Perfusion

Which of the following are sympathetic effects of the nervous system? a) Decreased respiratory rate b) Dilated pupils c) Decreased blood pressure d) Increased peristalsis

b

An emergency department nurse is interviewing a client with signs of an ischemic stroke that began 2 hours ago. The client reports that she had a cholecystectomy 6 weeks ago and is taking digoxin, coumadin, and labetelol. This client is not eligible for thrombolytic therapy for which of the following reasons? a) She had surgery 6 weeks ago. b) She is not within the treatment time window. c) She is taking coumadin. d) She is taking digoxin.

c

A client who has sustained a head injury to the parietal lobe cannot identify a familiar object by touch. The nurse knows that this deficit is which of the following? a) Positive Romberg b) Ataxia c) Visual agnosia d) Tactile agnosia

d

Which of the following values is a normal intracranial pressure in mm Hg? a) 5 b) 21 c) 9 d) 12

d ICP is usually measured in the lateral ventricles, with the normal pressure being 10 to 20 mm Hg

Thrombolytic therapy should be initiated within what time frame of an ischemic stroke for best functional outcome? a) 3 hours b) 6 hours c) 9 hours d) 12 hours

a

Which of the following areas of the brain are responsible for temperature regulation? a) Pons b) Hypothalamus c) Medulla d) Thalamus

b

A nurse assesses the patient's level of consciousness using the Glasgow Coma Scale. What score indicates severe impairment of neurologic function? a) 9 b) 15 c) 6 d) 3

d

A female client is being treated for increased intracranial pressure (ICP). Why should the nurse ensure that the client does not develop hypothermia? Choose the correct option. a) Because shivering in hypothermia can increase ICP b) Because hypothermia can cause death to the client c) Because hypothermia is indicative of malaria d) Because hypothermia is indicative of severe meningitis

a

A male patient is scheduled for an EEG. The patient asks about any diet-related prerequisites that he must take. Which of the following diet-related advice should the nurse provide to the patient? a) Avoid taking sedative drugs or drinks that contain caffeine for at least 8 hours prior to the test. b) Include increased amount of minerals in the diet. c) Decrease the amount of minerals in the diet. d) Avoid eating food at least 8 hours prior to the test.

a

Which of the following types of posturing is exhibited by abnormal flexion of the upper extremities and plantar flexion of the feet? a) Decorticate b) Decerebrate c) Flaccid d) Normal

a

The nurse is providing information about strokes to a community group. Which of the following would the nurse identify as the primary initial symptoms of an ischemic stroke? a) Severe headache and early change in level of consciousness b) Vomiting and seizures c) Weakness on one side of the body and difficulty with speech d) Footdrop and external hip rotation

c

Which of the following is accurate regarding a hemorrhagic stroke? a) Functional recovery usually plateaus at 6 months. b) It is caused by a large-artery thrombosis. c) One of the main presenting symptoms is numbness or weakness of the face. d) Main presenting symptom is an "exploding headache."

d

Which of the following is the earliest sign of increasing ICP? a) Posturing b) Headache c) Vomiting d) Change in level of consciousness (LOC)

d

Which of the following is the most common motor dysfunction seen in patients diagnosed with stroke? a) Hemiparesis b) Diplopia c) Ataxia d) Hemiplegia

d

A nurse is caring for a client with an injury to the central nervous system. When caring for a client with a spinal cord insult slowing transmission of the motor neurons, which deficits are anticipated? a) A delayed reaction in response due to the interrupted impulses from the central nervous system b) A delayed reaction in cognitive ability to understand the relayed information c) A delayed reaction in processing the information transferred from the environment d) A delayed reaction in identification of information due to slowed passages of information to brain

a

Which is the priority nursing diagnosis when caring for a patient with increased ICP who has an intraventricular catheter? a) Ineffective cerebral tissue perfusion b) Risk for infection c) Fluid volume deficit d) Risk for injury

