NCLEX 300-NEURO

The nurse is preparing a client for a computed tomography (CT) scan, which requires infusion of radiopaque dye. Which question is important for the nurse to ask?

"Are you allergic to seafood or iodine?"

When providing discharge teaching for a client with multiple sclerosis (MS), the nurse should include which instruction?

"Avoid hot baths and showers."

When teaching a client about levodopa and carbidopa (Sinemet) therapy for Parkinson's disease, the nurse should include which instruction?

"Be aware that your urine may appear darker than usual."

A client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction?

"Don't fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days."

A client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. What should the nurse tell the client about the paralysis?

"The paralysis caused by this disease is temporary."

A client who sustained a closed head injury in a motor vehicle accident is diagnosed as brain dead by a neurosurgeon. The physician has scheduled a meeting with the client's family about discontinuing life support. Before the meeting, a family member asks the nurse her opinion about life support. Which response by the nurse is appropriate?

"What has the physician explained about the client's prognosis?"

A client who sustained an L1 to L2 spinal cord injury in a construction accident asks a nurse if he'll ever be able to walk again. Which response by the nurse is appropriate?

"What has your physician told you about your ability to walk again?"

(SELECT ALL THAT APPLY) A client with a history of epilepsy is admitted to the medical-surgical unit. While assisting the client from the bathroom, the nurse observes the start of a tonic-clonic seizure. Which nursing interventions are appropriate for this client?

(1) Assist the client to the floor., (2) Turn the client to his side., (3) Place a pillow under the client's head.

(SELECT ALL THAT APPLY) The nurse is planning care for a client with multiple sclerosis. Which problems should the nurse expect the client to experience?

(1) Visual disturbances, (3) Balance problems, (5) Mood disorders

(SELECT ALL THAT APPLY) The nurse is teaching a client with trigeminal neuralgia how to minimize pain episodes. Which comments by the client indicate that he understands the instructions?

(2) "I'll try to chew my food on the unaffected side.", (4) "Drinking fluids at room temperature should reduce pain.", (5) "If brushing my teeth is too painful, I'll try to rinse my mouth instead."

(SELECT ALL THAT APPLY) A client is admitted to the medical-surgical unit after undergoing intracranial surgery to remove a tumor from the left cerebral hemisphere. Which nursing interventions are appropriate for the client's postoperative care?

(2) Turn the client on his right side., (5) Apply a soft collar to keep the client's neck in a neutral position.

(SELECT ALL THAT APPLY) A client who had a massive stroke exhibits decerebrate posture. What are the characteristics of this posture?

(2) Wrist pronation, (3) Stiff extension of the arms and legs, (4) Plantar flexion of the feet (5) Opisthotonos

(SELECT ALL THAT APPLY) The nurse is assigned to care for a client with early stage Alzheimer's disease. Which nursing interventions should be included in the client's care plan?

(3) Furnish the client's environment with familiar possessions., (4) Assist the client with activities of daily living (ADLs) as necessary., (5) Assign tasks in simple steps.

A client has an exacerbation of multiple sclerosis accompanied by leg spasticity. The physician prescribes dantrolene sodium (Dantrium), 25 mg by mouth daily. How soon after administration can the nurse expect to see a significant reduction in spasticity?

1 to 2 weeks

A client who's receiving phenytoin (Dilantin) to control seizures is admitted to the health care facility for observation. The physician orders measurement of the client's serum phenytoin level. Which serum phenytoin level is therapeutic?

10 to 20 mcg/ml

The nurse receives a physician's order to administer 1,000 ml of normal saline solution I.V. over 8 hours to a client who recently had a stroke. What should the drip rate be if the drop factor of the tubing is 15 gtt/ml?

31

The physician orders measurement of the serum acetaminophen level of a client admitted with a suspected overdose of this drug. To ensure an accurate result, the nurse should wait how long after acetaminophen (Tylenol) ingestion before drawing the blood sample?

