ATI Practice Exam 5: Chronic Neuro
A nurse is caring for a client who has global aphasia. Which of the following actions should the nurse take? a. Speak to the client about one idea at a time b. Ask the client to multi-task c. Ask open-ended questions d. Focus on a single form of communication
Answer: a The nurse should speak using sentences that contain one clear thought or idea for better communication and understanding. The nurse would use simple one-step directions, avoid asking questions that would require the client to say a lot of words, and use a variety of aids to assist with communication.
A nurse in a long-term care facility is caring for a client who has Alzheimer's disease. Which of the following actions should the nurse include in the plan of care? a. Post a written schedule of daily activities b. Use an overhead loudspeaker to announce events c. Provide a consistent daily routine d. Allow the client to choose free-time activities
Answer: c A consistent daily routine is appropriate for a client with Alzheimer's disease. Pictures rather than written schedules and personal communication with a low voice are best for this client. Providing this client with too many choices can increase their anxiety.
A community health nurse is providing teaching to the family of a client who has Alzheimer's dementia. Which of the following manifestations should the nurse tell the family to expect? a. Decreased auditory and visual acuity b. Decreased display of emotions c. Personality traits that are opposite of original traits d. Forgetfulness gradually progressing to disorientation
Answer: d Dementia usually appears first as forgetfulness. Other manifestations may be apparent only upon neurologic examination or cognitive testing. Loss of function progresses slowly from impaired language skills and difficulty with ordinary daily activities to severe memory loss and complete disorientation with withdrawal away from social interaction. Dementia is not known to affect auditory or visual senses, causes emotional outbursts, and an exaggeration of previous personality traits.
A nurse at a rehabilitation center is planning care for a client who had a left hemispheric cerebrovascular accident (CVA) 3 weeks ago. Which of the following goals should the nurse include in the client's rehabilitation program? a. Establish the ability to communicate effectively b. Compensate for loss of depth perception c. Learn to control impulsive behavior d. Improve left-side motor function
Answer: a A CVA is an interruption of the blood supply to any part of the brain, resulting in damaged brain tissue. The left hemisphere is usually dominant for language. Because the client has a left-sided CVA, the nurse should anticipate the client will have some degree of aphasia and will require speech therapy to establish communication. A client who has a right sided lesion experiences a loss of depth perception, proprioception, and spatial deficits and is likely to be impulsive.
A nurse is providing teaching to the family of a client who has Parkinson's disease. Which of the following information should the nurse include in the teaching? a. Provide client supervision b. Limit client physical activity c. Speak loudly to the client d. Leave the TV on continuously
Answer: a Because the clients voluntary motor control is affected by the disease, the nurse should recommend that the family provide client supervision to create a safe and respectful environment. The nurse should recommend an exercise program, alternated with periods of rest, to improve mobility. Speech, not hearing, is affected by Parkinson's disease. The nurse should recommend decreasing environmental stimuli.
A nurse is admitting an older adult client who has a suspected cognitive disorder. Which of the following assessments should be included as part of the admission process? a. Mini-Mental State Exam (MMSE) b. Brief Patient Health Questionnaire (Brief PHQ) c. Abnormal Involuntary Movements Scale (AIMS) d. Scale for Assessment of Negative Symptoms (SANS)
Answer: a The use of the MMSE assists in identifying the deterioration in mental status and brain damage, which are findings associated with cognitive disorders. The Brief PHQ is used as a screening tool to identify indications of depression in clients, rather than a cognitive disorder. The AIMS test is used to assess for tardive dyskinesia in clients taking antipsychotic medications. The SANS is used to assess for the presence of negative symptoms in clients who have schizophrenia.
The nurse is caring for a client who has dementia. When performing a Mental State Examination (MSE) the nurse should include which of the following data? (Select all that apply) a. Naming objects b. Coping skills c. Recall ability d. Long-term memory e. Level of orientation
Answer: a, c, d, e Naming an object is part of the MMSE. Identifying the clients ability to recall a list of objects or words, evaluating long-term (remote) memory, and determining the client's level of orientation are all included in an MSE.
