Neurological System Practice

An older adult has encouraged the spouse husband to visit their primary provider, stating that concern that spouse may have Parkinson disease. Which description of the spouse's health and function is most suggestive of Parkinson disease? A. "He's forgotten the names of some people that we've known for years. "B. "Lately he seems to move far more slowly than he ever has in the past. "C. "He's losing weight even though he has a ravenous appetite. "D. "He often complains that his joints are terribly stiff when he wakes up in the morning."

"B. "Lately he seems to move far more slowly than he ever has in the past.

A client is scheduled for CT scanning of the head because of a recent onset of neurologic deficits. What should the nurse tell the client in preparation for this test? A. "You need to fast for 8 hours prior to the test. "B. "You will need to lie still throughout the procedure. "C. "No metal objects can enter the procedure room. "D. "There will be a lot of noise during the test."

"B. "You will need to lie still throughout the procedure.

A 26-year-old female client, who is breastfeeding a newborn, is due to undergo a computed tomography (CT) scan with dye contrast. What instruction should the nurse provide to the client based on this procedure? A. "Do not eat or cook any shellfish prior to the procedure. "B. "Do not breastfeed your baby for two weeks after the procedure as recommended by your provider. "C. "Stop breastfeeding for the time frame given by the provider within the nuclear medicine department. "D. "Limit your intake of water and alcohol following the procedure."

"C. "Stop breastfeeding for the time frame given by the provider within the nuclear medicine department.

A client for whom the nurse is caring has positron emission tomography (PET) scheduled. In preparation, what should the nurse explain to the client? A. "The client will need to endure loud noises during the test. "B. "An allergy to iodine precludes getting the radio-opaque dye. "C. "The test may result in dizziness or lightheadedness ."D. "The test will temporarily limit blood flow through the brain."

"C. "The test may result in dizziness or lightheadedness

The nurse is caring for a client newly diagnosed with a primary brain tumor. The client asks the nurse where the tumor came from. What would be the nurse's best response? A. "Your tumor originated from cells within your brain itself. "B. "Your tumor originated from somewhere outside the CNS. "C. "Your tumor likely started out in one of your glands. "D. "Your tumor is from nerve tissue somewhere in your body."

A. "Your tumor originated from cells within your brain itself.

A nurse is reviewing the trend of a client's scores on the Glasgow Coma Scale (GCS). This provides what potential information to the nurse about the client's status? A. An assessment of the client's current level of consciousness B. An assessment of the client's lowest verbal and physical response to stimuli C. The client's level of knowledge about preceding events D. An in-depth and real-time neurological assessment of the client's condition

A. An assessment of the client's current level of consciousness

The nurse is assessing a client with a spinal cord injury that reports a severe headache with a rapid onset. The nurse knows that this could be a symptom of which complication of a spinal cord injury? A. Autonomic dysreflexia B. Retinal hemorrhage C. Myocardial infarction D. Spinal shock

A. Autonomic dysreflexia

A nurse is preparing to administer a client's scheduled dose of subcutaneous heparin. To reduce the risk of needlestick injury, the nurse should perform which action with used needles? A. Avoid recapping the needle before disposing of it. B. Wear gloves when administering the injection. C. For multiple injections, insert the needle into the bed. D. Recap the needle immediately before leaving the room.

A. Avoid recapping the needle before disposing of it.

A client with a new diagnosis of ischemic stroke is deemed to be a candidate for treatment with tissue plasminogen activator (t-PA) and has been admitted to the ICU. In addition to closely monitoring the client's cardiac and neurologic status, the nurse monitors the client for signs of what complication? A. Bleeding B. Seizures C. Acute pain D. Septicemia

A. Bleeding

A nurse is caring for a critically ill client with autonomic dysreflexia. What clinical manifestations would the nurse expect in this client? A. Bradycardia and hypertension B. Tachycardia and agitation C. Respiratory distress and projectile vomiting D. Third-spacing and hyperthermia

A. Bradycardia and hypertension

The nurse is planning the care of a client with Parkinson disease. The nurse should be aware that treatment will focus on what pathophysiologic phenomenon? A. Decreased availability of dopamine B. Insufficient synthesis of epinephrine C. Premature degradation of acetylcholine D. Delayed reuptake of serotonin