4 hours

The nurse is preparing to administer carbamazepine (Tegretol) oral suspension, 150 mg by mouth. The pharmacy has dispensed carbamazepine suspension 100 mg/5 ml. How many milliliters of carbamazepine should the nurse administer to the client?

7.5

The nurse is observing a client with cerebral edema for evidence of increasing intracranial pressure. She monitors his blood pressure for signs of widening pulse pressure. His current blood pressure is 170/80 mm Hg. What is the client's pulse pressure?

90

The nurse on the neurologic unit must provide care for four clients who require different levels of care. Which client should the nurse assist first with morning care?

A client who requires minimal bathing assistance and ambulates with a walker independently

A client with quadriplegia is in spinal shock. What should the nurse expect?

Absence of reflexes along with flaccid extremities

A client is transferred to the intensive care unit after evacuation of a subdural hematoma. Which nursing intervention would reduce the client's risk of increased intracranial pressure (ICP)?

Administering a stool softener as prescribed

A home health nurse visits a client who's taking pilocarpine, a miotic agent, to treat glaucoma. The nurse notes that the client's pilocarpine solution is cloudy. What should the nurse do first?

Advise the client to discard the drug because it may have undergone chemical changes or become contaminated.

The nurse is caring for an elderly client who exhibits signs of dementia. The most common cause of dementia in an elderly client is:

Alzheimer's disease.

What should the nurse do when administering pilocarpine (Pilocar)?

Apply pressure on the inner canthus to prevent systemic absorption.

A nurse is caring for a group of clients on the neurologic unit. Which task should the nurse perform first?

Arrange an escort for a client who needs to go to the physical therapy department.

A client diagnosed with a brain tumor experiences a generalized seizure while sitting in a chair. How should the nurse intervene first?

Assist the client to a side-lying position on the floor, and protect her with linens.

A client is thrown from an automobile during a collision. The nurse knows that the client will be able to maintain gross arm movements and diaphragmatic breathing if the injury occurs at what vertebral level?

C5

The nurse is performing a mental status examination on a client diagnosed with a subdural hematoma. This test assesses which of the following functions?

Cerebral function

A client complains of periorbital aching, tearing, blurred vision, and photophobia in her right eye. Ophthalmologic examination reveals a small, irregular, nonreactive pupil — a condition resulting from acute iris inflammation (iritis). As part of the client's therapeutic regimen, the physician prescribes atropine sulfate (Atropisol), two drops of 0.5% solution in the right eye twice daily. Atropine sulfate belongs to which drug classification?

Cholinergic blocker

A client who experienced a stroke that left her with residual right-sided weakness was just discharged to go home. The client lives in a two-story house in which the bathroom is located on the second floor. A home health care nurse is visiting the client for the first time. Which issue should the nurse address during this visit?

Client's ability to climb the stairs while using a walker

Family members would like to bring in a birthday cake for a client with nerve damage. What cranial nerve needs to be functioning so the client can chew?

Cranial nerve V

A young man was running along an ocean pier, tripped on an elevated area of the decking, and struck his head on the pier railing. According to his friends, "He was unconscious briefly and then he became alert and behaved as though nothing had happened." Shortly afterward, he began complaining of a headache and asked to be taken to the emergency department. If the client's intracranial pressure (ICP) is increasing, the nurse would expect to observe which sign first?

Declining level of consciousness

The nurse is collecting data on a geriatric client with senile dementia. Which neurotransmitter condition is likely to contribute to this client's cognitive changes?

Decreased acetylcholine level

The nurse is caring for a client in a coma who has suffered a closed head injury. What intervention should the nurse implement to prevent increases in intracranial pressure (ICP)?

Elevate the head of the bed to 30 degrees.

After a stroke, a 75-year-old client is admitted to a health care facility. The client has left-sided weakness and an absent gag reflex. He's incontinent and has a tarry stool. His blood pressure is 90/50 mm Hg, and his hemoglobin is 10 g. Which action is a priority for this client?

Elevating the head of the bed to 30 degrees

While bathing a client who sustained a stroke, a nurse is asked by a coworker to assist with repositioning another client. What should the nurse do?

