neuro practice questions - stokely

A nurse is teaching a client who has multiple sclerosis about a new prescription for baclofen. Which of the following instructions should the nurse include in the teaching? A. "Do not take antihistamines with this medication." B. "Take the medication on an empty stomach." C. "Stop taking the medication immediately for a headache." D. "Expect to develop diarrhea initially."

A. "Do not take antihistamines with this medication." Rationale: The nurse should instruct the client not to take antihistamines while taking baclofen. Antihistamines will intensity the depressant effects of baclofen.

A nursing is caring for a client who has aphasia following a stroke. A family member asks the nurse how she should communicate with the client. Which of the following responses by the nurse is appropriate? A. "Incorporate nonverbal cues in the conversation." B. "Ask multiple choice questions as part of the conversation." C. "Use a higher-pitched tone of voice when speaking." D. "Use simple, child-like statements when speaking."

A. "Incorporate nonverbal cues in the conversation." Rationale: Nonverbal cues enhance the client's ability to comprehend and use language.

A charge nurse is anticipating the admission of four clients and planning their room assignments. Which of the following clients should the nurse assign to the room closest to the nurses' station? A. A client who sustained a head injury and is having periods of confusion B. A client who reports a severe migraine headache C. A client who has a suspected diagnosis of tuberculosis (TB) D. A client who has a history of atrial fibrillation and is on continuous ECG monitoring.

A. A client who sustained a head injury and is having periods of confusion Rationale: A client who sustained a head injury and is confused is at risk for seizures. The nurse should place this client in a room near the nurses' station so that he can be closely monitored to prevent injury if a seizure occurs.

A nurse is caring for a client who has an epidural hematoma. Which of the following manifestations should the nurse expect? A. A lucid period followed by an immediate loss of consciousness B. A change in the level of consciousness that develops over 48 hr C. Neurologic deficits that increase up to 2 weeks post-injury D. Cognitive perception that decreases over several months post-injury

A. A lucid period followed by an immediate loss of consciousness Rationale: The nurse should expect the client who has an epidural hematoma to have a lucid period followed by an immediate loss of consciousness, which is caused by arterial bleeding into the space between the dura and skull.

A nurse is assessing a client who sustained a basal skull fracture and notes a thin stream of clear drainage coming from the client's right nostril. Which of the following actions should the nurse take first? A. Test the drainage for glucose. B. Suction the nostril. C. Notify the physician. D. Ask the client to blow his nose.

A. Test the drainage for glucose. Rationale: This is the priority nursing action. Because of the high risk of cerebral spinal fluid (CSF) leak in clients with basal skull fractures, the nurse should realize there is a possibility that the clear fluid coming from the client's nostril is CSF, which will test positive for glucose.

A nurse in the emergency department is caring for a client who has myasthenia gravis and is in crisis. Which of the following factors should the nurse identify as a possible cause of myasthenic crisis? A. Developing a respiratory infection B. Taking too much prescribed medication C. Diet high in protein D. Not exercising enough

A. Developing a respiratory infection Rationale: The most common triggers of myasthenic crises are respiratory infection, not taking, or taking

A nurse at a rehabilitation center is planning care for a client who had a left hemispheric cerebrovascular accident (CVA) 3 weeks ago. Which of the following goals should the nurse include in the client's rehabilitation program? A. Establish the ability to communicate effectively. B. Compensate for loss of depth perception. C. Learn to control impulsive behavior. D. Improve left-side motor function.

A. Establish the ability to communicate effectively. Rationale: A CVA is an interruption of the blood supply to any part of the brain, resulting in damaged brain tissue. The left hemisphere is usually dominant for language. Because this client had a left-side CVA, the nurse should anticipate the client will have some degree of aphasia and will require speech therapy to establish communication.

A nurse working on a medical unit is caring for a client who is prescribed seizure precautions. Which of the following interventions should the nurse include in the client's plan of care? A. Obtain IV access. B. Keep the lights on when the client is sleeping. C. Place the client's bed in the high position. D. Keep a padded tongue blade available at the client's bedside.

