Chapter 14: Care of the Patient with a Neurologic Disorder

A patient has recently suffered a stroke with left-sided weakness and has problems with choking, especially when drinking thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely? a. Use a straw b. Tuck chin when swallowing c. Take a sip of liquid with each bite d. Turn head to the left

B. Tuck chin when swallowing

What is the basic problem that prompts most of the early signs of Alzheimer disease? a. Changes in mood b. Misplacing things c. Memory loss that disrupts daily life d. Problems with words in speaking

C. Memory loss that disrupts daily life

What is the purpose of a "drug holiday" in the treatment of Parkinson disease? a. Change all drugs b. Allow the natural dopamine levels to rise c. Restart drugs at a lower dosage with favorable results d. Reduce the extrapyramidal symptoms

C. Restart drugs at a lower dosage with favorable results

What Glasgow Coma Scale rating would a patient receive who opens the eyes spontaneously, but has incomprehensible speech and obeys commands for movement? a. 8 b. 10 c. 11 d. 12

D. 12

An 83-year-old patient has had a stroke. He is right-handed and has a history of hypertension and "little" strokes. He presents with right hemiplegia. To afford him the best visual field, the nurse should approach him: a. from the right side. b. from the left side. c. from the center. d. from either side.

B. From the left side.

A frantic family member is distressed about the flaccid paralysis of her son following a spinal cord injury several hours ago. What does the nurse know about this condition? a. It is an ominous indicator of permanent paralysis. b. It is possibly a temporary condition and will clear. c. It degenerates into a spastic paralysis. d. It will progress up the cord to cause seizures.

B. It is possibly a temporary condition and will clear.

What are the effects of normal aging on the nervous system? (Select all that apply.) a. Small vessel occlusion b. Loss of neurons c. Calcification of cerebrum d. Reduction of cerebral blood flow e. Lipofuscin f. Decrease in oxygen use

B. Loss of neurons D. Reduction of cerebral blood flow E. Lipofuscin F. Decrease in oxygen use

Following a myelogram the nurse should include in the postprocedure care assessment for: a. elevation of blood pressure. b. urine retention. c. sensation in lower extremities. d. slurred speech.

C. Sensation in lower extremities.

What are the two divisions of the nervous system? a. Somatic and the autonomic b. Cerebellum and the brainstem c. Medulla oblongata and the diencephalon d. Central and the peripheral

D. Central and the peripheral

The waxy substance that covers the neuron fibers and increases the rate of transmission of impulses is the ________. a. sheet b. synaptic c. arachnoid d. myelin

D. myelin

What is the cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and also carries motor fibers to glands that produce digestive juices and other secretions? a. Somatic motor nerve b. Visceral sensory nerve c. Abducens nerve d. Vagus nerve

D. Vagus nerve

The nurse assures an anxious family member of a 92-year-old patient who is demonstrating signs of dementia that many causes of dementia are reversible and preventable. What is one example? a. Hypotension b. Alzheimer disease c. Diabetes d. Parkinson disease

A. Hypotension

A patient is in which stage of Alzheimer disease when she demonstrates "sundowning"? a. Early stage b. Second stage c. Third stage d. Final stage

B. Second stage

The nurse is aware that the drug t-PA (Activase), a tissue plasminogen activator, must be given in____hours of the onset of symptoms to have maximum benefit. a. 3 hours b. 4 hours c. 6 hours d. 8 hours

A. 3 hours

What are surgical navigational systems? a. Computerized devices that guide the surgeon b. A set of detailed anatomic maps pinpointing specific areas of the brain c. A written set of progressive processes for the resection of small brain tumors d. The use of radioactive materials to pinpoint small tumors of the brain

A. Computerized devices that guide the surgeon

What is the reticular activating system (RAS) essential to? (Select all that apply.) a. Concentration b. Wakefulness c. Speech d. Attention e. Memory f. Introspection

A. Concentration B. Wakefulness D. Attention F. Introspection

The newly admitted patient to the emergency room 30 minutes ago after a fall off a ladder has gradually decreased in consciousness and has slowly reacting pupils, a widening pulse pressure, and verbal responses that are slow and unintelligible. What is the most appropriate position for the patient? a. Neck placed in a neutral position b. Head raised slightly with hips flexed c. Supine in gravity neutral position d. Turn on right side with head elevated