Ensure the client's privacy, put up the side rail, and explain that she'll return shortly.

The nurse assesses normal pupils in a client who had a craniotomy, and then writes "PERRLA" in the nurse's notes, along with other findings. What does the "E" stand for in this acronym?

Equal

A client is hospitalized with Guillain-Barré syndrome. Which data collection finding is most significant?

Even, unlabored respirations

A client who sustained a closed head injury in a skating accident pulls out his feeding tube, I.V. catheter, and indwelling urinary catheter. To ensure this client's safety, a physician prescribes restraints. Which action should a nurse take when using restraints?

Fasten the restraint to the bed frame using a quick-release knot.

After a motor vehicle accident, a client is admitted to the medical-surgical unit with a cervical collar in place. The cervical spinal X-rays haven't been read, so the nurse doesn't know whether the client has a cervical spinal injury. Until such an injury is ruled out, the nurse should restrict this client to which position?

Flat, except for logrolling as needed

The nurse is teaching a client and his family about baclofen (Lioresal) therapy. Baclofen is an analogue of which neurotransmitter?

Gamma aminobutyric acid (GABA)

A client in the emergency department has a suspected neurologic disorder. To assess gait, the nurse asks the client to take a few steps; with each step, the client's feet make a half circle. To document the client's gait, the nurse should use which term?

Helicopod

A client undergoes cerebral angiography to evaluate for neurologic deficits. Afterward, the nurse checks frequently for signs and symptoms of complications associated with this procedure. Which findings indicate spasm or occlusion of a cerebral vessel by a clot?

Hemiplegia, seizures, and decreased level of consciousness (LOC)

The nurse formulates a nursing diagnosis of Risk for imbalanced body temperature for a client who suffers a stroke after surgery. The expected outcomes incorporate assessment of the client's temperature to detect abnormalities. The thermoregulatory centers are located in which part of the brain?

Hypothalamus

A client in a nursing home is diagnosed with Alzheimer's disease. He exhibits the following symptoms: difficulty with recent and remote memory, irritability, depression, restlessness, difficulty swallowing, and occasional incontinence. This client is in what stage of Alzheimer's disease?

II

When obtaining the vital signs of a client with multiple traumatic injuries, the nurse detects bradycardia, bradypnea, and systolic hypertension. The nurse must notify the physician immediately because these findings may reflect which complication?

Increased intracranial pressure (ICP)

In a client with amyotrophic lateral sclerosis and respiratory distress, which finding is the earliest sign of reduced oxygenation?

Increased restlessness

Which nursing diagnosis takes highest priority for a client with Parkinson's crisis?

Ineffective airway clearance

A client is admitted with a cervical spine injury sustained during a diving accident. When planning this client's care, the nurse should assign highest priority to which nursing diagnosis?

Ineffective breathing pattern

A client complains of vertigo. The nurse anticipates that the client may have a problem with which portion of the ear?

Inner ear

What is the function of cerebrospinal fluid (CSF)?

It cushions the brain and spinal cord.

The physician prescribes diazepam (Valium), 10 mg I.V., for a client experiencing status epilepticus. Which statement about I.V. diazepam is true?

It should be administered no faster than 5 mg/minute in an adult.

How should the nurse position a client for a lumbar puncture?

Laterally, with knees drawn up to the abdomen and chin touching the chest

A client admitted to an acute care facility after a car accident develops signs and symptoms of increased intracranial pressure (ICP). The client is intubated and placed on mechanical ventilation to help reduce ICP. To prevent a further rise in ICP caused by suctioning, the nurse anticipates administering which drug endotracheally before suctioning?

Lidocaine (Xylocaine)

A client comes to the emergency department complaining of headache, malaise, chills, fever, and a stiff neck. Vital sign assessment reveals a temperature elevation, increased heart and respiratory rates, and normal blood pressure. On physical examination, the nurse notes confusion, a petechial rash, nuchal rigidity, Brudzinski's sign, and Kernig's sign. What does Brudzinski's sign indicate?

