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After teaching a patient about management of migraine headaches, the nurse determines that the teaching has been effective when the patient says

"I will try to lie down someplace dark and quiet when the headaches begin."

rational: It is recommended that the patient with a migraine rest in a dark, quiet area.

When a patient is experiencing a cluster headache, the nurse will plan to assess for

unilateral eyelid swelling

rational: Unilateral eye edema, tearing, and ptosis are characteristic of cluster headaches.

A patient has a tonic-clonic seizure while the nurse is in the patient's room. Which action should the nurse take?

Note time, observe and record the details of the seizure and postictal state.

rational: Because diagnosis and treatment of seizures frequently are based on the description of the seizure, recording the length and details of the seizure is important. Insertion of an oral airway and restraining the patient during a seizure are contraindicated.

An elementary teacher who has just been diagnosed with epilepsy after having a generalized tonic-clonic seizure tells the nurse, "I cannot teach anymore, it will be too upsetting if I have a seizure at work." Which response by the nurse is best?

"Most patients with epilepsy are well controlled with antiseizure medications."

rational: The nurse should inform the patient that most patients with seizure disorders are controlled with medication.

Which action will the nurse take when evaluating a patient who is taking phenytoin (Dilantin) for adverse effects of the medication?

Inspect the oral mucosa.

rational: Phenytoin can cause gingival hyperplasia.

A patient found in a tonic-clonic seizure reports afterward that the seizure was preceded by numbness and tingling of the arm. The nurse knows that this finding indicates what type of seizure?

partial seizure

rational: The initial symptoms of a partial seizure involve clinical manifestations localized to a particular part of the body or brain.

myoclonic seizure

sudden jerk of the body or extremities

atonic seizure

patient loses muscle tone and (typically) falls to the ground

absence seizure

staring and a brief loss of consciousness

When obtaining a health history and physical assessment for a patient with possible multiple sclerosis (MS), the nurse should inquire about

any urinary tract problems.

rational: Urinary tract problems with incontinence or retention are common symptoms of MS.

A 28-year-old woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate?

"MS symptoms may be worse after the pregnancy."

rational: During the postpartum period, women with MS are at greater risk for exacerbation of symptoms, thought there is no increased risk for congenital defects in infants born of mothers with MS. Symptoms of MS may improve DURING pregnancy. Onset of labor is not affected by MS.

A patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching about mediaction administration?

How to draw up and administer injections of the medication

rational: Copaxone is administered by self-injection.

A patient is seen in the health clinic with symptoms of a stooped posture, shuffling gait, and pill rolling-type tremor. The nurse will anticipate teaching the patient about

antiparkinsonian drugs.

rational: The diagnosis of Parkinson's is made when two of the three characteristic signs of tremor, rigidity, and bradykinesia are present. The confirmation of the diagnosis is made on the basis of improvement when antiparkinsonian drugs are administered. This patient has symptoms of tremor and bradykinesia; the next anticipated step will be treatment with medications.

A patient seen at the health clinic with a severe migraine headache tells the nurse about having four similar headaches in the last 3 months. Which initial action should the nurse take?

Ask the patient to keep a headache diary.

rational: The initial nursing action should be further assessment of the precipitating causes of the headaches, quality, and location of pain, etc. Stress reduction, muscle relaxation, and the triptan drugs may be helpful, but more assessment is needed first.

A patient with multiple sclerosis (MS) has urinary retention caused by a flaccid bladder. Which action will the nurse plan to take?

Teach the patient how to use the Credé method.

rational: The Credé method can be used to improve bladder emptying.

An increased lab level of ___ in a patient with MS indicates that the nurse should consult with the health care provider before giving the prescribed dose of fampridine (Ampyra).

an increased creatinine level.

rational: Fampridine should not be given to patients with impaired renal function.

A patient with Parkinson's disease has a nursing diagnosis of impaired physical mobility related to bradykinesia. Which action will the nurse include in the plan of care?

Suggest that the patient rock from side to side to initiate leg movement.

rational: Rocking the body from side to side stimulates balance and improves mobility. The patient will be encouraged to continue exercising because this will maintain functional abilities. Maintaining a wide base of support will help with balance. The patient should lift the feet and avoid a shuffling gait.

A patient has a new prescription for bromocriptine (Parlodel) to control symptoms of Parkinson's disease. Which information obtained by the nurse may indicate a need for a decrease in the dose?

The patient's blood pressure is 90/46 mm Hg.

rational: Hypotension is an adverse effect of bromocriptine, and the nurse should check with the health care provider before giving the medication.

When teaching a patient with myasthenia gravis (MG) about management of the disease, the nurse advises the patient to perform physically demanding activities when?

in the morning.

rational: Muscles are generally strongest in the morning, and activities involving muscle activity should be scheduled then.

alcohol, only dietary trigger in ____ headache

cluster

chronic, dull, persisting intermittently over months or years, a ____ headache

tension-type

strong family history in ____ headache

migraine

bilateral pressure or tightness in ____ headache

tension-type

recurs several times a day for several weeks, a ____ headache

cluster

may occur with or between migraines, ____ headache

tension-type

severe, sharp penetrating head pain, a ____ headache

cluster

may be accompanied by unilateral ptosis or lacrimation, a ____ headache

cluster

may be accompanied by nausea, vomiting or irritability, a ____ headache

migraine

abrupt onset, 5-180 minutes, a ____ headache

cluster

unilateral or bilateral throbbing pain, a ____ headache

migraine

may be preceded by prodrome, a ____ headache

migraine

most important method of diagnosing functional headaches is

a thorough history, assessing specific details of the headache

drug therapy for acute migraine and cluster headaches that appear to alter the pathophysiologic process are

specific serotonin receptor agonists (sumatriptan; Imitrex) cause vasoconstriction, useful in treatment

The nurse is caring for a patient admitted for evaluation and surgical removal of a brain tumor. The nurse will plan interventions for this patient based on knowledge that brain tumors can lead to which of the following complications (select all that apply)?
a. Vision loss
b. Cerebral edema
c. Pituitary dysfunction
d. Parathyroid dysfunction
e. Focal neurologic deficits

A, B, C, E

A patient with a suspected closed head injury has bloody nasal drainage. The nurse suspects that this patient has a cerebrospinal fluid (CSF) leak when observing which of the following?
a. A halo sign on the nasal drip pad
b. Decreased blood pressure and urinary output
c. A positive reading for glucose on a Test-tape strip
d. Clear nasal drainage along with bloody discharge

A. When drainage containing both CSF and blood is allowed to drip onto a white pad, within a few minutes the blood will coalesce into the center, and a yellowish ring of CSF will encircle the blood, giving a halo effect.