A. Obtain IV access. Rationale: The nurse should obtain IV access as a precaution so the client can receive IV medications in the event of a seizure.

A nurse is caring for a client who had a stroke involving the right cerebral hemisphere. The nurse should monitor for which of the following findings? A. Poor impulse control B. Unable to discriminate words and letters C. Deficits in the right visual field D. Motor retardation

A. Poor impulse control Rationale: A client who had a stroke involving the right cerebral hemisphere is likely to have personality changes, which can include impulsiveness, confabulation, and poor judgment.

A nurse suspects a client who has myasthenia gravis is experiencing a myasthenic crisis. Which of the following interventions should the nurse take? A. Prepare the client for mechanical ventilation. B. Administer an anticholinesterase medication. C. Instruct the client to perform the pursed lip breathing. D. Prepare to administer a vasoconstrictor.

A. Prepare the client for mechanical ventilation. Rationale: The client who is experiencing a myasthenic crisis is at risk for loss of adequate respiratory function. The nurse should closely monitor the client's respiratory status and prepare for possible mechanical ventilation.

A nurse is providing teaching to the family of a client who has Parkinson's disease. Which of the following information should the nurse include in the teaching? A. Provide client supervision. B. Limit client physical activity. C. Speak loudly to the client. D. Leave the television on continuously.

A. Provide client supervision. Rationale: Because the client's voluntary motor control is affected by the disease, the nurse should recommend that the family provide client supervision to create a safe and respectful environment.

A nurse is in a client's room when the client begins having a tonic-clonic seizure. Which of the following actions should the nurse take first? A. Turn the client's head to the side. B. Check the client's motor strength. C. Loosen the clothing around the client's waist. D. Document the time the seizure began.

A. Turn the client's head to the side. Rationale: The first action the nurse should take when using the airway, breathing, circulation approach to client care is to turn the client's head to the side. This action keeps the client's airway clear of secretion to prevent aspiration.

A nurse is preparing to administer phenytoin IV to a client who has a seizure disorder. Which of the following actions should the nurse plan to take? A. Administer the medication at 100 mg/min. B. Administer a saline solution after injection. C. Hold the injection if seizure activity is present. D. Dilute the medication with dextrose 5% in water.

B. Administer a saline solution after injection. Rationale: The nurse should flush the injection site with a saline solution after the injection of phenytoin to reduce and prevent venous irritation.

A nurse in the ED is caring for a client following an automobile crash in which the client was unrestrained and thrown from the vehicle. When assessing the client, the nurse observes clear fluid draining from the client's nose. Which of the following interventions should the nurse take? A. Obtain a culture of the specimen using sterile swabs. B. Allow the drainage to drip onto a sterile gauze pad. C. Suction the nose gently with a bulb syringe. D. Insert sterile packing into the nares.

B. Allow the drainage to drip onto a sterile gauze pad. Rationale: The nurse should allow the drainage to drip onto a sterile gauze pad in order to assess for the presence of cerebrospinal fluid. This intervention allows for the collection of data without increasing the risk for further injury.

A nurse is modifying the diet of a client who has Parkinson's disease and is prescribed selegiline, an MAOI. Which of the following foods should the nurse eliminate? A. Fresh fish B. Cheddar cheese C. Cherries D. Chicken

B. Cheddar cheese Rationale: The nurse should eliminate aged cheeses from the diet of a client who is prescribed selegiline. Cheddar cheese contains tyramine, which can cause a hypertensive crisis.

A nurse in an emergency department is caring for a client who had a seizure and became unresponsive after stating she had a sudden, severe headache and vomiting. The client's vital signs are as follows: blood pressure of 198/110 mm Hg, pulse of 82/min, respirations of 24/min, and a temperature of 38.2° C (100.8° F). Which of the following neurologic disorders should the nurse suspect? A. Transient ischemic attack (TIA) B. Hemorrhagic stroke C. Thrombotic stroke D. Embolic stroke

B. Hemorrhagic stroke Rationale: A client who has a hemorrhagic stroke often experiences a sudden onset of symptoms including sudden onset of a severe headache, a decrease in the level of consciousness, and seizures. Hemorrhagic strokes occur when bleeding occurs in the brain caused by the rupture of an aneurysm or arteriovenous malformation, hypertension and atherosclerosis, or trauma.