A nurse is caring for a client who has had a stroke involving the right hemisphere. Which of the following alterations in function should the nurse expect? a. Difficulty reading b. Left hemiparesis c. Right hemiparesis d. Aphasia
Answer: b A client who has left hemiparesis would have involvement of the right hemisphere of the brain. The motor nerve fibers of the brain cross the medulla, and a motor deficit on one side of the body reflects damage to the upper motor neurons on the opposite side of the brain. The left hemisphere is the center for language, mathematical skills, and thinking analytically. A left hemisphere stroke would cause aphasia and difficulty reading.
A nurse is caring for a client who has dementia due to Alzheimer's disease and was admitted to a long-term care facility following the death of her partner of 40 years. The client states, "I want to go home; my husband is waiting for me to cook dinner." Which of the following responses by the nurse is appropriate? a. "This is where you live now." b. "This is a safer place for you to live." c. "Tell me what you like to cook for dinner." d. "Your family said there is no one to care for you at home."
Answer: c Alzheimer's disease is a progressive cognitive disorder. Dementia due to Alzheimer's disease means that the client is experiencing later stages of illness with moderately severe to severe cognitive decline. By asking the client to talk about what she likes to cook for dinner, the nurse is demonstrating validation therapy by asking the client to talk about the areas that concern her. The nurse could continue the conversation by discussing how much the client misses her home and partner. Validation therapy helps clients who have cognitive disorders discuss their feelings about past events and people.
A nurse is teaching a family of an older adult client who has a new diagnosis of dementia. Which of the following statements should the nurse include in the teaching? a. "Dementia is characterized by a sudden onset of confusion." b. "An altered level of consciousness is associated with dementia." c. "The signs of dementia are progressive and irreversible." d. "Dementia can be triggered by high fever or dehydration."
Answer: c Dementia is a progressive disorder that is irreversible. Delirium is characterized by sudden onset of confusion, altered level of consciousness, and may be caused by a medical condition such as infection, fever, or dehydration.
A nurse is planning care for a client who has dementia. Which of the following interventions should the nurse include in the plan of care? a. Provide a cognitively stimulating environment b. Rotate staff to prevent caregiver role strain c. Limit the client's choices for daily activities d. Use confrontation to manage negative behavior
Answer: c Limiting the client's choices is appropriate for a client who has dementia as this intervention decreases the client's level of anxiety. Client's with dementia should have a low-stimulation environment, consistent staff, and the nurse to provide distraction to manage negative behaviors.
A nurse is assessing a client who has Parkinson's disease. Which of the following manifestations should the nurse expect? a. Fast speech b. Hypertension c. Bradykinesia d. Backward tilt to posture
Answer: c The nurse should expect to find bradykinesia or difficulty moving in a client with Parkinson's disease. The nurse would also expect slow, monotonous slurred speech, orthostatic hypotension, and a forward tilt to posture.
A nurse on a long-term care unit is creating a plan of care for a client who has Alzheimer's disease. Which of the following interventions should the nurse include in the plan? a. Rotate assignment of daily caregivers b. Provide an activity schedule that changes from day to day c. Limit time for the client to perform activities d. Talk the client through tasks one step at a time
Answer: d The nurse should plan to talk the client through tasks one step at a time to minimize confusion and promote independence, which will decrease the client's anxiety level. The nurse should plan to assign the same staff whenever possible, provide a structured schedule of activities that does not change from day to day, and allow plenty of time for the client to perform activities.
A nurse is caring for a confused client who has Alzheimer's disease. Which of the following actions should the nurse take? a. Turn the television on at all times b. Hang abstract pictures on the wall c. Keep familiar personal items at the bedside d. Encourage bright glaring lighting in the room
Answer: c The client who is confused should have familiar personal items at the bedside in the same place at all times in order to lessen confusion. A confused client may become over-stimulated and confused by excessive noise from the TV, may misinterpret abstract pictures and become scared, and may become scared from shadows due to bright lighting in the room.
A nurse is instructing a client's family members about feeding safety for client who has dysphagia following a stroke. Which of the following instructions should the nurse include? a. Encourage brief exercise before meals to promote appetite b. Place food in the affected side of the mouth c. Encourage the client to take small bites d. Place the client with the head reclined back to facilitate swallowing
Answer: c The family members should encourage the client to take small bites and chew food thoroughly in order to prevent choking. The nurse should instruct the family members to have the client rest for 30 min before meals to preserve energy, place the food on the unaffected side of the mouth, and have the client sit upright at 90 degrees and place the chin a in a downward position to facilitate swallowing.