The nurse assesses a patient for signs of meningeal irritation and observes her for nuchal rigidity. Which of the following indicates the presence of this sign of meningeal irritation?
a. Tonic spasms of the legs
b. Curling in a fetal position
c. Arching of the neck and back
d. Resistance to flexion of the neck

D

The nurse is caring for a patient admitted with a subdural hematoma following a motor vehicle accident. Which of the following changes in vital signs would the nurse interpret as a manifestation of increased intracranial pressure?
a. Tachypnea
b. Bradycardia
c. Hypotension
d. Narrowing pulse pressure

B. Changes in vital signs indicative of increased intracranial pressure are known as Cushing's triad, which consists of increasing systolic pressure with a widening pulse pressure, bradycardia with a full and bounding pulse, and irregular respirations.

Which diseased area of the brain will produce a deficit in of vigilance, detection and a working memory?
a. Cortical Association Area
b. Hippocampal Area
c. Frontal Area
d. Thalamus

c. Frontal Area

Which is NOT a characteristic of the clonic phase in a grand-mal seizure?
a. flexion spasm of whole body interrupted by muscular relaxation
b. strenuous hyperventilation, and excessive salivation with froth of the mouth
c. contorted face, and eyes rolled
d. slow pulse
e. rapid pulse

d. slow pulse

Which is TRUE regarding Alzheimers Disease?
a. The brain increases in volume
b. The brain increase in weight
c. Diagnosis is made upon angiogram
d. Diagnosis is made by ruling out other causes of dementia by CT and blood tests

d. Diagnosis is made by ruling out other causes of dementia by CT and blood tests

Which motor neuron DIRECTLY influences the skeletal muscle?
a. Upper motor neuron
b. Astrocytes
c. Lower motor neuron
d. Third order neurons

c. Lower motor neuron

Which of following is a commonly occurring degenerative disorder of the basal ganglia involving the dopaminergic nigrostriatal pathway?
a. Parkinson disease
b. Huntington disease
c. Hydrocephalus
d. Paralysis

a. Parkinson disease

Which of the following interventions should the nurse perform in the acute care of a patient with autonomic dysreflexia?
a. Urinary catheterization
b. Administration of benzodiazepines
c. Suctioning of the patient's upper airway
d. Placement of patient in Trendelenburg position

a. Urinary catheterization

Which of the following nursing diagnoses is likely to be a priority in the care of a patient with myasthenia gravis (MG)?
a. Acute confusion
b. Bowel incontinence
c. Activity intolerance
d. Disturbed sleep pattern

c. Activity intolerance, the primary feature of MG is fluctuating weakness of skeletal muscle.

The nurse is caring for a patient admitted with a spinal cord injury following a motor vehicle accident. The patient exhibits a complete loss of motor, sensory, and reflex activity below the injury level. The nurse recognizes this condition as which of the following?
a. Central cord syndrome
b. Spinal shock syndrome
c. Anterior cord syndrome
d. Brown-Séquard syndrome

b. Spinal shock syndrome

Which of the following clinical manifestations would the nurse interpret as representing neurogenic shock in a patient with acute spinal cord injury?
a. Bradycardia
b. Hypertension
c. Neurogenic spasticity
d. Bounding pedal pulses

a. Bradycardia, neurogenic shock is due to the loss of vasomotor tone caused by injury and is characterized by hypotension and bradycardia

The nurse is caring for a patient admitted 1 week ago with an acute spinal cord injury. Which of the following assessment findings would alert the nurse to the presence of autonomic dysreflexia?
a. Tachycardia
b. Hypotension
c. Hot, dry skin
d. Throbbing headache

d. Throbbing headache, autonomic dysreflexia is related to reflex stimulation of the sympathetic nervous system reflected by hypertension, bradycardia, throbbing headache, and diaphoresis.

When assessing motor function of a patient admitted with a stroke, the nurse notes mild weakness of the arm demonstrated by downward drifting of the arm. The nurse would most accurately document this finding as
a. Athetosis.
b. Hypotonia.
c. Hemiparesis.
d. Pronator drift.

d. pronator drift, downward drifting of the arm or pronation of the palm is identified as a pronator drift

When assessing the accessory nerve, the nurse would
a. Assess the gag reflex by stroking the posterior pharynx.
b. Ask the patient to shrug the shoulders against resistance.
c. Ask the patient to push the tongue to either side against resistance.
d. Have the patient say "ah" while visualizing elevation of soft palate.

b. Ask the patient to shrug the shoulders against resistance.

A patient who has a neurologic disease that affects the pyramidal tract is likely to manifest which of the following signs?
a. Impaired muscle movement
b. Decreased deep tendon reflexes
c. Decreased level of consciousness
d. Impaired sensation of touch, pain, and temperature

a. Impaired muscle movement. Among the most important descending tracts are the corticobulbar and corticospinal tracts, collectively termed the pyramidal tract. These tracts carry volitional (voluntary) impulses from the cortex to the cranial and peripheral nerves.

How should the nurse most accurately assess the position sense of a patient with a recent traumatic brain injury?
a. Ask the patient to close his or her eyes and slowly bring the tips of the index fingers together.
b. Ask the patient to maintain balance while standing with his or her feet together and eyes closed.
c. Ask the patient to close his or her eyes and identify the presence of a common object on the forearm.
d. Place the two points of a calibrated compass on the tips of the fingers and toes and ask the patient to discriminate the points.

b. Ask the patient to maintain balance while standing with his or her feet together and eyes closed.

