Neurologic and Sensory Systems Adaptive Quizzing

The nurse is caring for a client one week after the client experienced a spinal cord injury at the T3 level. What is an appropriate short-term goal for this client?

"The client will carry out personal hygiene activities."

What action should the nurse take to prevent precipitating a painful attack in a client with tic douloureux?

Avoid walking swiftly by the client.

The nurse is caring for a client with a diagnosis of trachoma. Which drug does the nurse expect to be prescribed by the primary healthcare provider to manage the client's condition?

Azithromycin

A client who sustained a severe head injury remains unconscious. During the client's assessment, the nurse observes bleeding from the left ear and rhinorrhea. What injury does the nurse conclude that drainage from the ear and nose indicates?

Basilar fracture

A nurse is assessing the laboratory findings of cerebrospinal fluids of four different clients. Which finding is consistent with meningitis?

Client A

The nurse is assessing the clinical data of four clients. Which client's tears contain mucus strands?

Client A

After reviewing the assessment findings of four different clients, the primary healthcare provider prescribed benzodiazepines to only one. Which client will benefit the greatest from benzodiazepines?

Client D

After a craniotomy to remove a brain tumor, the client develops the syndrome of inappropriate secretion of antidiuretic hormone (ADH). For which clinical indicators should the nurse monitor the client? Select all that apply.

Increased weight Decreased serum sodium Decreased level of consciousness

Which actions should the nurse take for a client who underwent cerebral angiography? Select all that apply.

Maintain pressure dressing for two hours Obtain vital signs and complete neurologic checks Check dressing for bleeding and swelling around the site

A client is experiencing diplopia, ptosis, and mild dysphagia. Myasthenia gravis is diagnosed, and an anticholinergic medication is prescribed. The nurse is planning care with the client and spouse. What instruction is the priority?

Take the medication according to a specific schedule.

A nurse is caring for a client with a spinal cord injury. What is the specific reason fluid intake should be increased for this client?

To prevent a urinary tract infection

The registered nurse (RN) is teaching new nurses how to obtain information when introducing themselves to clients suspected of having nervous system disorders. Which statement made by a new nurse indicates the need for further learning? Select all that apply.

"I should wait to assess the speech of the client until later." "I should observe the client's ability to perform hand hygiene."

A client develops hydrocephalus two weeks after cranial surgery for a ruptured cerebral aneurysm. The nurse concludes that the hydrocephalus probably is related to which physiologic response?

Blocked absorption of fluid from the arachnoid space

Which is the priority assessment for the client with Guillain-Barré syndrome with rapidly ascending paralysis?

Monitoring respiratory status

A client is diagnosed with stage 3 of Parkinson disease. Which clinical manifestations are found in the client? Select all that apply.

Postural instability Increased gait disturbances

The nurse is caring for a client who underwent a contrast-based cerebral angiography. Which nursing interventions will be beneficial after the procedure? Select all that apply.

Provide oral or intravenous fluids Maintain pressure dressing at the injection site Evaluate kidney function 24 hours after the test

A nurse is monitoring a client who is having a computed tomography (CT) scan of the brain with contrast. Which response indicates that the client is having a reaction to the contrast medium?

Shortness of breath

A client is being evaluated based on client reports of an impairment of a portion of the peripheral vision. After testing is completed, a diagnosis of retinal detachment is made, and a cryosurgical procedure is scheduled. As part of the preoperative teaching, the nurse provides information about what the client can expect and includes which information?

A description of the surgical suite environment

The nurse is supporting cognitive ability in clients with Alzheimer disease. Which actions will the nurse take? Select all that apply.

Encouraging caregivers to support safe independence Using calendars, clocks, and pictures to support memory Providing a limited number of choices to support decision-making

Which clinical indicators does the nurse expect to identify when assessing a client with tic douloureux? Select all that apply.

Excruciating facial pain Twitching of the mouth

The nurse is caring for a 60-year-old client who is at an increased risk of corneal damage. Which instructions should the nurse share with the client? Select all that apply.

"Use saline drops." "Increase humidity at home." "Wear prescribed lens for best vision."

Which clinical findings does the nurse anticipate a client with an exacerbation of multiple sclerosis will experience? Select all that apply.

Double vision Scanning speech

The nurse is assessing an older adult client with suspected hearing loss. Which observations made by the nurse in the client indicates a decrease in hearing acuity? Select all that apply.

Frequent usage of words such as "what" Postural changes while listening to the speaker Bending towards the other person while talking Mismatch in the questions asked and the responses given

The family member of a client with newly diagnosed Guillain-Barré syndrome comes out to the nurse's station and informs the nurse that the client is having difficulty breathing. What is the first action the nurse should do?

Go with the family member to assess the client.