A. Decreased availability of dopamine

A client with suspected Creutzfeldt-Jakob disease (CJD) is being admitted to the unit. The nurse would expect what diagnostic test to be ordered for this client? A. EEG B. ABG analysis C. CT D. Cerebral angiography

A. EEG

A 25-year-old client with brain metastases is considering life expectancy after the client's most recent meeting with her oncologist. Based on the fact that the client is not receiving treatment for the brain metastases, what is the nurse's most appropriate action? A. Ensuring that the client receives adequate palliative care B. Ensuring that the family does not tell the client that the condition is terminal C. Promoting adherence to the prescribed medication regimen D. Promoting the client's functional status and ADLs

A. Ensuring that the client receives adequate palliative care

The nurse is caring for a client who has developed SIADH. What intervention is most appropriate? A. Fluid restriction B. Transfusion of fresh frozen plasma (FFP) C. Transfusion of platelets D. Electrolyte restriction

A. Fluid restriction

A client with a documented history of seizure disorder experiences a generalized seizure. What nursing action is most appropriate? A. Loosen the client's restrictive clothing. B. Restrain the client to prevent injury. C. Open the client's jaws to insert an oral airway. D. Place client in high Fowler position.

A. Loosen the client's restrictive clothing.

A client is recovering from intracranial surgery that was performed using the transsphenoidal approach. The nurse should be aware that the client may have required surgery on what neurologic structure? A. Pituitary gland B. Cerebellum C. Pineal gland D. Hypothalamus

A. Pituitary gland

The nurse in the intensive care unit (ICU) is using the neurological assessment flow chart to evaluate a calm client with traumatic brain injury (TBI) that has several medications infusing. Which medication would best allow an accurate assessment of the client's neurological status? A. Propofol B. Lorazepam C. Benzodiazepines D. Midazolam

A. Propofol

A client with Parkinson disease is undergoing a swallowing assessment because the client has recently developed adventitious lung sounds. The client's nutritional needs should be met by what method? A. Semisolid food with thick liquids B. Total parenteral nutrition (TPN) C. Provision of a low-residue diet D. Minced foods and a fluid restriction

A. Semisolid food with thick liquids

A trauma client was admitted to the intensive care unit (ICU) with a brain injury that resulted in a change in level of consciousness and altered vital signs. The client subsequently became diaphoretic and agitated. The nurse should recognize which of the following syndromes as the most plausible cause of these symptoms? A. Sympathetic storm B. Cranial nerve deficit C. Adrenal crisis D. Hypothalamic collapse

A. Sympathetic storm

The nurse is preparing health education for a client who is being discharged after hospitalization for a hemorrhagic stroke. What content should the nurse include in this education? A. Take antihypertensive medication as prescribed. B. Drowsiness is normal for the first week after discharge. C. Mild, intermittent seizures can be expected. D. Take ibuprofen for a serious headache.

A. Take antihypertensive medication as prescribed.

A client diagnosed with transient ischemic attacks (TIAs) is scheduled for a carotid endarterectomy. The nurse explains that this procedure will be done for which purpose? A. To remove atherosclerotic plaques blocking cerebral flow B. To prevent seizure activity that is common following a TIA C. To determine the cause of the TIA D. To decrease cerebral edema

A. To remove atherosclerotic plaques blocking cerebral flow

A client has developed diabetes insipidus after having increased ICP following head trauma. What nursing assessment best addresses this complication? A. Vigilant monitoring of fluid balance B. Serial arterial blood gases (ABGs) C. Continuous BP monitoring D. Monitoring of the client's airway for patency

A. Vigilant monitoring of fluid balance

A female client is admitted to the medical unit for evaluation of cerebral metastasis from a primary site. When reviewing the client's history, the nurse would most likely find which site as being the primary site? A. lung B. uterus C. prostate D. renal

A. lung

The nurse is preparing to provide care for a client diagnosed with myasthenia gravis. The nurse should know that the signs and symptoms of the disease are the result of what issue? A. Decreased conduction of impulses in an upper motor neuron lesion B. A lower motor neuron lesion C. Upper and lower motor neuron lesions D. Genetic dysfunction

B. A lower motor neuron lesion

A client with a metastatic brain tumor of the frontal lobe experiences a generalized seizure for the first time. The nurse should prepare for what action? A. Intubation B. Administration of anticonvulsants C. STAT computed tomography (CT) health care provider D. A STAT MRI

B. Administration of anticonvulsants

A clinic nurse is caring for a client diagnosed with migraine headaches. During the client teaching session, the client questions the nurse regarding alcohol consumption. What would the nurse be correct in telling the client about the effects of alcohol? A. Alcohol causes hormone fluctuations. B. Alcohol causes vasodilation of the blood vessels. C. Alcohol diminishes endorphins in the brain. D. Alcohol has an excitatory effect on the CNS.

