesthesia care unit. Which nursing action is most important when caring for this client? A. Take axillary and oral temperatures. B. Encourage coughing, but discourage deep breathing. C. Administer a prescribed opioid or sedative at the first sign of irritability. D. Report yellow or bloody drainage on the dressing to the healthcare provider immediately.

D. Report yellow or bloody drainage on the dressing to the healthcare provider immediately.

A client with quadriplegia is placed on a tilt table daily. The client asks why the angle of the head of the table is gradually increased. How should the nurse respond? A. It facilitates turning. B. This prevents pressure ulcers. C. It promotes hyperextension of the spine. D. This limits loss of calcium from the bones.

D. This limits loss of calcium from the bones.

During nursing report you learn that the patient you will be caring for has Guillain-Barré Syndrome. As the nurse you know that this disease tends to present with: A. signs and symptoms that are unilateral and descending that start in the lower extremities B. signs and symptoms that are symmetrical and ascending that start in the upper extremities C. signs and symptoms that are asymmetrical and ascending that start in the lower extremities D. signs and symptoms that are symmetrical and ascending that start in the lower extremities

D. signs and symptoms that are symmetrical and ascending that start in the lower extremities

A teenager is brought to the emergency department exhibiting slurring speech, a slight right-sided facial droop, and an inability to close the right eyelid. Bell palsy is diagnosed. List the following concerns in priority order for this client. 1. Chance of falls because of altered vision 2. Low self-esteem because of appearance 3. Difficulty communicating because of slurred speech 4. Risk for dental caries because of retained food particles 5. Risk for malnutrition because of facial droop

2. Low self-esteem because of appearance 3. Difficulty communicating because of slurred speech 5. Risk for malnutrition because of facial droop 4. Risk for dental caries because of retained food particles 1. Chance of falls because of altered vision

A client reports a severe throbbing unilateral headache, nausea, and intolerance to light and sound. Arrange the pathophysiologic events in chronologic order. 1. Throbbing pain 2. Release of prostaglandins 3. Activation of trigeminal nerve 4. Activation of nociceptors 5. Extravasation of intravascular molecules 6. Stimulation of hyper-excitable neuronal pathway

6. Stimulation of hyper-excitable neuronal pathway 3. Activation of trigeminal nerve 4. Activation of nociceptors 2. Release of prostaglandins 5. Extravasation of intravascular molecules 1. Throbbing pain 1. Throbbing pain

You're assessing your patient load for the patients who are at MOST risk for seizures. Select all the patients below that are at risk: A. A 32-year-old with a blood glucose of 20 mg/dL. B. A 63-year-old whose CT scan shows an ischemic stroke. C. A 72-year-old who is post opt day 5 from open heart surgery. D. A 16-year-old with bacterial meningitis. E. A 58-year-old experiencing ETOH withdrawal.

A. A 32-year-old with a blood glucose of 20 mg/dL. B. A 63-year-old whose CT scan shows an ischemic stroke. D. A 16-year-old with bacterial meningitis. E. A 58-year-old experiencing ETOH withdrawal.

You're teaching a group of nursing students about Guillain-Barré Syndrome and how it can affect the autonomic nervous system. Which signs and symptoms verbalized by the students demonstrate they understood the autonomic involvement of this syndrome? Select all that apply: A. Altered body temperature regulation B. Inability to move facial muscles C. Cardiac dysrhythmias D. Orthostatic hypotension E. Bladder distension

A. Altered body temperature regulation C. Cardiac dysrhythmias D. Orthostatic hypotension E. Bladder distension

A patient with Guillain-Barré Syndrome has a feeding tube for nutrition. Before starting the scheduled feeding, it is essential the nurse? Select all that apply: A. Assesses for bowel sounds B. Keeps the head of bed less than 30' degrees C. Checks for gastric residual D. Weighs the patient

A. Assesses for bowel sounds C. Checks for gastric residual

A patient with multiple sclerosis has issues with completely emptying the bladder. The physician orders the patient to take ___________, which will help with bladder emptying. A. Bethanechol B. Oxybutynin C. Avonex D. Amantadine

A. Bethanechol

A patient is suspected of having multiple sclerosis. The neurologist orders various test. The patient's MRI results are back and show lesions on the cerebellum and optic nerve. What signs and symptoms below would correlate with this MRI finding in a patient with multiple sclerosis? A. Blurry vision B. Pain when moving eyes C. Dysarthria D. Balance and coordination issues E. "Pill rolling" of fingers and hands G. Heat intolerance H. Dark spots in vision I. Ptosis

A. Blurry vision B. Pain when moving eyes C. Dysarthria D. Balance and coordination issues H. Dark spots in vision

A client has a history of diabetes mellitus. After assessing the client, the primary healthcare provider confirms damage to the sensory limb of the bladder spinal reflex arc. Which clinical manifestations could confirm this condition? A. Incomplete voiding B. Overdistention of bladder C. Lack of control on micturition D. Infrequent voiding of large residual volumes

D. Infrequent voiding of large residual volumes