a

Which of the following safety actions will the nurse implement for a patient receiving oxygen therapy who is undergoing magnetic resonance imaging (MRI)? a) Ensure that no patient care equipment containing metal enters the room where the MRI table is located. b) Check the patient's oxygen saturation level using a pulse oximeter after the patient has been placed on the MRI table. c) Note that no special safety actions need to be taken. d) Securely fasten the patient's portable oxygen tank to the bottom of the MRI table after the patient has been positioned on the top of the MRI tabl

a

You are caring for a client admitted with a stroke. Imaging studies indicate an embolus partially obstructing the right carotid artery. What type of stroke do you know this client has? a) Ischemic b) Right-sided c) Left-sided d) Hemorrhagic

a

A patient with increased ICP has a cerebral perfusion pressure (CPP) of 40 mm Hg. How should the nurse interpret the CPP? a) The CPP is low. b) The CPP is high. c) The CPP reading is inaccurate. d) The CPP is within normal limits.

a The normal CPP is 70 to 100 mm Hg.

64-year-old client reports symptoms consistent with a transient ischemic attack (TIA) to the physician in the emergency department. After completing ordered diagnostic tests, the physician indicates to the client what caused the symptoms that brought him to the hospital. What is the origin of the client's symptoms? a) Cardiac disease b) Impaired cerebral circulation c) Hypertension d) Diabetes insipidus

b

A client is admitted for evaluation of cerebral aneurysm. Which assessment finding is of greatest importance in prioritizing nursing care to this client? a) No bowel movement since yesterday b) Nausea c) Frequent voiding d) Complaint of headache off and on for past month

b

A nurse is preparing a client for a lumbar puncture. The client has heard about post-lumbar puncture headaches and asks what causes them. The nurse tells the client that these headches are caused by which of the following? a) Not ambulating soon enough after the procedure b) Cerebral spinal fluid leakage at the puncture site c) Traumatic puncture d) Damage to the spinal cord

b

A nurse working on a medical-surgical floor walks into a patient's room to find the patient with an altered level of consciousness (LOC). Which of the following nursing diagnoses would be the first priority for the plan of care? a) Risk for impaired skin integrity related to prolonged immobility b) Ineffective airway clearance related to altered LOC c) Risk of injury related to decreased LOC d) Deficient fluid volume related to inability to take fluids by mouth

b

If warfarin is contraindicated as a treatment for stroke, which of the following medication is the best option? a) Dipyridamole (Persantine) b) Aspirin c) Ticlodipine (Ticlid) d) Clopidogrel (Plavix)

b

Which of the following is a nonmodifiable risk factor for ischemic stroke? a) Atrial fibrillation b) Gender c) Smoking d) Hyperlipidemia

b

The nurse is assessing the client's pupils following a sports injury. Which of the following assessment findings indicates a neurologic concern? Select all that apply. a) Pupil reacts to light b) Pinpoint pupils c) Absence of pupillary response d) Unequal pupils e) Pupil reaction quick

b, c, d

Which of the following are contraindications for the administration of tissue plasminogen activator (t-PA)? Select all that apply. a) Age 18 years or older b) Intracranial hemorrhage c) Ischemic stroke d) Major abdominal surgery within 10 days e) Systolic BP less than or equal to 185 mm Hg

b, d

A nurse is instructing the wife of a patient who suffered a stroke about the use of eating devices her husband will be using. During the teaching, the wife starts to cry and states "One minute my husband is laughing, and the next he's crying; I just don't understand what's wrong with him." The nurse's best response is which of the following? a) "You sound stressed; maybe using some stress management techniques will help." b) "You seem upset, and it may be hard for you to focus on the teaching, I'll come back later." c) "Following a stroke, emotional lability is common, and it usually improves with time." d) "This behavior is common in stroke patients. Which does your husband do more often? Laugh or cry?"