B. Alcohol causes vasodilation of the blood vessels.

A client sustained a head injury as a result of trauma. The health care provider has instituted seizure prophylactic measures. The nurse anticipates which specific measures being initiated for this client? A. Antiemetic medications on day three of injury B. Anticonvulsant medications on day two of injury C. Aspiration precautions on day four of injury D. Intubation and ventilator support on day one of injury

B. Anticonvulsant medications on day two of injury

A client with a brain tumor has begun to exhibit signs of cachexia. What subsequent assessment should the nurse prioritize? A. Assessment of cranial nerve function B. Assessment of nutritional status C. Assessment of peripheral nervous function D. Assessment of respiratory status

B. Assessment of nutritional status

The nurse is caring for a client who is known to be at risk for cardiogenic embolic strokes. What arrhythmia does this client most likely have? A. Supraventricular tachycardia B. Atrial fibrillation C. Ventricular tachycardia D. Bundle branch block

B. Atrial fibrillation

To alleviate pain associated with trigeminal neuralgia, a client is taking carbamazepine. What health education should the nurse provide to the client before initiating this treatment? A. Concurrent use of calcium supplements is contraindicated. B. Blood levels of the drug must be monitored. C. The drug is likely to cause hyperactivity and agitation. D. Carbamazepine can cause tinnitus during the first few days of treatment.

B. Blood levels of the drug must be monitored.

A client has a concentration of S. aureus located on the skin. The client is not showing signs of increased temperature, redness, or pain at the site. The nurse is aware that this is a sign of a microorganism at which of the following stages? A. Disease B. Colonization C. Bacteremia D. Infection

B. Colonization

A client is being given a medication that stimulates the parasympathetic system. Following administration of this medication, the nurse should anticipate what effect? A. Dilated bronchioles B. Constricted pupils C. Decreased peristaltic movement D. Relaxed muscular walls of the urinary bladder

B. Constricted pupils

The nurse is caring for a client with a brain tumor. What drug would the nurse expect to be prescribed to reduce the edema surrounding the tumor? A. Dextromethorphan B. Dexamethasone C. Furosemide D. Solumedrol

B. Dexamethasone

The nurse has created a plan of care for a client who is at risk for increased ICP. The client's care plan should specify monitoring for what early sign of increased ICP? A. Decreased pulse and respirations B. Disorientation and restlessness C. Loss of corneal reflex D. Projectile vomiting

B. Disorientation and restlessness

A client is admitted from the ED diagnosed with Neisseria meningitides. What type of isolation precautions should the nurse institute? A. Contact precautions B. Droplet precautions C. Airborne precautions D. Observation precautions

B. Droplet precautions

When caring for a client who has had a stroke, a priority is reduction of ICP. What client position is most consistent with this goal? A. Extension of the neck B. Elevation of the head of the bed C. Head turned slightly to the right side D. Position changes every 15 minutes while awake

B. Elevation of the head of the bed

A client is admitted to the medical unit with an exacerbation of multiple sclerosis. When assessing this client, the nurse has the client stick out the tongue and move it back and forth. What is the nurse assessing? A. Function of the vagus nerve B. Function of the hypoglossal nerve C. Function of the trochlear nerve D. Function of the spinal nerve

B. Function of the hypoglossal nerve

A client has recently begun mobilizing during the recovery from an ischemic stroke. To protect the client's safety during mobilization, the nurse should perform what action? A. Avoid mobilizing the client in the early morning or late evening. B. Have a colleague follow the client closely with a wheelchair. C. Ensure that the client's family members do not participate in mobilization. D. Support the client's full body weight with a waist belt during ambulation.