A client who had a brain attack (cerebrovascular accident, CVA) frequently cries when family members visit, and they obviously are upset by the crying. What explanation for the client's behavior does the nurse provide the family members?

Having difficulty controlling emotions

Which cerebral lobe includes the speech area that allows the client to process words into coherent thoughts?

Temporal lobe

A client with a history of parkinsonism recently developed rigidity, tremors, and signs of pneumonia. The client is hospitalized for treatment. What should the nursing plan of care include?

Passive range-of-motion exercises at least every eight hours

A client with glaucoma is receiving a carbonic anhydrase inhibitor. Which statement made by the client will require the nurse to notify the primary healthcare provider?

"I am allergic to sulfonamides."

A nurse is providing instructions to a client with glaucoma. Which statements made by the client indicate the nurse needs to intervene? Select all that apply.

"I can lift objects that weigh more than 10 lbs (4.5 kg)." "I should keep my head in a dependent position."

After interacting with a client, the nurse believes the client is in the prodromal phase of a migraine. Which statements made by the client led the nurse to reach this conclusion? Select all that apply.

"I feel drowsy all the time." "I feel confused at this point in time." "I feel weakness in the left side of my body."

The registered nurse (RN) is teaching a client about cholinergic crisis. Which statement made by the client indicates the nurse needs to intervene?

"I will have decreased urine output."

A client who had a brain attack (cerebrovascular accident, CVA) two weeks ago is having problems communicating. The nurse shows the client a picture of a baseball and asks the client to identify it and its characteristics. The client describes its color, size, and purpose but cannot identify it as a ball. How will the nurse document this finding in the client's medical record?

Anomia

While assessing the client, the nurse observes abnormal eye movement. The client reports dizziness when standing or walking. Which structure of the auditory system might be affected in this client?

B

A nurse assesses a client and observes the condition depicted in the image. How will the nurse chart this finding?

Battle's sign present

A client has inflammation of the facial nerve, causing facial paralysis on one side. Which diagnosis will the nurse most likely observe written in the medical record?

Bell palsy

Which prostaglandin agonist is used in the treatment of clients with glaucoma?

Bimatoprost

While interacting with a client who reported visual changes, the nurse finds that the client is frequently exposed to the sun. Which conditions might this client have? Select all that apply.

Cataracts Pterygium Pinguecula

Four clients who sustained head injuries are presented below. Which client has the least score on the Glasgow coma scale?

Client C

The nurse on a community terrorism response team is reviewing triage protocols. In contrast to triage policies used during local emergency situations occurring in the hospital, triage practices during mass casualty events do not prescribe treatment for clients who have which type of injury?

Closed head injuries

A client with a cerebrovascular accident ("brain attack") has dysarthria. What should the nurse include in the plan of care to address this problem?

Effective communication

A nurse is assessing a client and finds the following (see image). Which abnormal finding can be identified from the given figure?

Hordeolum

A client arrives in the emergency department unconscious and exhibiting decerebrate posturing. When assessing the client, what does the nurse expect to observe?

Hyperextension of both the upper and lower extremities

A client has a brain attack (stroke) that involves the right cerebral cortex and cranial nerves. Which areas of paralysis should the nurse find upon assessment? Select all that apply.

Left leg Left arm Left side of face

A client reports severe right-sided headache with runny nose, droopy eyelids, and tearing of the eye on the right side. Which drugs are specific to treat this headache? Select all that apply.

Lithium Oral glucosamine

A client is admitted to the hospital with a diagnosis of Parkinson disease. Which common signs of Parkinson disease does the nurse expect to identify when completing a nursing admission history and physical? Select all that apply.

Muscle rigidity Blank facial expression

A client who had an infratentorial craniotomy is admitted to the intensive care unit after discharge from the postanesthesia care unit. Frequent assessments reveal that the client's intracranial pressure is increasing. What should the nurse do first?

Notify the healthcare provider.

A nurse is precepting an orientee (newly hired nurse). The nurse observes the orientee caring for an unconscious client with increasing intracranial pressure. The nurse should question which intervention that the orientee performs?

Suctioning the oropharynx routinely

What should the nurse infer from the given figure?

Used for self-administration of eye drops.

The primary healthcare provider prescribes an adrenergic agonist to a client with increased intraocular pressure. Which question is priority that the nurse should ask the client?

"Do you take antidepressants?"

The nurse is assessing the clinical data of four clients. Which client is characterized with mixed conductive-sensorineural type of hearing loss?

Client B

When performing a neurologic check on a client with a head injury, the nurse identifies a diminished corneal reflex in the left eye. What does appropriate nursing care for a client with an absent corneal reflex include?

Instilling artificial tears frequently

A nurse is assessing a client with multiple sclerosis. Which common initial clinical effects should the nurse expect to find? Select all that apply.

Nystagmus Scanning speech Intention tremors