A. Neck placed in a neutral position

_________________ is/are responsible for the transmission of impulses between synapses. a. Neurotransmitters b. Dopamine c. Neurons d. Brain

A. Neurotransmitters

How would a nurse record the behavior when a patient with Alzheimer disease attempts to eat using a napkin rather than a fork? a. Apraxia b. Agnosia c. Aphasia d. Dysphagia

B. Agnosia

The nurse explains that the two divisions of the autonomic nervous system work to maintain homeostasis. Place in order the autonomic events. (Separate letters by a comma and space as follows: A, B, C, D) a. Parasympathetic nervous system dominates b. Extremely stressful or frightening event c. Blood pressure, heart rate, and adrenaline output decrease d. Sympathetic nervous system dominates e. Heart rate and blood pressure rise, secretion of adrenaline

B. Extremely stressful or frightening event D. Sympathetic nervous system dominates E. Heart rate and blood pressure rise, secretion of adrenaline A. Parasympathetic nervous system dominates C. Blood pressure, heart rate, and adrenaline output decrease

A ___________ is a diagnostic procedure used to identify lesions by observing the flow of radiopaque dye through the subarachnoid space. a. Diagram b. Myelogram c. X-Ray d. Fluoroscopy

B. Myelogram

What should the nurse do when the child arrives on the floor with the diagnosis of bacterial meningitis? a. Arrange for humidified oxygen per mask b. Place the child in respiratory isolation c. Inquire about drug allergy d. Hold NPO until orders arrive

B. Place the child in respiratory isolation

As the result of a stroke, a patient has difficulty discerning the position of his body without looking at it. In the nurse's documentation, which would best describe the patient's inability to assess spatial position of his body? a. Agnosia b. Proprioception c. Apraxia d. Sensation

B. Proprioception

The nurse is aware that the characteristic gait of the person with Parkinson disease is a propulsive gait, which causes the patient to: a. stagger and need support of a walker. b. shuffle with arms flexed. c. fall over to one wide when walking. d. take small steps balanced on the toes.

B. Shuffle with arms flexed.

Which question is likely to elicit the most valid response from the patient who is being interviewed about a neurologic problem? a. "Do you have any sensations of pins and needles in your feet?" b. "Does the pain radiate from your back into your legs?" c. "Can you describe the sensations you are having?" d. "Do you ever have any nausea or dizziness?"

C. "Can you describe the sensations you are having?"

The nurse is aware that when assessing a patient by the FOUR score coma scale, the patient is assessed in four categories: eye response, brainstem reflexes, motor response, and respiration. How are these results reported? a. As a sum of the scores of the four categories b. As part of the Glasgow coma scale c. As individual scores in each category d. As progressive scores during a 24-hour period

C. As individual scores in each category

What is the nurse aware of when assessing a person with a craniocerebral injury? a. Most injuries of this type are irreversible b. Open injuries are always more serious than closed injuries c. Signs and symptoms may not occur until several days after the trauma d. Trauma to the frontal lobe is more significant than to any other area

C. Signs and symptoms may not occur until several days after the trauma

Why is the patient with suspected Guillain-Barre Syndrome (GBS) hospitalized immediately? a. The infection needs to be treated with IV antibiotics to prevent paralysis b. The brain may swell quickly causing seizures c. The disease can rapidly progress into respiratory failure d. IV hydration is needed to prevent possible fatal hypotension

C. The disease can rapidly progress into respiratory failure

How would the nurse instruct a patient with Parkinson disease to improve activity level? a. To use a soft mattress to relax the spine b. To walk with a shuffling gait to avoid tripping c. To walk with hands clasped behind back to help balance d. To sit in hard chair with arms for posture control

C. To walk with hands clasped behind back to help balance

What is the cardinal sign of increased intracranial pressure in a brain injured patient? a. Pupil changes b. Ipsilateral paralysis c. Vomiting d. Decrease in the level of consciousness

D. Decrease in the level of consciousness

What is the nurse assessing when asking the patient, "Who is the president of the United States?" during a level of consciousness assessment? a. Orientation b. Memory c. Calculation d. Fund of knowledge