The nurse is providing care for a patient admitted to the hospital with a head injury and who requires regular neurologic vital signs. Which of the following assessments will be components of the patient's score on the Glasgow Coma Scale (GCS) (select all that apply)?
a. Judgment
b. Eye opening
c. Abstract reasoning
d. Best verbal response
e. Best motor response
f. Cranial nerve function

b. Eye opening
d. Best verbal response
e. Best motor response

Which of the following nursing actions should be implemented in the care of a patient who is experiencing increased intracranial pressure (ICP)?
a. Monitor fluid and electrolyte status astutely.
b. Position the patient in a high Fowler's position.
c. Administer vasoconstrictors to maintain cerebral perfusion.
d. Maintain physical restraints to prevent episodes of agitation.

a. Monitor fluid and electrolyte status astutely.

Magnetic resonance imaging (MRI) has revealed the presence of a brain tumor in a patient. The nurse would recognize the patient's likely need for which of the following treatment modalities?
a. Surgery
b. Chemotherapy
c. Radiation therapy
d. Pharmacologic treatment

a. Surgery

The nurse is providing care for a patient who has been diagnosed with Guillain-Barré syndrome. Which of the following assessments should the nurse prioritize?
a. Pain assessment
b. Glasgow Coma Scale
c. Respiratory assessment
d. Musculoskeletal assessment

c. Respiratory assessment

Which of the following signs and symptoms in a patient with a T4 spinal cord injury should alert the nurse to the possibility of autonomic dysreflexia?
a. Headache and rising blood pressure
b. Irregular respirations and shortness of breath
c. Decreased level of consciousness or hallucinations
d. Abdominal distention and absence of bowel sounds

a. Headache and rising blood pressure

When planning care for a patient with a C5 spinal cord injury, which nursing diagnosis is the highest priority?
a. Risk for impairment of tissue integrity caused by paralysis
b. Altered patterns of urinary elimination caused by quadriplegia
c. Altered family and individual coping caused by the extent of trauma
d. Ineffective airway clearance caused by high cervical spinal cord injury

d. Ineffective airway clearance caused by high cervical spinal cord injury

Musculoskeletal assessment is an important component of care for patients on long-term therapy of
a. Corticosteroids.
b. Antiplatelet aggregators.
c. b-Adrenergic blockers.
d. Calcium-channel blockers.

a. Corticosteroids

When assessing a patient with a traumatic brain injury, the nurse notes uncoordinated movement of the extremities. The nurse would document this as
a. Ataxia.
b. Apraxia.
c. Anisocoria.
d. Anosognosia.

a. Ataxia

The nurse would expect to find which of the following clinical manifestations in a patient admitted with a left-brain stroke?
a. Impulsivity
b. Impaired speech
c. Left-side neglect
d. Short attention span

b. Impaired speech Clinical manifestations of left-sided brain damage include right hemiplegia, impaired speech/language aphasias, impaired right/left discrimination, and slow and cautious performance. The other options are all manifestations of right-sided brain damage.

Which of the following measures should the nurse prioritize when providing care for a patient with a diagnosis of multiple sclerosis (MS)?
a. Vigilant infection control and adherence to standard precautions
b. Careful monitoring of neurologic vital signs and frequent reorientation
c. Maintenance of a calorie count and hourly assessment of intake and output
d. Assessment of blood pressure and monitoring for signs of orthostatic hypotension

a. Vigilant infection control and adherence to standard precautions. Infection control is a priority in the care of patients with MS, since infection is the most common precipitator of an exacerbation of the disease.

Which of the following characteristics of a patient's recent seizure is congruent with a partial seizure?
a. The patient lost consciousness during the seizure.
b. The seizure involved lip smacking and repetitive movements.
c. The patient fell to the ground and became stiff for 20 seconds.
d. The etiology of the seizure involved both sides of the patient's brain.

b. The seizure involved lip smacking and repetitive movements.

A male patient with a diagnosis of Parkinson's disease (PD) has been admitted recently to a long-term care facility. Which of the following actions should the health care team take in order to promote adequate nutrition for this patient?
a. Provide multivitamins with each meal.
b. Provide a diet that is low in complex carbohydrates and high in protein.
c. Provide small, frequent meals throughout the day that are easy to chew and swallow.
d. Provide the patient with a minced or pureed diet that is high in potassium and low in sodium.

c. Provide small, frequent meals throughout the day that are easy to chew and swallow.

Which of the following sensory-perceptual deficits is associated with left-brain stroke (right hemiplegia)?
a. Overestimation of physical abilities
b. Difficulty judging position and distance
c. Slow and possibly fearful performance of tasks
d. Impulsivity and impatience at performing tasks

c. Slow and possibly fearful performance of tasks, patients with a left-brain stroke (right hemiplegia) commonly are slower in organization and performance of tasks and may have a fearful, anxious response to a stroke.

For a 65 year old woman who has lived with a T1 spinal cord injury for 20 years, which of the following health teaching instructions should the nurse emphasize?
a. a mammogram needed every year
b. bladder function tends to improve with age
c. heart disease is not common in persons with spinal cord injury
d. as a person ages the need to change body position is less important

a. a mammogram needed every year

The most common early symptom of a spinal cord tumor is
a. urinary incontinence
b. back pain that worsens with activity
c. paralysis below the level of involvement
d. impaired sensation of pain, temperature, light touch

b. back pain that worsens with activity

A patient with a C7 spinal cord injury undergoing rehabilitation tells the nurse he must have the flu because he as had a bad headache and nausea. The initial action of the nurse is to
a. call the physician
b. check the patient's temperature
c. take the patient's blood pressure
d. elevate the head of the bed to 90 degrees

c. take the patient's blood pressure

A patient is admitted to the hospital with a C4 spinal cord injury after a motorcycle collision. The patient's BP is 83/49 mm Hg, and his pulse is 39 beats/min, and he remains orally intubated. The nurse identifies this pathophysiologic response as caused by
a. increased vasomotor tone after injury
b. a temporary loss of sensation and flaccid paralysis below the level of injury
c.loss of parasympathetic nervous system innervation resulting in vasoconstriction
d. loss of sympathetic nervous system innervation resulting in peripheral vasodilation

d. loss of sympathetic nervous system innervation resulting in peripheral vasodilation