c

A nurse working on a medical-surgical floor walks into a patient's room to find the patient with an altered level of consciousness (LOC). Which of the following actions would be the first priority? a) Determination of the cause b) Assessment of pupillary light reflexes c) Maintenance of a patent airway d) Positioning to prevent complications

c

Following the use of a thrombolytic agent in the management of cerebrovascular accident (CVA) client, which is the priority nursing assessment? a) Pulse b) Respirations c) Blood pressure d) Airway

c

How often should neurologic assessments and vital signs be taken initially for the patient receiving tissue plasminogen activator (tPA)? a) Every 45 minutes b) Every 30 minutes c) Every 15 minutes d) Every hour

c

The physician's office nurse is caring for a client who has a history of a cerebral aneurysm. Which diagnostic test does the nurse anticipate to monitor the status of the aneurysm? a) Electroencephalogram b) Myelogram c) Cerebral angiography d) Echoencephalography

c

Which of the following is a modifiable risk factor for transient ischemic attacks and ischemic strokes? a) Thyroid disease b) Advanced age c) History of smoking. d) Social drinking

c

Which of the following is an inaccurate manifestation of Cushing's triad? a) Hypertension b) Bradypnea c) Tachycardia d) Bradycardia

c

Which of the following is indicative of a right hemisphere stroke? a) Aphasia b) Altered intellectual ability c) Spatial-perceptual deficits d) Slow, cautious behavior

c

Which of the following is the initial diagnostic in suspected stroke? a) Cerebral angiography b) Magnetic resonance imaging (MRI) c) Noncontrast computed tomography (CT) d) CT with contrast

c

Which of the following should be avoided in patients with increased ICP? a) Suctioning b) Minimal environmental stimuli c) Enemas d) Position changes

c

Which of the following symptoms characterizes Korsakoff syndrome? a) Tremor, rigidity, and bradykinesia b) Choreiform movement and dementia c) Psychosis, disorientation, delirium, insomnia, and hallucinations d) Severe dementia and myoclonus

c

Which of the following terms refers to blindness in the right or left halves of the visual fields of both eyes? a) Diplopia b) Scotoma c) Homonymous hemianopsia d) Nystagmus

c

Which of the following would not be a recommended intervention for a patient with dysphagia? a) Allow ample time to eat b) Assist patient with meals c) Place food on the affected side of mouth d) Test gag reflex prior to offering food or fluids

c

While providing information to a community group, the nurse tells them the primary initial symptoms of a hemorrhagic stroke are: a) Weakness on one side of the body and difficulty with speech b) Footdrop and external hip rotation c) Severe headache and early change in level of consciousness d) Confusion or change in mental status

c

A nurse is continually monitoring a client with a traumatic brain injury for signs of increasing intracranial pressure. The cranial vault contains brain tissue, blood, and cerebrospinal fluid; an increase in any of the components causes a change in the volume of the others. This hypothesis is called which of the following? a) Hashimoto's disease b) Dawn phenomenon c) Cushing's d) Monro-Kellie

d

A patient is admitted to the hospital for management of an extrapyramidal disorder. Included in the physician's admitting orders are the medications levodopa, Cogentin, and Eldepryl. The nurse knows that most likely, the client has a diagnosis of ________. a) Multiple sclerosis b) Huntington's disease c) Seizure disorder d) Parkinson's disease

d

A patient with neurologic infection develops cerebral edema from syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following is an important nursing action for this patient? a) Maintaining adequate hydration b) Hyperoxygenation before and after tracheal suctioning c) Administering prescribed antipyretics d) Restricting fluid intake and hydration

d

Structural and motor changes related to aging that may be assessed in geriatric patients during an examination of neurologic function include which of the following? a) Increased pupillary responses b) Increased autonomic nervous system responses c) Enhanced reaction and movement times d) Decreased or absent deep tendon reflexes

d

The nurse is caring for a patient diagnosed with a hemorrhagic stroke. The nurse recognizes that which of the following interventions is most important? a) Monitoring for seizure activity b) Administering a stool softener c) Elevating the head of the bed at 30 degrees d) Maintaining a patent airway

