Chapter 37, 38

There are two main categories of glial tumors. One of the categories is:

Astrocytic

The most common cause of an ischemic stroke is which of the following?

Thrombosis

The nurse suggests which action to a mother who is taking her 2-month-old infant on an airplane ride?

Breast-feed or bottle feed the infant during the airplane's ascent or descent.

A client with Alzheimer disease (AD) is forgetful and has started to lose interest in social activities. Which treatment routine would be beneficial for the client?

Donepezil

As the eyes rotate upward, the upper eyelid reflexively retracts. Which cranial nerve is primarily responsible for this response?

Cranial nerve III

Conductive hearing loss can occur for a variety of reasons, including foreign bodies in the ear canal, damage to the ear drum, or disease. What disease is associated with conductive hearing loss?

Paget disease

Following focal seizures that have damaged the dominant hemisphere of a client's auditory association cortex, the nurse may observe the client displaying:

Receptive aphasia

The nurse is caring for a client who has suffered a stroke affecting the Wernicke area. The nurse expects the client to exhibit:

Receptive aphasia

The nurse is treating a client with a history of chronic alcohol abuse. The client's spouse tells the nurse that the client has no difficulty speaking and responds when spoken to but is having difficulty understanding what is being said. The spouse asks if the nurse believes the client needs a hearing aid. The nurse explains to the spouse that the client probably does not require a hearing aid but may be suffering from:

Receptive aphasia

The nurse is caring for an older adult client with a suspected diagnosis of presbycusis. Select the most likely manifestation.

Sensorineural hearing loss of aging

The parents of an infant born with hydrocephalus are concerned about the size of the baby's head. The doctors are telling them that the infant needs the surgical placement of a shunt. The nurse caring for the infant in the neonatal intensive care unit explains that placement of a shunt will:

decrease the likelihood of further neurological deficits.

While performing a Romberg test on a client, the client asks, "What is the purpose of this test?" Which response by the nurse is most accurate?

It assesses for static vestibular function.

Distraught at the persistent ringing in his ears and his inability to alleviate it, a 50-year-old man has visited his health care provider. After diagnostic testing, no objective cause (like impacted cerumen or vascular abnormality) was found. Given these testing results, which teaching point by the care provider is most appropriate?

"There are some treatments like tinnitus retraining therapy, which includes the extended use of low-noise generators, which has shown good success."

A 70-year-old woman with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond?

"There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo."

Which intracranial pressure (ICP) would the nurse consider a normal reading?

0 to 15 mm Hg

According to the Glasgow Coma Scale, opening one's eyes to only painful stimuli would receive which score?

2

The nurse is caring for a pediatric client whose parent reports that the child has been pulling at her ears, has a fever, and has been crying more than usual. The nurse suspects the client may be experiencing which of the following?

Acute otitis media

The nurse understands that an antimicrobial drug is most likely to be prescribed for which condition?

Acute otitis media

Which individual is most likely to be diagnosed with a central vestibular disorder?

A woman who has ongoing difficulty balancing herself when walking

A client reports sudden, acute left eye pain with blurred vision and a headache on the affected side. The client is most likely experiencing:

Acute angle-closure glaucoma

A nurse is teaching a client newly diagnosed with a seizure disorder. Which statement is most important for the nurse to provide regarding antiepileptic medications?

Antiepileptic medications should never be discontinued abruptly.

The nurse is caring for a pediatric client who has been diagnosed with otitis media with effusion (OME). The nurse expects the health care professional may prescribe which treatment? Select all that apply.

Antimicrobial agent Corticosteriod agent Observation Analgesics

The nurse is caring for a client with a brain tumor when the client begins to vomit. Which intervention should the nurse do first?

Assess for other signs/symptoms of increased intracranial pressure.

A young child has been diagnosed with amblyopia. The parents ask the nurse when treatment should be considered. At what age should treatment of children with the potential for development of amblyopia be instituted?

Before 6 years

The nurse is working at a first aid station in an amusement park. A 45-year-old client arrives reporting severe dizziness after a ride on the roller coaster. The nurse understands that a common cause of this sensation is:

Benign paroxysmal positional vertigo

When the suspected diagnosis is bacterial meningitis, what assessment techniques can assist in determining if meningeal irritation is present?