A patient is admitted to the ICU with a C7 spinal cord injury and diagnosed with brown-sequard syndrome. On physical examination, the nurse would most likely find
a. upper extremity weakness only
b. complete motor and sensory loss below C7
c. loss of position sense and vibration in both lower extremities
d. ipsilateral motor loss and contralateral sensory loss below C7

d. ipsilateral motor loss and contralateral sensory loss below C7

Goals of rehabilitation for the patient with an injury at the C6 level include (select all that apply)
a. stand erect with leg brace
b. feed self with hand devices
c. drive an electric wheelchair
d. assist with transfer activities
e. drive adapted van from wheelchair

b. feed self with hand devices
c. drive an electric wheelchair
d. assist with transfer activities
e. drive adapted van from wheelchair

Social effects of a chronic neurologic disease include (select all that apply)
a. divorce
b. job loss
c. depression
d. role changes
e. loss of self esteem

a. divorce
b. job loss
c. depression
d. role changes
e. loss of self esteem

One major goal of treatment for a patient with Huntington's Disease is
a. disease cure
b. symptomatic relief
c. maintaining employment
d. improving muscle strength

b. symptomatic relief

The patient has been receiving scheduled doses of phenytoin (Dilantin) and begins to experience diplopia. The nurse immediately assesses the patient for which of the following?
a. An aura
b. Nystagmus or confusion
c. Abdominal pain or cramping
d. Irregular pulse or palpitations

b. Nystagmus or confusion

A female patient has left-sided hemiplegia following an ischemic stroke that she experienced 2 weeks earlier. How should the nurse best promote the health of the patient's integumentary system?
a. Position the patient on her weak side the majority of the time.
b. Alternate the patient's positioning between supine and side-lying.
c. Avoid the use of pillows in order to promote independence in positioning.
d. Establish a schedule for the massage of areas where skin breakdown emerges.

b. Alternate the patient's positioning between supine and side-lying.

A patient's sudden onset of hemiplegia has necessitated a computed tomography (CT) of her head. Which of the following assessments should the nurse complete prior to this diagnostic study?
a. Assess the patient's immunization history.
b. Screen the patient for any metal parts or a pacemaker.
c. Assess the patient for allergies to shellfish, iodine, or dyes.
d. Assess the patient's need for tranquilizers or antiseizure medications.

c. Assess the patient for allergies to shellfish, iodine, or dyes.

Interferon β-1b (Betaseron) has been prescribed for a young woman who has been diagnosed with relapsing-remitting multiple sclerosis. The nurse determines that additional teaching about the drug is needed when the patient says,
a."I will need to rotate injection sites with each dose I inject."
b."I should report any depression or suicidal thoughts that develop."
c."I should avoid direct sunlight and use sunscreen and protective clothing when out of doors."
d."Because this drug is a corticosteroid, I should reduce my sodium intake to prevent edema."

d."Because this drug is a corticosteroid, I should reduce my sodium intake to prevent edema." Interferon β-1b (Betaseron) is an immunomodulator drug (and not a corticosteroid). The drug is given subcutaneously every other day. Patient teaching should include the following: rotate injection sites with each dose; assess for depression and suicidal ideation; wear sunscreen and protective clothing while exposed to the sun; and know that flu-like symptoms are common following initiation of therapy.

An appropriate nursing diagnosis for a patient with advanced Parkinson's disease is
a. Risk for injury related to limited vision.
b. Risk for aspiration related to impaired swallowing.
c. Urge incontinence related to effects of drug therapy.
d. Ineffective breathing pattern related to diaphragm fatigue.

b.Risk for aspiration related to impaired swallowing. As swallowing becomes more difficult (dysphagia), malnutrition or aspiration may result.

The nurse is called to the patient's room by the patient's spouse when the patient experiences a seizure. Upon finding the patient in a clonic reaction, the nurse should:
a.Turn the patient to the side.
b.Start oxygen by mask at 6 L/min.
c.Restrain the patient's arms and legs to prevent injury.
d.Record the time sequence of the patient's movements and responses as they occur.

a.Turn the patient to the side. During the seizure, the nurse should maintain a patent airway, protect the patient's head, turn the patient to the side, loosen constrictive clothing, and ease the patient to the floor, if seated. The patient should not be restrained, and no objects should be placed in the mouth. After the seizure, the patient may require repositioning to open and maintain the airway, suctioning, and oxygen. When a seizure occurs, the nurse should carefully observe and record details of the event because diagnosis and subsequent treatment often rest solely on the seizure description.

Which of the following are risk factors for late onset sporadic Alzheimer disease?
a. Increased BP and cholesterol
b. ApoE gene
c. Environmental triggers, toxins
d. All of these are risk factors

d. All of these are risk factors

What is the antidote for a cholenergic medication?

atropine

The Tonic phase of a seizure consists of?
a. A state of muscle contraction in which there is excessive muscle tone
b. A state of alternating contraction and relaxation of muscles
c. The period immediately following the cessation of seizure activity
d. None of the above choices

a. A state of muscle contraction in which there is excessive muscle tone

You are working in the emergency department when a college freshman is brought in by his roommate. The freshman has a severe headache, stiff neck, subjective fever and his roommate had to pull over en route to the hospital to let the patient vomit. The lights of the ER triage area seem to bother his eyes. Which of the following is an important part of caring for this patient?
a. Speaking to the client a slower rate
b. Allowing plenty of time for the client to respond
c. Completing the sentences that the client cannot finish
d. Looking directly at the client during attempts at speech

c. Completing the sentences that the client cannot finish. Note that the question asks which is least helpful. These words indicate a negative event query and ask you to select an option that is and incorrect action. The patient should be placed on droplet precautions.