B. Have a colleague follow the client closely with a wheelchair.

What neurologic assessment should the nurse perform to gauge the client's function of cranial nerve I? A. Utilize the Snellen chart. B. Have the client identify familiar odors with the eyes closed. C. Test for air and bone conduction (Rinne test). D. Assess papillary reflex.

B. Have the client identify familiar odors with the eyes closed.

A client has a poor prognosis after being involved in a motor vehicle accident resulting in a head injury. As the client's ICP increases and condition worsens, the nurse knows to assess for indications of approaching death. These indications include which of the following? A. Hemiplegia B. Loss of brain stem reflexes C. Signs of internal bleeding D. Dry mucous membranes

B. Loss of brain stem reflexes

A client is scheduled for a myelogram, and the nurse explains to the client that this is an invasive procedure, which assesses for any lesions in the spinal cord. The nurse should explain that the preparation is similar to which of the following neurologic tests? A. Cerebral angiography B. Lumbar puncture C. MRI D. EEG

B. Lumbar puncture

The nurse is providing care for a client who is unconscious. What nursing intervention takes highest priority? A. Inserting a nasogastric (NG) tube as prescribed B. Maintaining a patent airway C. Maintaining accurate records of intake and output D. Providing appropriate pain control

B. Maintaining a patent airway

The nurse who provides care at a wilderness camp is teaching staff members about measures that reduce campers' and workers' risks of developing Giardia infections. The nurse should emphasize which of the following practices? A. Avoiding the consumption of wild berries B. Making sure not to drink water that has not been purified C. Using mosquito repellent consistently D. Removing ticks safely and promptly

B. Making sure not to drink water that has not been purified

An ED nurse has just received a call from EMS that they are transporting a 17-year-old client who has just sustained a spinal cord injury (SCI). The nurse recognizes that the most common cause of this type of injury is what event? A. Suicide attempts B. Motor vehicle accidents C. Syncope (fainting) D. Workplace injuries

B. Motor vehicle accidents

A client with possible bacterial meningitis is admitted to the ICU. What assessment finding would the nurse expect for a client with this diagnosis? A. Numbness and tingling in the lower extremities B. Neck flexion produces flexion of knees and hips C. Pain upon ankle dorsiflexion of the foot D. Inability to stand with eyes closed and arms extended without swaying

B. Neck flexion produces flexion of knees and hips

A hospital client has experienced a seizure. In the immediate recovery period, what action best protects the client's safety? A. Administer antianxiety medications as prescribed. B. Place the client in a side-lying position. C. Reassure the client and family members. D. Pad the client's bed rails.

B. Place the client in a side-lying position.

Nursing care during the immediate recovery period from an ischemic stroke should normally prioritize which intervention? A. Administering hypertonic intravenous (IV) solution B. Positioning the client to avoid intercranial pressure (ICP) C. Initiating early mobilization D. Maximizing partial pressure of carbon dioxide (PaCO2)

B. Positioning the client to avoid intercranial pressure (ICP)

A 50-year-old female client reports a new onset, moderate headache after a lumbar puncture. What is the most likely condition that the client is experiencing? A. Cranial arteritis B. Secondary headache C. Paroxysmal hemicranias D. Cluster headache

B. Secondary headache

A client newly diagnosed with a cervical disk herniation is receiving health education from the clinic nurse. What conservative management measures should the nurse teach the client to implement? A. Wear the cervical collar for at least 2 hours at a time. B. Sleep on a firm mattress. C. Apply cool compresses to the back of the neck daily. D. Perform active ROM exercises three times daily.

B. Sleep on a firm mattress.

A 48-year-old client has been diagnosed with trigeminal neuralgia following recent episodes of unilateral face pain. The nurse should recognize what implication of this diagnosis? A. The disease is self-limiting and the client will achieve pain relief over time. B. The client needs to be assessed for MS. C. The client has a disproportionate risk of developing myasthenia gravis later in life. D. The client will likely require lifelong treatment with anticholinergic medications.

B. The client needs to be assessed for MS.

A client who has experienced an ischemic stroke has been admitted to the medical unit. The client's family is adamant that the client remain on bed rest to hasten recovery and to conserve energy. What principle of care should inform the nurse's response to the family? A. To prevent contractures and muscle atrophy, bed rest should not exceed 4 weeks. B. The client should mobilize as soon as physically able. C. The client should remain on bed rest until the client expresses a desire to mobilize. D. Lack of mobility will greatly increase the client's risk of stroke recurrence.