D. Fund of knowledge

A family member of a patient who has just suffered a tonic-clonic seizure is concerned about the patient's deep sleep. What is this behavior called? a. Convalescent period b. Neural recovery period c. Sombulant period d. Postictal period

D. Postictal period

Why are the drugs neostigmine (Prostigmin) and pyridostigmine (Mestinon) helpful to the person with myasthenia gravis? a. Improves speech b. Improves visual disturbances c. Reduces pain d. Promotes nerve impulse transmission

D. Promotes nerve impulse transmission

Which symptom is specific to migraine headaches? a. Tachycardia b. They become worse in the evening c. They involve the entire head d. They are preceded by an aura

D. They are preceded by an aura

What does the nurse know about the stroke patient who has expressive aphasia? a. Has difficulty comprehending spoken and written communication b. Cannot make any vocal sounds c. Has total loss and comprehension of language d. Can understand the spoken word, but cannot speak

D. Can understand the spoken word, but cannot speak

What is the first sign of Bell's palsy? a. Inability to wrinkle forehead and pucker lips on affected side b. Sudden pain in nostril on affected side c. Excessive salivation on the affected side d. Excessive mucus running from nostril on affected side

A. Inability to wrinkle forehead and pucker lips on affected side

The nurse is caring for a home health patient who had a spinal cord injury at C5 three years ago. The nurse bases the plan of care on the knowledge that the patient will be able to: a. feed self with setup and adaptive equipment. b. transfer self to wheelchair. c. stand erect with full leg braces. d. sit with good balance.

A. Feed self with setup and adaptive equipment.

Involuntary rhythmic movement of the eyes, with oscillations that may be horizontal, vertical, or mixed movements, is called ___________________ a. Nystagmus b. Priapism c. Glaucoma d. Cataracts

A. Nystagmus

A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned with respect to this diagnostic test? a. Obtain an allergy history before the test. b. Ambulate the patient when returned to the room after the test. c. Use heated blanket to keep patient warm after procedure. d. Keep NPO for 6 to 8 hours after the test.

A. Obtain an allergy history before the test.

Which foods should the person who suffers from migraine headaches avoid? (Select all that apply.) a. Yogurt b. Caffeine c. Beef d. Pears e. Marinated foods f. Milk

A. Yogurt B. Caffeine E. Marinated foods

The nurse explains that the triad of signs of Parkinson disease is: _______, _______ and _______ a. tremors, rigidity, and bradykinesia b. hypertension, fever, bradycardia c. diaphoresis, tremors, fever d. tremors, ataxia, dysphagia

A. tremors, rigidity, and bradykinesia

Which of the following techniques are necessary for safely feeding a hemiplegic patient? (Select all that apply.) a. Mixing liquids and solid foods together b. Taking the patient's dentures out to prevent choking c. Checking the affected side of mouth for food accumulation d. Offering small bites of food e. Elevating the patient to no more than 30 degrees f. Adding a thickening agent to liquids

C. Checking the affected side of mouth for food accumulation D. Offering small bites of food F. Adding a thickening agent to liquids

The newly admitted patient to the emergency room after a motorcycle accident has serosanguineous drainage coming from the nose. What is the most appropriate nursing response to this assessment? a. Cleanse nose with a soft cotton-tipped swab b. Gently suction the nasal cavity c. Gently wipe nose with absorbent gauze d. Ask patient to blow his nose

C. Gently wipe nose with absorbent gauze

A patient with a spinal cord injury at T1 complains of stuffiness of the nose and a headache. The nurse notes a flushing of the neck and "goose flesh." What should be the primary nursing intervention based on these assessments? a. Place patient in flat position and check temperature b. Administer oxygen and check oxygen saturation c. Place on side and check for leg swelling d. Sit upright and check blood pressure

D. Sit upright and check blood pressure

What are the three signs of Cushing response? (Select all that apply.) a. Increased pulse rate b. Increased blood pressure c. Widened pulse pressure d. Bradycardia e. Increased systolic blood pressure f. Uncontrolled thermoregulation

C. Widened pulse pressure D. Bradycardia E. Increased systolic blood pressure