A nurse is caring for a client who who has had a stroke involving the right hemisphere. Which of the following alterations in function should the nurse expect? A. Difficulty reading B. Inability to recognize his family members C. Right hemiparesis D. Aphasia

B. Inability to recognize his family members Rationale: The right hemisphere is involved with visual and spatial awareness. A client who is unable to recognize faces would have involvement with the right hemisphere.

A nurse is caring for a client who has a suspected diagnosis of myasthenia gravis. The provider prescribes a Tensilon test. Which of the following findings indicates a positive test? A. A pill-rolling tremor appears. B. Muscle contractions become progressively stronger. C. Electrical charge in a muscle increases in intensity. D. Muscle strength shows no change.

B. Muscle contractions become progressively stronger. Rationale: A positive Tensilon test is indicated by a 4 to 5 min period of improved muscle tone and strength.

A nurse is teaching a client who has a new diagnosis of atrial fibrillation. The nurse should instruct the client to monitor for which of the following complications? A. Bradycardia B. Pulmonary embolism C. Peripheral vascular disease D. Hypertension

B. Pulmonary embolism Rationale: Altered atrial contractions can cause blood pooling and thrombus formation. The client is at risk for developing a pulmonary embolism or embolic stroke. The client should monitor and report immediately manifestations, such as shortness of breath, or neurological changes.

A nurse is caring for a client who has a new diagnosis of myasthenia gravis. For which of the following manifestations should the nurse monitor? A. Confusion B. Weakness C. Increased intracranial pressure D. Increased urinary output

B. weakness Rationale: Generalized weakness of the diaphragmatic and intercostal muscles may produce respiratory distress or predispose the client to respiratory infections.

A nurse is assessing a client who has Parkinson's disease. Which of the following manifestations should the nurse expect? A. Pruritus B. Hypertension C. Bradykinesia D. Xerostomia

C. Bradykinesia Rationale: The nurse should expect to find bradykinesia or difficulty moving in a client who has Parkinson's disease.

A nurse is assessing a client who has meningitis and notes when passively flexing the client's neck there is an involuntary flexion of both legs. Which of the following conditions is the client displaying? A. Kernig's sign B. Nuchal rigidity C. Brudzinski's sign D. Bradykinesia

C. Brudzinski's sign Rationale: This client is manifesting a positive Brudzinski's sign, which is indicated when the hips and knees flex when neck is flexed. A positive Brudzinski's sign is a common sign of meningitis.

A nurse who is off duty finds a woman who has collapsed and has right-sided weakness and slurred speech. Which of the following actions should the nurse take? A. Obtain the telephone number of the client's provider. B. Find a location for the client to sit. C. Call emergency services. D. Drive the client to the nearest emergency department.

C. Call emergency services. Rationale: The client might have had a stroke, and if she has, she needs emergency medical intervention and transport to a stroke center.

A nurse is providing teaching to a client who has a new diagnosis of Parkinson's disease. On which of the following medications should the nurse prepare to instruct the client? A. Piperacillin/tazobactam B. Levothyroxine C. Levodopa/carbidopa D. Carbamazepine

C. Levodopa/carbidopa Rationale: Levodopa/carbidopa is the cornerstone of Parkinson's treatment. The nurse should prepare to instruct the client on the use of this medication.

An acute care nurse receives shift report for a client who has increased intracranial pressure. The nurse is told that the client demonstrates decorticate posturing. Which of the following findings should the nurse expect to observe when assessing the client? A. Extension of the arms B. Pronation of the hands C. Plantar flexion of the legs D. External rotation of the lower extremities

C. Plantar flexion of the legs Rationale: Plantar flexion of the legs is an indicator of decorticate posturing and is a result of lesions of the corticospinal tracts.