The nurse is planning to test the function of the trigeminal nerve (cranial nerve V). The nurse would gather which of the following items to perform the test?
a. Tuning fork and audiometer
b. Snellen chart, ophthalmoscope
c. Flashlight, pupil size chart or millimeter ruler
d. Safety pin, hot and cold water in test tubes, cotton wisp

d. Safety pin, hot and cold water in test tubes, cotton wisp

The nurse is planning to institute seizure precautions for a client who is being admitted from the emergency department. Which of the following measures would the nurse avoid in planning for the client's safety?
a. Padding the side rails of the bed
b. Putting a padded tongue blade at the head of the bed
c. Placing an airway, oxygen, and suction equipment at the bedside
d. Having intravenous equipment ready for insertion of an intravenous catheter

b. Putting a padded tongue blade at the head of the bed. Seizure precautions may vary from agency to agency but the generally have some common features. Usually an airway, oxygen, and suctioning equipment are kept available at the bedside. The side rails of the bed are padded, and the bed is kept in the lowest position. The client has an intravenous access in place to have a readily accessible route if anticonvulsant medications must be administered. The use of padded tongue blades is highly controversial, and they should not be kept at bedside. Forcing a tongue blade into the mouth during a seizure more likely will harm the client who bites down during seizure activity. Risks include blocking the airway from improper placement, chipping the client's teeth.

The nurse is evaluation the respiratory outcomes for the client with Guillain-Barre syndrome. The nurse determines that which of the following is the least optimal outcome for the client?
a. Spontaneous breathing
b. Oxygen saturation of 98%
c. Adventitious breath sounds
d. Vital capacity within normal range

c. Adventitious breath sounds

Which of the following nursing interventions is most appropriate when communicating with a patient suffering from aphasia poststroke?
a. Present several thoughts at once so that the patient can connect the ideas.
b. Ask open-ended questions to provide the patient the opportunity to speak.
c. Use simple, short sentences accompanied by visual cues to enhance comprehension.
d. Finish the patient's sentences so as to minimize frustration associated with slow speech.

c. Use simple, short sentences accompanied by visual cues to enhance comprehension.

Computed tomography of a 68-year-old male patient's head reveals that he has experienced a hemorrhagic stroke. Which of the following is a nursing priority intervention in the emergency department?
a. Maintenance of the patient's airway
b. Positioning to promote cerebral perfusion
c. Control of fluid and electrolyte imbalances
d. Administration of tissue plasminogen activator (tPA)

a. Maintenance of the patient's airway

The nurse is discharging a patient admitted with a transient ischemic attack (TIA). For which of the following medications might the nurse expect to provide discharge instructions (select all that apply)?
a. Clopidogrel (Plavix)
b. Enoxaparin (Lovenox)
c. Dipyridamole (Persantine)
d. Enteric-coated aspirin (Ecotrin)
e. Tissue plasminogen activator (tPA)

a. Clopidogrel (Plavix)
c. Dipyridamole (Persantine)
d. Enteric-coated aspirin (Ecotrin)

A patient with Alzheimer's disease has a nursing diagnosis of impaired memory related to effects of dementia. An appropriate nursing intervention for the patient is to:
1.Let the patient know what behavior is socially appropriate.
2.Assist the patient with all self-care to maintain self-esteem.
3.Maintain familiar routines of sleep, meals, drug administration, and activities.
4.At every encounter with the patient, ask the day, time, and place to promote orientation.

3.Maintain familiar routines of sleep, meals, drug administration, and activities.
Rationale: The nurse should maintain familiar routines by identifying usual patterns of behavior for activities such as sleep, medication use, elimination, food intake, and self-care.

A 69-year-old patient is admitted to the hospital with a urinary infection and possible bacterial sepsis. The patient is disoriented and has a disturbed sleep-wake cycle. The nurse administers the Confusion Assessment Method (CAM) tool to differentiate among various cognitive disorders, primarily because:
1.Delirium can be reversed by treating the underlying causes.
2.Depression is a common cause of dementia in older adults.
3.Nursing care should be based on the cause of the cognitive impairment.
4.Drug therapy with antipsychotic agents is indicated in the treatment of dementia.

1.Delirium can be reversed by treating the underlying causes.
Rationale: Delirium, a state of temporary but acute mental confusion, is a common, life-threatening, and possibly preventable syndrome in older adults. Clinically, delirium is rarely caused by a single factor. It is often the result of the interaction of the patient's underlying condition with a precipitating event.

A patient experiencing TIAs is scheduled for a carotid endarterectomy. The nurse explains that this procedure is done to
1.Decrease cerebral edema
2.Reduce the brain damage that occurs during a stroke in evolution
3.Prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow
4.Provide a circulatory bypass around thrombotic plaques obstructing cranial circulation

3.Prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow
Rationale: This is completed to prevent impending cerebral infarction. Atherosclerotic plaques are removed.

A patient with a stroke has dysphagia. Before allowing the patient to eat, which of the following actions should the nurse take first?
1. Check the patient's gag reflex.
2. Request a soft diet with no liquids.
3. Place the patient in high-Fowler's position.
4. Test the patient's ability to swallow with a small amount of water.

1. Check the patient's gag reflex.
Rationale: Before initiation of feeding, assess the gag reflex by gently stimulating the back of the throat with a tongue blade. If a gag reflex is present, the patient will gag spontaneously. If it is absent, defer the feeding, and begin exercises to stimulate swallowing. To assess swallowing ability, elevate the head of the bed to an upright position (unless contraindicated), and give the patient a small amount of crushed ice or ice water to swallow.