d

The nurse is performing a neurological assessment of a client who has sustained damage to the frontal cortex. Which of the following deficits will the nurse look for during assessment? a) Absence of movement below the waist b) Intentional tremors c) The inability to maintain steady balance for the Romberg test d) The inability to tell how a mouse and a cat are alike

d

The nurse is preparing a client for a neurological examination by the physician and explains tests the physician will be doing, including the Romberg test. The client asks the purpose of this particular test. The correct reply by the nurse is which of the following? a) "It is a test for muscle strength." b) "It is a test for coordination." c) "It is a test for motor ability." d) "It is a test for balance."

d

Which neurotransmitter demonstrates inhibitory action, helps control mood and sleep, and inhibits pain pathways? a) Norepinephrine b) Enkephalin c) Acetylcholine d) Serotonin

d

Which of the following occurs when reflexes are hyperactive when the foot is abruptly dorsiflexed? a) Rigidity b) Ataxia c) Flaccidity d) Clonus

d

Which of the following cerebral lobes contains the auditory receptive areas? a) Temporal b) Occipital c) Parietal d) Frontal

a

Lillian Anderson, a 73-year-old retired dancer, is being seen by a neurologist in the group where you practice nursing. She reports light-headedness, speech disturbance, and left-sided weakness, which lasted for several hours. The neurologist diagnosed a transient ischemic attack, which caused Ms. Anderson great concern. During your client education with Ms. Anderson, you would include which of the following? a) Symptoms of a TIA may linger for up to a week. b) When symptoms cease, she will return to her presymptomatic state. c) Two thirds of people that experience a TIA will go on to develop a stroke. d) A TIA is an insidious, often chronic episode of neurologic impairment

b

Which of the following positions are employed to help reduce intracranial pressure (ICP)? a) Rotating the neck to the far right with neck support b) Keeping the head flat with use of no pillow c) Extreme hip flexion supported by pillows d) Avoiding flexion of the neck with use of a cervical collar

d

Which of the following terms is used to describe the fibrous connective tissue that covers the brain and spinal cord? a) Pia mater b) Dura mater c) Arachnoid mater d) Meninges

d

A 73-year-old client is visiting the neurologist. The client reports light-headedness, speech disturbance, and left-sided weakness that have lasted for several hours. In the examination, an abnormal sound is auscultated in an artery leading to the brain. What is the term for the auscultated discovery? a) Diplopia b) Bruit c) Atherosclerotic plaque d) TIA

b

Aneurysm rebleeding occurs most frequently during which time frame after the initial hemorrhage? a) First month b) First week c) First 2 weeks d) First 48 hours

c

A client is exhibiting signs of increasing intracranial pressure (ICP). Which intravenous solution (IV) would the nurse anticipate hanging? a) Mannitol(Osmitrol) b) Dextrose 5% in water (D5W) c) Half-normal saline (0.45% NSS) d) One-third normal saline (0.33% NSS)

a

A nurse and nursing student are caring for a client recovering from a lumbar puncture yesterday. The client reports a headache despite being on bedrest overnight. The physician plans an epidural blood patch this morning. The student asks how this will help the headache. The correct reply from the nurse is which of the following? a) "The blood will seal the hole in the dura and prevent further loss of cerebral spinal fluid." b) "The blood will replace the cerebral spinal fluid that has leaked out." c) "The blood can repair damage to the spinal cord that occurred with the procedure." d) "The blood provides moisture at the site, which encourages healing."