Meningeal irritation

A client is admitted to an acute care facility for treatment of a brain tumor. When reviewing the chart, the nurse notes that the client's extremity muscle strength is rated 1/5. What does this mean?

Muscle contraction is palpable and visible.

The nurse is monitoring a client for adverse reactions to dantrolene (Dantrium). Which adverse reaction is most common?

Muscle weakness

During the course of a busy shift, a nurse fails to document that a client's ventricular drain had an output of 150 ml. Assuming that the drain was no longer draining cerebrospinal fluid, the physician removes the drain. When the nurse arrives for work the next morning, she learns that the client became agitated during the night and his blood pressure became elevated. What action should the nurse take?

Notify the physician of the documentation omission.

A client who recently experienced a stroke tells the nurse that he has double vision. Which nursing intervention is the most appropriate?

Notify the physician.

The physician determines that a client's chronic, progressive hearing loss results from excess bone formation around the oval window, which impedes normal stapes movement and prevents sound transmission. What is the clinical term for this correctable middle ear disorder?

Otosclerosis

After striking his head on a tree while falling from a ladder, a young man is admitted to the emergency department. He's unconscious and his pupils are nonreactive. Which intervention would be the most dangerous for the client?

Perform a lumbar puncture.

A client with amyotrophic lateral sclerosis (ALS) tells the nurse, "Sometimes I feel so frustrated. I can't do anything without help!" This comment best supports which nursing diagnosis?

Powerlessness

The nurse is planning care for a client who suffered a stroke in the right hemisphere of his brain. What should the nurse do?

Provide close supervision because of the client's impulsiveness and poor judgment.

When caring for a client with a head injury, the nurse must stay alert for signs and symptoms of increased intracranial pressure (ICP). Which cardiovascular findings are late indicators of increased ICP?

Rising blood pressure and bradycardia

A client is admitted in a disoriented and restless state after sustaining a concussion from a car accident. Which nursing diagnosis takes highest priority in this client's plan of care?

Risk for injury

A client admitted with a cerebral contusion is confused, disoriented, and restless. Which nursing diagnosis takes highest priority?

Risk for injury related to neurologic deficit

The nurse is administering neostigmine to a client with myasthenia gravis. Which nursing intervention should the nurse implement?

Schedule the medication before meals.

A client with respiratory complications of multiple sclerosis (MS) is admitted to the medical-surgical unit. Which equipment is most important for the nurse to keep at the client's bedside?

Suction machine with catheters

The nurse is monitoring a client for adverse reactions to atropine sulfate (Atropine Care) eyedrops. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction?

Tachycardia

Damage to which area of the brain results in receptive aphasia?

Temporal lobe

When caring for a client with head trauma, the nurse notes a small amount of clear, watery fluid oozing from the client's nose. What should the nurse do?

Test the nasal drainage for glucose.

A client comes to the clinic for an ophthalmologic screening, which will include measurement of intraocular pressure with a tonometer. When teaching the client about the test, the nurse should cover which point?

The tonometer will register the force required to indent or flatten the corneal apex.

A client accidentally splashes chemicals into his eye. The nurse knows that eye irrigation with plain tap water should begin immediately and continue for 15 to 20 minutes. What is the primary purpose of this first-aid treatment?

To prevent vision loss

The nurse is caring for a client who underwent a lumbar laminectomy 2 days ago. Which finding should the nurse consider abnormal?

Urine retention or incontinence

A client with hypertension comes to the clinic for a routine checkup. Because hypertension is a risk factor for cerebral hemorrhage, the nurse questions the client closely about warning signs and symptoms of hemorrhage. Which complaint is a possible indicator of cerebral hemorrhage in this client?

Vertigo

The nurse is collecting data on a 38-year-old client diagnosed with multiple sclerosis. Which of the following symptoms would the nurse expect to find?

Vision changes

A 58-year-old client complaining of difficulty driving at night states that the "lights bother my eyes." The client wears corrective glasses. The nurse would suspect that the client is experiencing a deficiency in which of the following vitamins?

Vitamin A

A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by:

a positive edrophonium (Tensilon) test.