Brudzinski sign and Kernig sign

Intracranial aneurysms that rupture cause subarachnoid hemorrhage in the client. How is the diagnosis of intracranial aneurysms and subarachnoid hemorrhage made?

CT scan

The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include?

CT scan

The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer's disease. What intervention will be implemented to slow cognitive decline?

Cholinesterase inhibitors

The nurse assessing a client with a traumatic brain injury assesses for changes in which neurologic component? Select all that apply.

Cognition Level of consciousness Motor function Sensory function

The nurse is caring for a client whose hearing is impaired due to impacted earwax. The nurse understands that the associated deafness is due to:

Conduction disorder

Which cranial nerve is designated as the vestibulocochlear nerve?

Cranial nerve VIII

The health care provider is concerned that a client may be at risk for problems with cerebral blood flow. The most important data to assess would be:

Decreased level of oxygen

After evaluating the client, the physician thinks that his older adult client is exhibiting signs and symptoms of normal pressure hydrocephalus. Which symptom would be seen?

Disturbances in gait

As part of the diagnostic workup for a client's longstanding vertigo, a clinician wants to gauge the eye movements that occur in the client. Which diagnostic test is the clinician most likely to utilize?

Electronystagmography (ENG)

A child is being seen in the emergency department (ED) after ingesting crayons with lead in them. He is disoriented and having seizures. The provider suspects he has which of the following?

Encephalitis

Excessive activity of the excitatory neurotransmitters and their receptor-mediated effects is the cause of which type of brain injury?

Excitotoxic

A group of student nurses is reviewing the anatomy of the eye for an upcoming exam. One of the student nurses asks where the tarsal plate is located. What is the response?

Eyelid

An emergency room nurse receives a report that a client's Glasgow Coma Scale (GCS) is 3. The nurse prepares to care for a client with which of the following?

Flaccid motor response

A client with memory loss is concerned about the possibility that it may be inherited. Which disorder is an inherited dementia?

Huntington disease

The nurse is planning an inservice on hypoxia versus ischemia in brain-injured clients. The nurse should include which of the following?

Hypoxia produces a generalized depressive effect on the brain.

During an eye assessment the nurse notes inflammation of the client's cornea. The nurse should document this as which condition?

Keratitis

A 2-year-old child who has had otitis media (OM) for 4 months and been treated with several courses of antibiotics now appears to have some hearing loss. The nurse anticipates that the most appropriate treatment for the child would be:

Tympanostomy tube insertion

Which condition or situation is a risk factor for the development of acute otitis media in a child?

Upper respiratory infection

The nurse is preparing a client for a surgical procedure to create an endolymphatic shunt. The nurse understands that this procedure aims to relieve which symptom?

Vertigo

A client is having difficulty with balance. The nurse understands that the area of the ear that impacts balance is:

Vestibular apparatus

A client is distraught because she has suddenly lost vision in the right half of both of her eyes. The care team's subsequent diagnostic testing will address the likelihood of:

an optic nerve lesion.

The nurse is explaining to the parent of a 5-year-old that the child has otitis media with effusion (OME), noted by otoscopic exam, following an upper respiratory infection. Unlike acute otitis media (AOM), OME does not require treatment with antibiotics because it is usually:

asymptomatic and often self-limiting.

The nurse understands that vestibular rehabilitation includes:

exercises in balance retraining.

A client tells the health care provider he has noticed a recent change in his vision: he can bring distant images into focus, but near images become blurred. The client has most likely developed:

hyperopia.

The ophthalmologist is performing a client's annual eye exam and notes an increase in intraocular pressure. The condition most likely is the result of:

imbalance between aqueous production and outflow.

If the anterior-posterior dimension of the eyeball is too long, the focus point for an infinitely distant target is anterior to the retina. This client would be diagnosed as having:

myopia

The nurse is performing her morning assessment on a 69-year-old client on a medical-surgical unit. Upon assessing her pupils the nurse notices that they are equal and responsive to light but not to accommodation. The nurse is aware that with aging the lens becomes thicker and its capsule less elastic so she believes this to be the case. When accommodation is diminished in an older person as a result of aging this is referred to as:

presbyopia.