A nurse is performing discharge teaching for a client who has seizures and a new prescription for phenytoin. Which of the following statements by the client indicates a need for further teaching? A. "I will notify my doctor before taking any other medications." B. "I have made an appointment to see my dentist next week." C. "I know that I cannot switch brands of this medication." D. "I'll be glad when I can stop taking this medicine."

D. "I'll be glad when I can stop taking this medicine." Rationale: Phenytoin is an anticonvulsant used to treat various types of seizures. Clients on anticonvulsant medications commonly require them for lifetime administration, and phenytoin should not be stopped without the advice of the client's provider.

A nurse is teaching the family of a client who has a new diagnosis of epilepsy about actions to take if the client experiences a seizure. Which of the following instructions should the nurse include in the teaching? A. "Insert a padded tongue blade into the client's mouth." B. "Restrain the client." C. "Place the client on his back." D. "Move objects away from the client."

D. "Move objects away from the client." Rationale: The nurse should instruct the family to move objects away from the client to reduce the risk of injury to the client.

A nurse is assessing a client's cranial nerves as part of a neurological examination. Which of the following actions should the nurse take to assess cranial nerve III? A. Testing visual acuity B. Observing for facial symmetry C. Eliciting the gag reflex D. Checking the pupillary response to light

D. Checking the pupillary response to light Rationale: Cranial nerve III is the oculomotor nerve and is responsible, along with cranial nerves IV (trochlear) and VI (abducens), for eye movement and pupillary response to light. If the cranial nerve is functioning properly, the expected reaction is pupil constriction in response to light.

A nurse is caring for a client who had a stroke involving the left cerebral hemisphere. The nurse should monitor for which of the following findings? A. Impaired sense of humor B. Loss of depth perception C. Poor judgment D. Intellectual impairment

D. Intellectual impairment Rationale: A client who had a stroke involving the left cerebral hemisphere is likely to have deficits that involve language, mathematical skills, and thinking.

A nurse is caring for a client who is experiencing Cushing's Triad following a subdural hematoma. Which of the following medications should the nurse plan to administer? A. Albumin 25% B. Dextran 70 C. Hydroxyethyl glucose D. Mannitol 25%

D. Mannitol 25% Rationale: Cushing's Triad is an indication that the client is experiencing increased intracranial pressure. The nurse should administer mannitol 25%, an osmotic diuretic that promotes diuresis to treat cerebral edema.

A nurse is caring for a child who is experiencing a seizure. Which of the following actions should the nurse take? A. Attempt to stop the seizure. B. Restrain the child's arms. C. Use a padded tongue blade. D. Position the child laterally.

D. Position the child laterally. Rationale: Positioning the child laterally facilitates airway patency.

A nurse suspects that a client admitted for treatment of bacterial meningitis is experiencing increased intracranial pressure (ICP). Which of the following assessment findings by the nurse supports this suspicion? A. Photophobia B. Nuchal rigidity C. Positive Kernig's sign D. Restlessness

D. Restlessness Rationale: Clients who have meningitis can be at risk for developing increased ICP. The nurse should monitor the client's vital signs and neurological status at least every four hours. Indications of increased ICP include increased restlessness and confusion, a decreased level of consciousness, and the presence of Cushing's triad (severe hypertension, widened pulse pressure, and bradycardia).

A nurse is caring for a client who has a traumatic brain injury. Which of the following findings should the nurse identify as an indication of increased intracranial pressure (ICP)? A. Tachycardia B. Amnesia C. Hypotension D. Restlessness

D. Restlessness Rationale: Increased intracranial pressure is a condition in which the pressure of the cerebrospinal fluid or brain matter within the skull exceeds the upper limits for normal. Signs of increasing ICP include restlessness, irritability and confusion along with a change in level of consciousness, or a change in speech pattern.