B. The client should mobilize as soon as physically able.

A client with a left hemispheric stroke is having difficulty with their normal speech patterns. The nurse is not sure whether the client has expressive aphasia or apraxia. Which statement would most likely be reflective of apraxia? A. The client sits up and turns to one side to see the object and states what is needed. B. The client starts by saying "good morning" but finishes with saying "good day" to the nurse. C. The nurse gives direction to get out of bed but the client does not understand. D. The client points and gestures to an object needed on the overhead table.

B. The client starts by saying "good morning" but finishes with saying "good day" to the nurse.

A client who has been experiencing numerous episodes of unexplained headaches and vomiting has subsequently been referred for testing to rule out a brain tumor. What characteristic of the client's vomiting is most consistent with a brain tumor? A. The client's emesis is blood-tinged. B. The client's vomiting is unrelated to food intake. C. The client's vomiting is accompanied by epistaxis. D. The client's vomiting does not relieve his nausea.

B. The client's vomiting is unrelated to food intake.

A client who has sustained a nondepressed skull fracture is admitted to the acute medical unit. Nursing care should include which of the following? A. Fluid resuscitation B. Watchful waiting and close monitoring C. Administration of inotropic drugs D. Preparation for emergency craniotomy

B. Watchful waiting and close monitoring

A nurse is conducting an assessment of a client who is suspected of having a brain tumor. Assessment reveals reports of a headache, for which the nurse gathers additional information. The nurse determines that these reports support the suspicion of a brain tumor when the client reports that the headache occurs: A. at bedtime. B. early in the morning. C. in the middle of the afternoon. D. around lunchtime.

B. early in the morning

A nurse has received an unconscious client with a traumatic brain injury (TBI). The nurse is concerned about the client's skin integrity and implements interventions to prevent pressure injuries. Which action should the nurse implement during the shift? A. Turning and repositioning the client every 6 hours B. Assisting the client to get out of bed to a chair four times a day. C. Assessing all body surfaces and documenting skin integrity every 8 hours D. Providing skin care with barrier care ointments once a day

C. Assessing all body surfaces and documenting skin integrity every 8 hours

A nursing student is writing a care plan for a newly admitted client who has been diagnosed with a stroke. What major nursing diagnosis should most likely be included in the client's plan of care? A. Adult failure to thrive B. Post-trauma syndrome C. Disturbed sensory perception D. Hyperthermia

C. Disturbed sensory perception

The nurse is writing a care plan for a client with brain metastases. The nurse decides that an appropriate nursing diagnosis is "anxiety related to lack of control over the health circumstances." In establishing this plan of care for the client, the nurse should include which intervention? A. Antianxiety medications every 4 hours B. Family instruction on planning the client's care C. Encouragement to verbalize concerns related to the disease and its treatment D. Intensive therapy with the goal of distraction

C. Encouragement to verbalize concerns related to the disease and its treatment

What should be included in the client's care plan when establishing an exercise program for a client affected by a stroke? A. Keep activity limited, as the client may be overstimulated. B. Schedule passive range of motion every other day. C. Exercise the affected extremities passively four or five times a day. D. Have the client perform active range-of-motion (ROM) exercises once a day.

C. Exercise the affected extremities passively four or five times a day.

A client diagnosed with a hemorrhagic stroke has been admitted to the neurologic ICU. The nurse knows that teaching for the client and family needs to begin as soon as the client is settled on the unit and will continue until the client is discharged. What will family education need to include? A. How to differentiate between hemorrhagic and ischemic stroke B. Techniques for adjusting the client's medication dosages at home C. How to correctly modify the home environment D. Risk factors for ischemic stroke

C. How to correctly modify the home environment

A client in the OR goes into malignant hyperthermia due to an abnormal reaction to the anesthetic. The nurse knows the brain regulates body temperature in which of the following areas? A. Midbrain B. Cerebellum C. Hypothalamus D. Thalamus

C. Hypothalamus

A nurse is planning the care of a 28-year-old client hospitalized with a diagnosis of myasthenia gravis. What approach would be most appropriate for the care and scheduling of diagnostic procedures for this client? A. Before meals, to stimulate the client's appetite B. All at one time, to provide a longer rest period C. In the morning, with frequent rest periods D. Before bedtime, to promote rest