The nurse observes a new nurse performing the test for Kernig sign on a client. The new nurse performs the test by providing resistance to flexion of the knees while the client is lying with the hip flexed at a right angle. The nurse should explain to the new nurse that:

resistance should be provided with the knee in a flexed position.

The nurse understands that movement of otoliths may result in:

vertigo and nystagmus.

A client with a diagnosis of benign paroxysmal positional vertigo (BPPV) is receiving teaching from her physician about her diagnosis. The client is eager to avoid future episodes of vertigo and has asked the physician what she can do to prevent future episodes. How can the physician best respond?

"There are some exercises that I'll teach you to help reorient your inner ear and prevent vertigo."

The nursing instructor is teaching a class on diabetes and discusses complications of the disease. The instructor further states that diabetic retinopathy is one of the leading causes of blindness. What does the instructor tell the students are major risk factors for developing diabetic retinopathy? Select all that apply.

Chronic hyperglycemia Hypertension Smoking

A client reveals that when they are in bed, changes in head position causes brief periods of vertigo, usually lasting less than 1 minute. Which condition is the client most likely experiencing?

Benign paroxysmal positional vertigo

A 9 year-old boy has been brought to the emergency department by his father who is concerned by his son's recent fever, stiff neck, pain, and nausea. Examination reveals a petechial rash. Which assessment question by the emergency room physician is most appropriate?

"Has your son had any sinus or ear infections in the last little while?"

The nurse is teaching a teenaged client strategies to avoid recurrent ear infections. The nurse understands that further teaching is required when the client states:

"I will dry the inside of my ears thoroughly with cotton-tipped applicators after swimming."

What would be considered an abnormal finding when the nurse practitioner uses an otoscope to look at a toddler's ear?

"Yellow, amber discoloration noted."

A 20 year-old has been diagnosed with an astrocytic brain tumor located in the brainstem. Which statement by the oncologist treating the client is most accurate?

"Your prognosis will depend on whether we can surgically resect your tumor."

Which individuals would be considered at high risk for developing cataracts? Select all that apply.

A 51-year-old female whose rheumatoid arthritis is controlled with oral corticosteroids A 39-year-old woman with a history of open-angle glaucoma and poorly controlled diabetes A 29-year-old artist who spends long hours in sunlight painting landscapes. An 88-year-old female with osteoporosis and congestive heart failure

A 42-year-old client reports increasing difficulty reading the labels on packages. He states that he has to continually hold it further and further away from his face in order to see the type clearly. Which eye disorder is this client most likely experiencing?

An age-related change in accommodation.

A 46 year-old male has presented to the emergency department because of the eye pain, severe headache and blurred vision that has followed an eye exam at an optometrist's office earlier in the day. The client tells the triage nurse that he received eye drops during the exam "to keep my pupils wide open." What differential diagnosis will the care team first suspect?

Angle-closure glaucoma

Where is the aqueous humor located? Select all that apply.

Anterior chamber Posterior chamber Between the iris and the sclera

The students are reviewing the anatomy of the eye and where the eye structures are located. Where is the anterior chamber located?

Anterior segment of the globe

What medication teaching should be done for a woman of childbearing age with a seizure disorder?

Antiseizure drugs increase the risk for congenital abnormalities.

An adult client has presented to the emergency department reporting symptoms of vertigo. Further assessment reveals that the client is ataxic and has facial weakness. The care team should consider which possible cause of this client's health problem?

Brain stem ischemia

The nurse is conducting a community education class on amblyopia. The nurse determines that the participants understand the concepts when they identify which time period as the time when amblyopia is generally diagnosed?

Infancy

The nurse is assessing a client who has been diagnosed with esotropia. The nurse would expect the assessment findings to include

Medial deviation

A 30-year-old woman has presented to her family doctor reporting three distressing episodes over the last several months in which she got extremely dizzy, had loud ringing in her ears and felt like her ears were full of fluid. She states that her hearing diminishes and she feels nauseous during these episodes. What diagnosis is the physician most likely to first suspect?

Ménière disease

A client has glaucoma. The nurse is taking a health history and knows that the most common form of glaucoma is which type?