a

A patient is experiencing severe pain related to increased ICP. You are about to administer an analgesic. Which of the following would you expect to be ordered for this client to help alleviate pain? a) Codeine b) Hydrocodone c) Morphine d) Fentanyl

a

An osmotic diuretic, such as mannitol, is given to the patient with increased intracranial pressure (IICP) for which of the following therapeutic effects? a) To dehydrate the brain and reduce cerebral edema b) To lower uncontrolled fevers c) To increase urine output d) To reduce cellular metabolic demands

a

The nurse is caring for a client with a traumatic brain injury who has developed increased intracranial pressure resulting in syndrome of inappropriate antidiuretic hormone (SIADH). While assessing this client, the nurse expects which of the following findings? a) Oliguria and serum hyponatremia b) Excessive urine output and serum hyponatremia c) Excessive urine output and decreased urine osmolality d) Oliguria and serum hyperosmolarity

a

The nurse is caring for a patient with a history of transient ischemic attacks (TIAs) and moderate carotid stenosis who has undergone a carotid endarterectomy. Which of the following postoperative findings would cause the nurse the most concern? a) Difficulty swallowing b) Blood pressure (BP): 128/86 mm Hg c) Neck pain: 3/10 (0 to 10 pain scale) d) Mild neck edema

a

Which of the following antiseizure medication has been found to be effective for post-stroke pain? a) Lamotrigine (Lamictal) b) Carbamazepine (Tegretol) c) Topiramate (Topamax) d) Phenytoin (Dilantin)

a

Which of the following is the chief cause of intracerebral hemorrhage (ICH)? a) Uncontrolled hypertension b) Migraine headaches c) Diabetes d) Hypercholesterolemia

a

A client has experienced an ischemic stroke that has damaged the frontal lobe of his brain. Which of the following deficits does the nurse expect to observe during assessment? a) Visual and auditory agnosia b) Limited attention span and forgetfulness c) Lack of deep tendon reflexes d) Hemiplegia or hemiparesis

b

A female patient has undergone a lumbar puncture for a neurological assessment. The patient is put under the postprocedure care of a nurse. Which of the following important postprocedure nursing interventions should be performed to ensure maximum comfort to the patient? a) Keep the room brightly lit and play soothing music in the background b) Encourage a liberal fluid intake for the patient c) Administer antihistamines according to the physician's prescription d) Help the patient take a brisk walk around the testing area

b

A nurse is caring for a client with deteriorating neurologic status. The nurse is performing an assessment at the beginning of the shift that reveals a falling blood pressure and heart rate, and the client makes no motor response to stimuli. Which documentation of neuromuscular status is most appropriate? a) Decorticate posturing b) Flaccidity c) Weak muscular tone d) Abnormal posture

b

A patient has been diagnosed as having global aphasia. The nurse recognizes that the patient will be unable to do which of the following actions? a) Comprehend the spoken word b) Form words that are understandable or comprehend the spoken word c) Speak at all d) Form words that are understandable

b

An unresponsive patient is brought to the ED by a family member. The family states, "We don't know what happened." Which of the following is the priority nursing intervention? a) Assess Glasgow Coma Scale. b) Assess for a patent airway. c) Assess vital signs. d) Assess pupils.

b

In your assessment of a 39-year-old victim of a motor vehicle collision, he directly and accurately answers your questions. Beginning at his head, you note a contusion to his forehead; the client reports a headache. As you assess his pupils, what reaction would confirm your suspicion of increasing intracranial pressure? a) Rapid response b) Unequal response c) Constricted response d) Equal response

b

The family nurse practitioner is performing the physical examination of a client with a suspected neurologic disorder. In addition to assessing other parts of the body, the nurse should assess for neck rigidity. Which method should help the nurse assess for neck rigidity correctly? a) Moving the head toward both sides b) Moving the head and chin toward the chest c) Lightly tapping the lower portion of the neck to detect sensation d) Gently pressing the bones on the neck

b

The nurse is assessing the mental status of a patient. Which of the following questions will the nurse include in the assessment? a) "Can you write your name on this piece of paper?" b) "Who is the president of the United States?" c) "Are you having hallucinations now?" d) "Can you count backward from 100?"