A patient with right-sided paresthesias and hemiparesis is hospitalized and diagnosed with a thrombotic stroke. Over the next 72 hours, the nurse plans care with the knowledge that the patient:
1.Is ready for aggressive rehabilitation.
2.Will show gradual improvement of the initial neurologic deficits.
3.May show signs of deteriorating neurologic function as cerebral edema increases.
4.Should not be turned or exercised to prevent extension of the thrombus and increased neurologic deficits.

3.May show signs of deteriorating neurologic function as cerebral edema increases.
Rationale: Ischemic stroke symptoms may progress in the first 72 hours as infarction and cerebral edema increase.

Management of the patient with bacterial meningitis includes:
1.Administering antibiotics immediately after collection of specimens for culture.
2.Waiting for results of a CSF culture to identify an organism before initiating treatment.
3.Providing symptomatic and supportive treatment because drug therapy is not effective in treatment.
4.Obtaining skull x-rays and CT scans to determine the extent of the disease before treatment is started.

1.Administering antibiotics immediately after collection of specimens for culture.
Rationale: Bacterial meningitis is a medical emergency. Rapid diagnosis based on history and physical examination is crucial because the patient is usually in a critical state when health care is sought. When meningitis is suspected, antibiotic therapy is instituted after collection of specimens for cultures, even before the diagnosis is confirmed.

In teaching a patient with chronic fatigue syndrome (CFS) about this disorder, the nurse understands that
a. palpating tender points is an indicator of CFS severity
b. many symptoms are similar to fibromyalgia syndrome
c. definitive treatment includes low dose hydrocortisone
d. CFS is characterized by progressive memory impairment

d. CFS is characterized by progressive memory impairment.

During routine assessment of a patient with guillain-barre syndrome, the nurse finds the patient to be short of breath. The patient's respiratory distress is caused by
a. elevated protein levels in the CSF
b. immobility resulting from ascending paralysis
c. degeneration of motor neurons in the brainstem and spinal cord
d. paralysis ascending to the nerves that stimulate the thoracic area

d. paralysis ascending to the nerves that stimulate the thoracic area

During assessment of the patient with trigeminal neuralgia, the nurse should (select all that apply)
a. inspect all aspects of the mouth and teeth
b. assess the gag reflex and respiratory rate and depth
c. lightly palpate the affected side of the face for edema
d. test for temperature and sensation perception n the face
e. ask the patient to describe factors that initiate an episode

a. inspect all aspects of the mouth and teeth
d. test for temperature and sensation perception n the face
e. ask the patient to describe factors that initiate an episode

The nurse assesses that a n 87 year old woman with alzheimers disease is continually rubbing, flexing, and kicking out her legs throughout the day. The night shift reports that this same behavior escalates at night, preventing her from obtaining her required sleep. The next step the nurse should take is to:
a. ask the physician for a daytime sedative for the patient
b. request soft restraints to prevent her from falling out of her bed
c. ask the physician for a nighttime sleep medication for the patient
d. assess the patient more closely, suspecting a disorder such as restless leg syndrome

d. assess the patient more closely, suspecting a disorder such as restless leg syndrome

A 65 year old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is
a. searching the internet for educational videos
b. evaluating the home for environmental safety
c. promoting physical exercise and a well balanced diet
d. designing an exercise program to strengthen and stretch specific muscles

c. promoting physical exercise and a well balanced diet

A 50 year old man complains of recurring headaches. He describes these as sharp, stabbing, and located around his left eye. He also reports that his eye seems to swell and get teary when these headaches occur. Based on this history you suspect that he has
a. cluster headaches
b. tension headaches
c. migraine headaches
d. medication overuse headaches

a. cluster headaches

Common psychosocial reactions of the stroke patient to the stroke include (select all that apply)
a. depression
b. disassociation
c. intellectualization
d. sleep disturbances
e. denial of the severity of the stroke

a. depression
d. sleep disturbances
e. denial of the severity of the stroke

When is a lumbar puncture indicated?

To determine if there is an infection in the spine (CNS) such as meningitis.

When is a lumbar puncture not indicated?

When the patient has a possible brain tumor.

A client is admitted to the ER for head trauma is diagnosed with an epidural hematoma. The underlying cause of epidural hematoma is usually related to which of the following conditions?

Laceration of the middle meningeal artery

A client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The nurse would avoid which of the following measures to minimize the risk of recurrence?

Limiting bladder catherization to once every 12 hours

Which of the following physiologic changes would be expected in a patient with presbyopia?

Loss of lens elasticity

Lower motor neuron syndromes originating in the anterior horn cells or the motor nuclei of the cranial nerves are called_________?
a. Akinesia
b. Distonia
c. Amyotrophy
d. Cogwheel Rigidity

c. Amyotrophy

Major Nursing Concern for Guillian-Barre syndrome (polyneuritis)

Breathing Problems

Which measures should an RN take when placing a client in seizure precautions?

Have suction, airway & amp; oxygen at bedside.

a state of continuous seizure activity or a condition in which seizures recur in rapid succession without return to consciousness between seizures

status epilepticus

The client has experienced an episode of Myasthenic crisis. The nurse would assess whether the client has precipitating factors such as:
a. Getting too little exercise
b. Taking excess medication
c. Omitting doses of medication
d. Increasing intake of fatty foods

c. Omitting doses of medication

The client is admitted to the hospital with a diagnosis of Guillian-Barre syndrome. The nurse inquires during the nursing admission interview if the client has a history of:
a. Seizures or trauma to the brain
b. Meningitis during the last 5 years
c. Back injury or trauma to the spinal cord
d. Respiratory or gastrointestinal infection during the previous month

d. Respiratory or gastrointestinal infection during the previous month

The client with a stroke has residual dysphagia. When the diet order is initiated, the nurse avoids doing which of the following?
a. Giving the client thin liquids
b. Thickening liquids to the consistency of oatmeal
c. Placing food on the unaffected side of the mouth
d. Allowing plenty of time for chewing and swallowing

a. Giving the client thin liquids
Rationale: before the client with dyshagia is started on a diet, the gag and swallow reflexes must have returned. The client is assisted with meals as needed and is given ample time to chew and swallow. Food is placed on the unaffected side of the mouth. Liquids are thickened to avoid aspiration.