Open angle

A mother brings her toddler to the clinic and tells the nurse that she thinks something is wrong with the baby's eyes. Upon further assessment the nurse notices that the child has upper deviation in movement in only one eye. What diagnosis should the nurse suspect for this child?

Strabismus

The nurse is teaching a client who has tinnitus about suggested dietary modifications. The most important information for the nurse to include would be:

"Cut down on takeout meals because of high amounts of monosodium glutamate."

A client is having difficulty with sleeping and has also been experiencing marital difficulties over the past couple of months. The client tells the nurse at the physician's office that all this started after he had a car accident earlier that year. What would be the most important question for the nurse to ask?

"Did you sustain any injuries in the accident?"

As part of a health promotion initiative, a public health nurse is meeting with a group of older adult residents of an assisted living facility. Which of the following teaching points about hearing loss in the elderly should the nurse include in the teaching session?

"Experts don't quite know what causes seniors to lose their hearing with age, but drugs like aspirin can contribute to the problem."

Which of these clients' statements would be most suggestive of retinal detachment?

"I feel like there's a shadow that's blocking my vision."

While working at the triage desk in the local emergency department, which client is likely having a medical emergency and needs to be seen first?

55-year-old truck driver complaining of sudden onset of ocular pain and blurred vision

Which individual would be most likely to experience global ischemia to his or her brain?

A man who has entered cardiogenic shock following a severe myocardial infarction

A 26 year-old female is resting after a 1-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced?

A tonic-clonic seizure

The nurse is caring for a client admitted to the emergency room with suspected meningitis. The nurse prepares to perform which nursing intervention upon physician orders, while diagnostic testing is being completed?

Administration of antibiotics

Global and focal brain injuries manifest differently. What is almost always a manifestation of a global brain injury?

Altered level of consciousness

Following a collision while mountain biking, the diagnostic work up of a 22-year-old male has indicated the presence of an acute subdural hematoma. Which pathophysiologic process most likely underlies his diagnosis?

Blood has accumulated between the man's dura and subarachnoid space.

The nurse is conducting a community education program on concussions. The nurse evaluates that the participants understand the education when they state that which of these offers the brain protection from external forces?

Cerebrospinal fluid

Which client is at least risk for rapid bleeding?

Client with a subdural hematoma

A client begins to exhibit manifestations of a stroke while attending a community health fair. What type of emergency care should the staff at the health fair implement first?

Going to the nearest stroke center

The nurse is performing a health history for a 72-year-old client. When reviewing the client's medications, the client states, "I take a baby aspirin every day, but I'm worried. I heard that aspirin can cause hearing problems!" What is an appropriate response by the nurse?

"A baby aspirin is a low dose that is considered to be safe."

A 2-year-old child has been diagnosed with uncomplicated acute otitis media by a nurse practitioner. When explaining the plan of care, which description is most appropriate?

"Let's keep a close eye on his condition for a couple of days before starting antibiotics."

The spouse of a client diagnosed with Alzheimer disease asks the nurse why the client often neglects to take a shower. The spouse states that the client was always diligent with hygiene in the past; however, over the past few months that has not been the case. What is the nurse's best response?

"You should remind the client to shower."

The nurse is educating a client diagnosed with Meniere disease on lifestyle modifications to reduce the frequency and/or intensity of exacerbations. Which should the nurse include?

Decrease dietary intake of sodium

Amblyopia, or lazy eye, occurs at a time when visual deprivation or abnormal binocular interactions occur in visual infancy. Whether amblyopia is reversible depends on which factor?

Maturity of the visual system at time of onset.

A young teenager is brought to the clinic for an eye exam. The client has been reporting difficulty in school because of the inability to see the blackboard as clearly as when younger. The client tells the nurse that vision is blurry. What should the nurse suspect is wrong with this child?

Myopia

The nurse is preparing a client for oculovestibular reflex assessment (cold caloric test). The nurse explains that the test is used to elicit which of the following?

Nystagmus

The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with:

Subarachnoid hemorrhage

When a client reports that he feels like he is spinning but the room is stable, the nurse should document the finding as:

Subjective vertigo

The nurse is explaining to a client's family how vasogenic brain edema occurs. The most appropriate information for the nurse to provide would be:

The blood-brain barrier is disrupted, allowing fluid to escape into the extracellular fluid.

