Module 13 Skills Lab Entrance Ticket - Neuro Assessment

A client with Guillain-Barré syndrome has been hospitalized for three days. Which assessment finding would the nurse expect and need to monitor frequently in this client?

Ascending weakness

The nurse is performing a neurologic assessment on a client and is completing the Glasgow Coma Scale (GCS). What components make up this assessment tool? Select all that apply.

Best verbal response, Best motor response, Best eye-opening response

A client is admitted to the hospital with a tentative diagnosis of a brain tumor. Which diagnostic test result will the nurse check for confirmation of this diagnosis?

Computed tomography

A nurse is caring for a client who just has had surgery on the ear. The nurse should assess for which early indicator of potential damage to the motor branch of the facial nerve?

Professor Turner is going to look at this question because the answer is not correct and we apparently don't need to know it. However, the correct answer per the test is: Pain behind the ear

The nurse is teaching a client with multiple sclerosis methods to reduce fatigue. Which statement indicates an understanding of the education?

Rest in an air-conditioned room.

The nurse is caring for a client with Parkinson disease. Which is a priority nursing concer?

Risk for injury related to gait disturbances

The nurse is caring for a client who is admitted with a crushing injury to the spinal cord above the level of phrenic nerve origin. What should the nurse consider about this type of injury when planning care?

Lack of diaphragmatic contractions and respiratory paralysis

A client has returned from spinal surgery. Which action is essential for the nurse to take?

Assess the client's feet for circulation and sensation.

Which clinical indicator does a nurse identify when assessing a client with hemiplegia?

Paralysis of one side of the body.

A nurse is caring for a client with a tumor of the cerebellum. What clinical manifestation does the nurse expect the client to exhibit?

Inability to execute coordinated movements

After a client is treated for a spinal cord injury, the healthcare provider informs the family that the client is a paraplegic. The family asks the nurse what this means. Which explanation should the nurse provide?

Lower extremities are paralyzed.

A nurse is performing the history and physical examination of a client with Parkinson disease. Which assessments identified by the nurse support this diagnosis? Select all that apply.

Nonintention tremors, Masklike facial expression, Rigidity to passive movement

A client experiences expressive aphasia as a result of a brain attack (cerebrovascular accident, CVA). The client's spouse asks whether the client's speech will ever return. What is the best response by the nurse?

"It is hard to say how much improvement will occur."

Initially after a stroke, a client's pupils are equal and reactive to light. Later, the nurse assesses that the right pupil is reacting more slowly than the left and that the systolic blood pressure is beginning to rise. What complication should the nurse consider that the client is developing?

Increasing intracranial pressure

A nurse is caring for a client with a brain tumor in the occipital lobe. What clinical indicator does the nurse expect to identify when assessing the client?

Visual hallucinations