C. In the morning, with frequent rest periods

The clinic nurse is caring for a client with a recent diagnosis of myasthenia gravis. The client has begun treatment with pyridostigmine bromide. What change in status would most clearly suggest a therapeutic benefit of this medication? A. Decreased pain B. Improved GI function C. Increased muscle strength D. Improved cognition

C. Increased muscle strength

The nurse is caring for a client with an upper motor neuron lesion. What clinical manifestations should the nurse anticipate when planning the client's neurologic assessment? A. Flaccid paralysis B. Slow reflexes C. Loss of voluntary control of movement D. Decreased muscle tone

C. Loss of voluntary control of movement

The neurologic ICU nurse is admitting a client with increased intracranial pressure. How should the nurse best position the client? A. Position the client supine. B. Maintain bed in Trendelenburg position. C. Maintain head of bed (HOB) elevated at 30 to 45 degrees. D. Position client in prone position.

C. Maintain head of bed (HOB) elevated at 30 to 45 degrees.

The staff educator is precepting a nurse new to the critical care unit when a client with a T2 spinal cord injury is admitted. The client is soon exhibiting manifestations of neurogenic shock. In addition to monitoring the client closely, what would be the nurse's most appropriate action? A. Place the client in the Trendelenburg position. B. Prepare an ice bath to lower core body temperature. C. Prepare for interventions to increase the client's BP. D. Prepare to transfuse packed red blood cells.

C. Prepare for interventions to increase the client's BP.

A gerontologic nurse planning the neurologic assessment of an older adult is considering normal, age-related changes that may influence the assessment results. Of what phenomenon should the nurse be aware? A. Increased cerebral metabolism B. Hyperactive deep tendon reflexes C. Reduction in cerebral blood flow D. Hypersensitivity to painful stimuli

C. Reduction in cerebral blood flow

What is the best rationale for health care providers receiving the influenza vaccination on a yearly basis? A. To decrease nurses' susceptibility to health care-associated infections B. To eventually eradicate the influenza virus in the United States C. To decrease risk of transmission to vulnerable clients D. To prevent the emergence of drug-resistant strains of the influenza virus

C. To decrease risk of transmission to vulnerable clients

Family members are caring for a client with HIV in the client's home. What should the nurse encourage family members to do to reduce the risk of infection transmission? A. Use separate dishes for the client and family members. B. Disinfect the client's bedclothes regularly. C. Use caution when shaving the client. D. Use separate bed linens for the client.

C. Use caution when shaving the client.

A client diagnosed with Bell palsy is having decreased sensitivity to touch of the involved nerve. What should the nurse recommend to prevent atrophy of the muscles? A. Smiling repeatedly B. Blowing up balloons C. Whistling D. Deliberately frowning

C. Whistling

A client with herpes simplex virus encephalitis (HSV) has been admitted to the ICU. What medication would the nurse expect the health care provider to order for the treatment of this disease process? A. Cyclobenzaprine B. Ampicillin C. Cyclosporine D. Acyclovir

D. Acyclovir

A client who has been on long-term phenytoin therapy is admitted to the unit. In light of the adverse of effects of this medication, the nurse should prioritize which of the following in the client's plan of care? A. Administration of a low-protein diet B. Fluid restriction as prescribed C. Monitoring of pulse oximetry D. Administration of thorough oral hygiene

D. Administration of thorough oral hygiene

A nurse is assisting a client who had a recent stroke with getting dressed for physical therapy. The client looks at each piece of clothing before putting it on the body. The client states, "This is how I know what item I am holding." What impairment is this client likely experiencing? A. Receptive aphasia B. Homonymous hemianopsia C. Hemiplegia D. Agnosia

D. Agnosia

The nurse is caring for a client who had a hemorrhagic stroke. What assessment finding constitutes an early sign of deterioration? A. Shortness of breath B. Generalized pain C. Tonic-clonic seizures D. Alteration in level of consciousness (LOC)

D. Alteration in level of consciousness (LOC)

The nurse is caring for a client whose recent health history includes an altered LOC. What should be the nurse's first action when assessing this client? A. Assessing the client's response to pain B. Assessing the client's ability to follow complex commands C. Assessing the client's judgment D. Assessing the client's verbal response

D. Assessing the client's verbal response

The nurse is discharging a client home after surgery for trigeminal neuralgia. What advice should the nurse provide to this client in order to reduce the risk of injury? A. Rinse the eye on the affected side with normal saline daily for 1 week. B. Avoid watching television or using a computer for more than 1 hour at a time. C. Use over-the-counter antibiotic eye drops for at least 14 days. D. Avoid rubbing the eye on the affected side of the face.