The nurse is teaching a client about the treatment of open-angle glaucoma. The most appropriate information for the nurse to give the client would be:

administration of topical beta-adrenergic antagonists to lower the pressure.

A nurse on a neurology unit is assessing a client with a brain injury. The client is unresponsive to speech, with dilated pupils that do not react to light. The client is breathing regularly with a respiratory rate is 45 breaths per minute. In response to a noxious stimulus, the client's arms and legs extend rigidly. What is the client's level of impairment?

coma

The parent of an infant who developed hydrocephalus while in utero is very concerned that the child will have significant intellectual dysfunction. The best response to the parent would be:

"Because the skull sutures are not fused there may be no brain damage."

The nurse is conducting a community education class on acute otitis media. Which statement by the participants indicates to the nurse that they understand the education?

It can be caused by a bacterial infection.

A client has been diagnosed with hemianopia. The client asks the nurse what this is describing concerning the eye?

Loss of half of the visual field in one eye

The emergency room doctor suspects a client may have bacterial meningitis. The most important diagnostic test to perform would be:

Lumbar puncture

Select the statement that best describes Meniere disease.

Meniere disease is a disorder of the inner ear due to distention of the endolymphatic compartment of the inner ear, causing hearing loss, vertigo, and tinnitus.

A college junior calls his mother, a nurse, reporting "not being able to see." When questioned further, he describes the following: "A gray curtain just went down my right visual field. I don't know what to do." The nurse should recognize this symptom as which condition and have the teenager go to the emergency department immediately?

Retinal detachment

An older adult client comes to the clinic complaining of seeing flashing lights and small spots. The client tells the nurse that this has been going on for over 24 hours but now it is as if there is a dark curtain whenever the client opens the eyes. The client asks the nurse if this means that blindness is imminent. What diagnosis should the nurse suspect?

Retinal detachment

Otitis media (OM), which can occur is any age group, is the most common diagnosis made by health care providers who care for children. Which bacterial pathogen causes the largest proportion of cases that result in sensorineural hearing loss?

Streptococcus pneumoniae

The nurse is discussing measures that a client may take to prevent barotrauma related to airplane travel. Which measure will the nurse recommend during changes in air pressure?

Swallowing

A young child is flying on a plane for the first time. As the plane begins its decent for landing, his ears begin to hurt. The flight attendant sees that he is in pain and tells him to swallow until the pain goes away. Which structure is the child using to equalize the pressure and relieve the pain?

Swallowing pulls air through the eustachian tubes, allowing the air pressure to equalize in the inner ear.

A nurse at a long term care facility provides care for an 85 year-old man who has had recent transient ischemic attacks (TIAs). Which statement best identifies future complications associated with TIAs?

TIAs resolve rapidly but may place the client at an increased risk for stroke.

A client has experienced severe head trauma during a bicycle accident. What assessment findings would suggest that the client has experienced brain death? Select all that apply.

The client exhibits no detectable brain stem reflexes. The client makes no respiratory effort in the absence of mechanical ventilation. The client's pupils are unresponsive to light. The client has no detectable motor responses to stimulus.

An adult client has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which aspect of the client's history would be considered to have contributed to his stroke?

The client's blood pressure has historically been in the range of 150/90 to 160/100 mm Hg.

A client suffering a thrombotic stroke is brought into the emergency department by ambulance and the health care team is preparing to administer a synthetic tissue plasminogen activator for which purpose?

Thrombolysis

A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing:

Transient ischemic attack (TIA)

A client is brought to the emergency department and is diagnosed with an ischemic stroke confirmed by CT scan. The most important treatment for this client would be to:

administer IV tissue plasminogen activator (tPA).

The chart of a client admitted because of seizures notes that the seizure activity began simultaneously in both cerebral hemispheres. The nurse should interpret this to mean that the client experienced:

generalized seizure.

During a physical exam, the nurse practitioner notes that the client's optic disk is very pale with a larger size/depth of the optic cup. At this point, the NP is thinking that the client may have:

glaucoma.

A client has developed global ischemia of the brain. The nurse determines this is:

inadequate to meet the metabolic needs of the entire brain.