The client with Guillian-Barre syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which of the following strategies would the nurse incorporate in the plan of care to help the client cope with this illness?
a. Giving client full control over care decisions and restricting visitors
b. Providing positive feedback and encouraging active range of motion
c. Providing information, giving positive feedback, and encouraging relaxation
d. Providing intravenously administered sedatives, reducing distractions, and limiting visitors

c. Providing information, giving positive feedback, and encouraging relaxation

The client with Parkinson's disease has a nursing diagnosis of falls, Risk for related to an abnormal gait documented in the nursing care plan. The nurse assesses the client, expecting to observe which type of gait?
a. Unsteady and staggering
b. Shuffling and propulsive
c. Broad-based and waddling
d. Accelerating with walking on the toes

b. Shuffling and propulsive

The Glasgow Coma scale is a 15 point scale that is used to measure neurological status, what does it measure responses to?

Eyes Open, Verbal Response, Motor Response

The end of spinal shock occurs when the spinal reflexes return within a few days to weeks, and all of the following characteristics occur when spinal shock resolves EXCEPT...
a. Flaccid paralysis
b. Spasticity
c. Increased muscle tone
d. Hyperactive reflexes

a. Flaccid paralysis

The nurse has given instructions to the client with Parkinson's disease about maintaining mobility. The nurse determines that the client understands the directions if the client sates that he or she will:
a. Sit in soft, deep chairs
b. Exercise in the evening to combat fatigue
c. Rock back and forth to start movement with bradykinesia
d. Buy clothes with many buttons to maintain finger dexterity

c. Rock back and forth to start movement with bradykinesia

The nurse has given suggestions to the client with trigeminal neuralgia about strategies to minimize episodes of pain. The nurse determines that the client needs reinforcement of information if the client makes which of the following statements?
a. "I will wash my face with cotton pads."
b. "I'll have to start chewing on the unaffected side."
c. "I'll try to eat my food either very warm or very cold."
d. "I should rinse my mouth sometimes if toothbrushing is painful."

c. "I'll try to eat my food either very warm or very cold."

The nurse has given the client with Bell's Palsy instructions on preserving muscle tone in the face and preventing denervation. The nurse determines that the client needs additional information if the client states that he or she will:
a. Expose the face to cold and drafts
b. Massage the face with a gently upward motion
c. Perform facial exercises
d. Wrinkle the forehead, blow out the cheeks, and whistle.

a. Expose the face to cold and drafts

The nurse has instructed the family of a client with a stroke who has homonymous hemianopsia about measures to help the client overcome the deficit. The nurse determines that the family understands the measures to use if the state that they will:
a. Place objects in the client's impaired field of vision
b. Discourage the client from wearing eyeglasses.
c. Approach the client from the impaired field of vision
d. Remind the client to turn the head to scan the lost visual field.

d. Remind the client to turn the head to scan the lost visual field.
Rationale: Homonymous hemianopsia is loss of half of the visual field. The client with Homonymous hemianopsia should have objects placed in the intact field of vision, and the nurse also should approach the client from the intact side. The nurse instructs the client to scan the environment to overcome the visual deficit and does client teaching from within the intact field of vision: The nurse encourages the use of personal eye glasses, if they are available.

The nurse is admitting a client with Guillian- Barre syndrome to the nursing unit. The client has an ascending paralysis to the level of the waist. Knowing the complication of the disorder, the nurse brings which of the following items into the client's room?
a. Nebulizer and pulse oximeter
b. Blood pressure and flashlight
c. Flashlight and incentive spirometer
d. Electrocardiographic monitoring electrodes and intubation tray

d. Electrocardiographic monitoring electrodes and intubation tray

The nurse is assessing the motor function of an unconscious client. The nurse would plan to use which of the following to test the client's peripheral response to pain?
a. Sternal rub
b. Nail bed pressure
c. Pressure on the orbital rim
d. Squeezing of the sternocleidomastoid muscle

b. Nail bed pressure
Rationale: Motor testing in the unconscious client can be done only by testing response painful stimuli. Nail bed pressure tests a basic peripheral pressure on the orbital rim, or squeezing the clavical or sternoleidomastoid muscle.

The nurse is assigned to care for a client with complete right-sided hemiparesis, the nurse plans care knowing that in this condition:
a. The client has complete bilateral paralysis of the arms and legs
b. The client has weakness on the right side of the body, including the face and tongue
c. The client has lost the ability to move the right arm but is able to walk independently
d. The client has lost the ability to feed and bathe self without assistance.

b. The client has weakness on the right side of the body, including the face and tongue
Rationale: Hemiparesis is a weakness of one side of the body that may occur after a stroke. Complete hemiparesis is weakness of the face and tongue, arm and leg on one side. Complete bilateral paralysis does not occur in the condition. The client with right- sided hemiparesis has weakness of the right arm and leg and needs assistance with feeding, bathing and ambulating.

The nurse is caring for the client who begins to experience seizure activity while in bed. Which of the following actions by the nurse would be contraindicated?
a. Loosening restrictive clothing
b. Restraining the client's limbs
c. Removing the pillow and raising padded side rails
d. Positioning the client to the side, if possible, with the head flexed forward

b. Restraining the client's limbs
Rationale: Nursing Actions during a seizure include providing for privacy, loosening restrictive clothing, removing the pillow and raising the side rails in the bed, and placing the client on one side with the head flexed forward, if possible, to allow the tongue to fall forward and facilitate drainage. The limbs are never restrained because the strong muscle contractions could cause the client harm. If the client is not in bed when seizure activity begins, the nurse lowers the client to the floor, if possible protects the head from injury, and moves furniture that may injure the client. Other aspects of care are as described for the client who is in bed.