D. Avoid rubbing the eye on the affected side of the face.

The nurse is caring for a client whose spinal cord injury has caused recent muscle spasticity. What medication should the nurse expect to be prescribed to control this? A. Dexamethasone B. Phenobarbital C. Mannitol D. Baclofen

D. Baclofen

The nurse is planning the care of a client with a T1 spinal cord injury. The nurse has identified the diagnosis of "risk for impaired skin integrity." How can the nurse best address this risk? A. Teach the client deep breathing and coughing exercises. B. Provide a high-protein diet. C. Provide light massage at least daily. D. Change the client's position frequently.

D. Change the client's position frequently.

A client has presented at the ED with copious diarrhea and accompanying signs of dehydration. During the client's health history, the nurse learns that the client recently ate oysters from the Gulf of Mexico. The nurse should recognize the need to have the client's stool cultured for microorganisms associated with what disease? A. Legionnaire disease B. Ebola C. West Nile virus D. Cholera

D. Cholera

The nurse is assessing a client with a suspected stroke. What assessment finding is most suggestive of a stroke? A. Periorbital edema B. Projectile vomiting C. Dysrhythmias D. Facial droop

D. Facial droop

The nurse is planning the care of a client who has been recently diagnosed with a cerebellar tumor. Due to the location of this client's tumor, the nurse should implement measures to prevent what complication? A. Labile BP B. Respiratory depression C. Audio hallucinations D. Falls

D. Falls

When preparing to discharge a client home, the nurse has met with the family and warned them that the client may exhibit unexpected emotional responses. The nurse should teach the family that these responses are typically a result of what cause? A. Temporary changes in metabolism B. Changes in brain activity during sleep and wakefulness C. Unmet physiologic needs D. Frustration around changes in function and communication

D. Frustration around changes in function and communication

A client has been admitted to the neurologic ICU with a diagnosis of a brain tumor. The client is scheduled to have a tumor resection/removal in the morning. Which of the following assessment parameters should the nurse include in the initial assessment? A. Hearing acuity B. Deep tendon reflexes C. Abdominal girth D. Gag reflex

D. Gag reflex

A client has experienced a seizure in which she became rigid and then experienced alternating muscle relaxation and contraction. What type of seizure does the nurse recognize? A. Absence seizure B. Unclassified seizure C. Focal seizure D. Generalized seizure

D. Generalized seizure

The nurse is caring for a client who is scheduled for a cervical discectomy the following day. During health education, the client should be made aware of what potential complications? A. Renal trauma B. Vertebral fracture C. Scoliosis D. Hematoma at the surgical site

D. Hematoma at the surgical site

The nurse is conducting a focused neurologic assessment and is assessing the client's gag reflex. How should the nurse best perform this aspect of the assessment? A. Ask the client to swallow a small quantity of any soft food. B. Depress the client's tongue with a sterile tongue depressor. C. Observe the client swallowing a small mouthful of water. D. Lightly touch the client's pharynx with a cotton swab.

D. Lightly touch the client's pharynx with a cotton swab.

A client is admitted to the neurologic intensive care unit (ICU) with a suspected diffuse axonal injury. Which primary neuroimaging diagnostic tool would be used on this client to evaluate the brain structure? A. X-ray of the head B. Ultrasound of the head C. Positron emission tomography (PET) scan D. Magnetic resonance imaging (MRI)

D. Magnetic resonance imaging (MRI)

A client is brought to the ED by family after falling off the roof. The care team suspects an epidural hematoma, prompting the nurse to anticipate for which priority intervention? A. Administration of anticoagulant therapy B. Insertion of an intracranial monitoring device C. Treatment with antihypertensives D. Making openings in the skull