b

The nurse is caring for a client with a significant allergy history to various medications and shellfish. Because the client needs to have a diagnostic study with contrast, which medication classification is anticipated? a) Bronchodilator b) Antihistamine c) Cardio tonic d) Antibiotic

b

The nurse is caring for a patient with aphasia. Which of the following strategies will the nurse use to facilitate communication with the patient? a) Speaking loudly b) Establishing eye contact c) Speaking in complete sentences d) Avoiding the use of hand gestures

b

Which of the following is the most common side effect of tissue plasminogen activator (tPA)? a) Hypertension b) Bleeding c) Headache d) Increased intracranial pressure (ICP)

b

Which of the following positions should be utilized after supratentorial intracranial surgery? a) Body and head aligned b) Supine position with head slightly elevated c) Sitting position d) Bed rest with a firm mattress and bed board

b

Which of the following terms refers to the inability to coordinate muscle movements, resulting difficulty walking? a) Rigidity b) Ataxia c) Spasticity d) Agnosia

b

A client with a history of atrial fibrillation has experienced a TIA. In an effort to reduce the risk of cerebrovascular accident (CVA), the nurse anticipates the medical treatment to include which of the following? a) Carotid endarterectomy b) Monthly prothrombin levels c) Anticoagulant therapy d) Cholesterol-lowering drugs

c

A critical care nurse is documenting her assessment of a client she is caring for. The client is status postresection of a brain tumor. The nurse documents that the client is flaccid on the left. What does this mean? a) The client is hyperresponsive on the left. b) The client has an abnormal posture response to stimuli. c) The client is not responding to stimuli. d) The client is hyporesponsive on the left.

c

A nurse is preparing to administer an antiseizure medication to a client. Which of the following is an appropriate antiseizure medication? a) Labetalol b) Lamisil c) Lamictal d) Lomotil

c

A patient diagnosed with a stroke is having difficulty forming words during communication. This would be appropriately documented as which of the following? a) Diplopia b) Receptive aphasia c) Dysarthria d) Dysphagia

c

A patient is actively hallucinating during an assessment. The nurse would be correct in documenting the hallucination as a disturbance in which of the following? a) Motor ability b) Emotional status c) Thought content d) Intellectual function

c

Which of the following are used to help reduce ICP? a) Extreme hip flexion supported by pillows b) Keeping the head of bed flat c) Using a cervical collar d) Rotating the neck to the far right with neck support

c

A client has experienced an ischemic stroke that has damaged the temporal (lateral and superior portions) lobe. Which of the following deficits would the nurse expect during assessment of this client? a) Limited attention span and forgetfulness b) Hemiplegia or hemiparesis c) Lack of deep tendon reflexes d) Auditory agnosia

d

In reviewing a client's history and physical examination, a nurse finds that the client was found positive for ataxia during the physician's neurological testing. Which nursing diagnosis will be a priority for this client? a) Autonomic dysreflexia b) Risk for falls c) Risk for infection d) Deficient fluid volume

d

Which of the following clinical manifestations would be exhibited by a patient following a hemorrhagic stroke of the right hemisphere? a) Inability to move the right arm b) Neglect of the side opposite to the hemisphere affected c) Expressive aphasia d) Neglect of the left side

d

Which of the following is a contraindication for the administration of tissue plasminogen activator (t-PA)? a) Age 18 years of age or older b) Systolic blood pressure less than or equal to 185 mm Hg c) Ischemic stroke d) Intracranial hemorrhage

d

Which of the following terms refer to a method of recording, in graphic form, the electrical activity of the muscle? a) Electroencephalogram b) Electrocardiography c) Electrogastrography d) Electromyogram

d

Which of the following terms refer to the inability to perform previously learned purposeful motor acts on a voluntary basis? a) Agnosia b) Perseveration c) Agraphia d) Apraxia

d

he nurse is aware that burr holes may be used in neurosurgical procedures. Which of the following is a reason why a neurosurgeon may choose to create a burr hole in a patient? a) Access for intravenous (IV) fluids b) Visualization of a hemorrhage c) To assess visual acuity d) Aspiration of a brain abscess

d