A client is sitting in a chair and begins having a tonic-clonic seizure. The most appropriate nursing response is to:

carefully move him to a flat surface and turn him on his side.

A client is color blind. The nurse understands that this client has a problem with:

cones.

During recovery from a stroke, a client is given nothing by mouth, to help prevent aspiration. To determine when the client is ready for a liquid diet, the nurse assesses the client's swallowing ability once each shift. This assessment evaluates:

cranial nerves IX and X.

An auto mechanic accidentally has battery acid splashed in his eyes. His coworkers irrigate his eyes with water for 20 minutes, and then take him to the emergency department of a nearby health care facility. He receives emergency care for corneal injury. The physician prescribes dexamethasone (Maxidex Ophthalmic Suspension), two drops of 0.1% solution to be instilled initially into the conjunctival sacs of both eyes every hour; and polymyxin B sulfate (Neosporin Ophthalmic), 0.5% ointment to be placed in the conjunctival sacs of both eyes every 3 hours. Dexamethasone exerts its therapeutic effect by:

decreasing leukocyte infiltration at the site of ocular inflammation.

A client has just been diagnosed with early glaucoma. During a teaching session, the nurse should:

demonstrate eyedrop instillation.

The nurse observes that a comatose client's response to painful stimuli is decerebrate posturing. The client exhibits extended and pronated arms, flexed wrists with palms facing backward, and rigid legs extended with plantar flexion. Decerebrate posturing as a response to pain indicates:

dysfunction in the brain stem.

A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order:

electromyography (EMG).

To evaluate a client's cranial nerve function, the nurse should assess:

gag reflex.

A client injured in a train derailment is admitted to an acute care facility with a suspected dysfunction of the lower brain stem. The nurse should monitor this client closely for:

hypoxia.

A client with a spinal cord injury and subsequent urine retention receives intermittent catheterization every 4 hours. The average catheterized urine volume has been 550 ml. The nurse should plan to:

increase the frequency of the catheterizations.

A client with an inflammatory ophthalmic disorder has been receiving a ½-inch ribbon of corticosteroid ointment in the lower conjunctival sac four times per day as directed. The client reports a headache and blurred vision. The nurse suspects that these symptoms represent:

increased intraocular pressure.

After an eye examination, a client is diagnosed with open-angle glaucoma. The physician's prescription says "pilocarpine ophthalmic solution (Pilocar), 0.25% 1 gtt both eyes q.i.d." Based on this prescription, the nurse should teach the client or a family member to administer the drug by:

instilling one drop of pilocarpine 0.25% into both eyes four times daily.

The nurse is caring for a client with an acute bleeding cerebral aneurysm. The nurse should take all of the following steps except:

keep the client in one position to decrease bleeding.

A client recovering from a stroke has right-sided hemiplegia and telegraphic speech and often seems frustrated and agitated, especially when trying to communicate. However, the chart indicates that the client's auditory and reading comprehension are intact. The nurse suspects that the client has:

nonfluent aphasia.

A client who has been severely beaten is admitted to the emergency department. The nurse suspects a basilar skull fracture after assessing:

raccoon eyes and Battle's sign.

The nurse is teaching a client with multiple sclerosis. When teaching the client how to reduce fatigue, the nurse should tell the client to:

rest in a room set at a comfortable temperature.

To encourage adequate nutritional intake for a client with Alzheimer's disease, the nurse should:

stay with the client and encourage him to eat.

The physician suspects myasthenia gravis in a client with chronic fatigue, muscle weakness, and ptosis. Myasthenia gravis is associated with:

thymus gland hyperplasia.

When communicating with a client who has sensory (receptive) aphasia, the nurse should:

use short, simple sentences.

A client is admitted to the facility for investigation of balance and coordination problems, including possible Ménière's disease. When assessing this client, the nurse expects to note:

vertigo, tinnitus, and hearing loss.

A 78-year-old Alzheimer's client is being treated for malnutrition and dehydration. The nurse decides to place him closer to the nurses' station because of his tendency to:

wander.