D. Making openings in the skull

The nurse is caring for a boy who has muscular dystrophy. When planning assistance with the client's ADLs, what goal should the nurse prioritize? A. Ensuring the client's adherence to treatment B. Promoting the client's recovery from the disease C. Fostering the family's participation in care D. Maximizing the client's level of function

D. Maximizing the client's level of function

A client with increased intracranial pressure (ICP) has a ventriculostomy for monitoring ICP. The nurse's most recent assessment reveals that the client is now exhibiting nuchal rigidity and photophobia. The nurse would be correct in suspecting the presence of what complication? A. Cerebral spinal fluid leak B. Catheter occlusion C. Encephalitis D. Meningitis

D. Meningitis

The critical care nurse is caring for 25-year-old admitted to the ICU with a brain abscess. What is a priority nursing responsibility in the care of this client? A. Providing health education B. Maintaining the client's functional independence C. Promoting mobility D. Monitoring neurologic status closely

D. Monitoring neurologic status closely

Following a spinal cord injury, a client is placed in halo traction. While performing pin site care, the nurse notes that one of the traction pins has become detached. The nurse would be correct in implementing what priority nursing action? A. Stabilize the head in a lateral position. B. Reattach the pin to prevent further head trauma. C. Complete the pin site care to decrease risk of infection. D. Notify the neurosurgeon of the occurrence.

D. Notify the neurosurgeon of the occurrence.

A client presents to the clinic reporting a headache. The nurse notes that the client is guarding the neck and tells the nurse about stiffness in the neck area. The nurse suspects the client may have meningitis. What is another well-recognized sign of this infection? A. Hyperpatellar reflex B. Negative Brudzinski sign C. Sluggish pupil reaction D. Positive Kernig sign

D. Positive Kernig sign

A client with a recent stroke history is admitted to a rehabilitation unit and placed on high fall risk precautions. The client is impulsive, easily distracted, frequently forgets his/her cane when walking, and the location of his/her room. What stroke conditions do these signs best indicate? A. Left hemispheric stroke B. Ischemic stroke C. Hemorrhagic stroke D. Right hemispheric stroke

D. Right hemispheric stroke

A client with metastatic cancer has developed trigeminal neuralgia and is taking carbamazepine for pain relief. What principle applies to the administration of this medication? A. The medication should be first taken in the maximum dosage form to be effective. B. Carbamazepine is not known to have serious adverse effects. C. Side effects of the medication include renal dysfunction. D. The client should be monitored for bone marrow depression.

D. The client should be monitored for bone marrow depression.

A client recovering from a stroke has severe shoulder pain from subluxation of the shoulder. To prevent further injury and pain, the nurse caring for this client is aware of what principle of care? A. The client should be fitted with a cast because use of a sling should be avoided due to adduction of the affected shoulder. B. Passively exercising the affected extremity is avoided in order to minimize pain. C. Elevation of the arm and hand can lead to further complications associated with edema. D. The client should be taught to interlace fingers, place palms together, and slowly bring scapulae forward to avoid excessive force to shoulder.

D. The client should be taught to interlace fingers, place palms together, and slowly bring scapulae forward to avoid excessive force to shoulder.

A nurse is educating a group of students about stages of syphilis. Which is true for secondary syphilis? A. Multiple organ involvement occurs. B. Chancres will resolve without treatment. C. Neurological symptoms occur. D. Transmission can occur with contact with chancres.

D. Transmission can occur with contact with chancres.

The nurse planning caring for a client diagnosed with Guillain-Barré syndrome. The nurse's communication with the client should reflect the possibility of which sign or symptom of the disease? A. Tongue enlargement B. Tinnitus C. Intermittent hearing loss D. Vocal paralysis

D. Vocal paralysis

A nurse is caring for a child who was admitted to the pediatric unit with infectious diarrhea. The nurse should be alert to what assessment finding as an indicator of dehydration? A. Fever B. Labile BP C. Diaphoresis D. Weak pulse

D. Weak pulse

A client comes to the clinic for an evaluation. During the visit, the client reports a fever, malaise, hair loss, and weight loss. Further assessment reveals lymphadenopathy. The client also reports a penile ulcer that appeared about 4 weeks ago but went away. The nurse suspects the client may have syphilis and interprets the client's assessment findings as suggestive of which stage of this disease? A. primary B. tertiary C. latent D. secondary

D. secondary