The nurse is evaluating the status of the client who had a craniotomy 3 days ago. The nurse would suspect that the client is developing meningitis as a complication of surgery if the client exhibits:
a. A negative Kernig's sign
b. Absence of nuchal rigidity
c. A positive Brudzinski's sign
d. A Glasgow Coma Scale score of 15

c. A positive Brudzinski's sign

The nurse is developing a care plan for a client with hepatic encephalopathy. Which of the following should the nurse include?
a. Administering a lactulose enema as ordered.
b. Encouraging a protein rich diet
c. Adminis.tering sedatives as needed.
d. Encouraging ambulation at least 4 times a day.

a. Hepatic encephalopathy is a degenerative disease of the brain that is a complication of cirrhosis.
Rationale: For the client with hepatic encephalopathy, the nurse may administer the laxative lactulose to reduce ammonia levels in the colon.
Protein intake is usually restricted to reduce serum ammonia levels until the client's mental status begins to improve.
Sedatives are avoided because they can cause respiratory or circulatory failure.
Bed rest is encouraged because physical activity increases metabolism, leading to an increased production of ammonia

When caring for a patient with systemic sclerosis, the nurse knows it is important to instruct the patient related to (select all that apply)
a. avoiding consumption of high purine foods
b. strategies for good dental hygiene and mouth care
c. protecting the extremities from hot and cold temperatures
d. maintaining joint function and preserving muscle strength
e. performing mouth excursion (yawning) exercises on a daily basis

b. strategies for good dental hygiene and mouth care
c. protecting the extremities from hot and cold temperatures
d. maintaining joint function and preserving muscle strength
e. performing mouth excursion (yawning) exercises on a daily basis

In teaching a patient with SLE about the disorder, the nurse knows that the pathophysiology of SLE includes
a. circulating immune complexes formed from IgG autoantibodies reacting with IgG
b. an autoimmune T cell reaction that results in destruction of the deep dermal skin layer
c. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles
d. the production of a variety of autoantibodies directed against component of the cell nucleus

d. the production of a variety of autoantibodies directed against component of the cell nucleus

For a patient who is suspected of having a stroke, one of the most important pieces of information that the nurse can obtain is
a. time of the patient's last meal
b. time at which stroke symptoms first appeared
c. patient's hypertension history and management
d. family history of stroke and other cardiovascular diseases

b. time at which stroke symptoms first appeared

A patient experiencing TIAs is scheduled for a carotid endarterectomy. The nurse explains that this procedure is done to
a. decreased cerebral edema
b. reduce the brain damage that occurs during a stroke in evolution
c. prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow
d. provide a circulatory bypass around thrombotic plaques obstructing cranial circulation

c. prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow

The nurse explains to the patient with a stroke who is scheduled for aniography that this test is used to determine
a. presence of increased ICP
b. site and size of the infarction
c. patency of the cerebral blood vessels
d. presence of blood in the cerebrospinal fluid

c. patency of the cerebral blood vessels

A patient with right sided hemiplegia and asphasia resulting from a stroke most likely has involvement of the
a. brainstem
b. vertebral artery
c. left middle cerebral artery
d. right middle cerebral artery

c. left middle cerebral artery

Information provided by the patient that would help differentiate a hemorrhagic stroke from a thrombotic stroke includes
a. sensory disturbance
b. a history of hypertension
c. presence of motor weakness
d. sudden onset of severe headache

d. sudden onset of severe headache

The factor related to cerebral blood flow that most often determines the extent of cerebral damage from a stroke is the
a. amount of cardiac output
b. oxygen content of the blood
c. degree of collateral circulation
d. level of carbon dioxide in the blood

c. degree of collateral circulation

Of the following patients, the nurse recognizes that the one with the highest risk for a stroke is
a. an obese 45 year old native american
b. a 35 year old asian american woman who smokes
c. a 32 year old white woman taking oral contraceptives
d. a 65 years old African American man with hypertension

d. a 65 years old African American man with hypertension

A nursing measure that is indicated to reduce the potential for seizures and increased intracranial pressure in the patient with bacterial meningitis is
a. administering codeine for relief of head and neck pain
b. controlling fever with prescribed drugs and cooling techniques
c. keeping the room darkened and quite to minimize environmental stimulation
d. maintaining the patient on strict bed rest with the head of the bed slightly elevated

b. controlling fever with prescribed drugs and cooling techniques

The nurse on the clinical unit is assigned to four patients. Which patient should she assess first?
a. patient with a skull fracture whose nose is bleeding
b. elderly patient with a stroke who is confused and whose daughter is present
c. patient with meningitis who is suddenly agitated and reporting a headache of 10 on a zero to ten scale
d. patient who had a craniotomy for a brain tumor who is now 3 days postoperative and has had continued emesis

c. patient with meningitis who is suddenly agitated and reporting a headache of 10 on a zero to ten scale

Nursing management of a patient with a brain tumor includes (select all that apply)
a. discussing with the patient methods to control inappropriate behavior
b. using diversion techniques to keep the patient stimulated and motivated
c. assisting and supporting the family in understanding any changes in behavior
d. limiting self-care activities until the patient has regained maximum physical functioning
e. plan for seizure precautions and teaching the patient and caregiver about antiseizure drugs

c. assisting and supporting the family in understanding any changes in behavior
e. plan for seizure precautions and teaching the patient and caregiver about antiseizure drugs

A patient is suspected of having a cranial tumor. The signs and symptoms include memory deficits, visual disturbances, weakness of right upper and lower extremities, and personality changes. The nurse recognizes that the tumor is most likely located in the
a. frontal lobe
b. parietal lobe
c. occipital lobe
d. temporal lobe

a. frontal lobe

During admission of a patient with a severe head injury to the emergency department, the nurse places the highest priority on assessment for
a. patency of airway
b. presence of a neck injury
c. neurologic status with the glasgow coma scale
d. cerebrospinal fluid leakage from the ears or nose

a. patency of airway

The nurse is alerted to a possible acute subdural hematoma in the patient who
a. has a linear skull fracture crossing a major artery
b. has focal symptoms of brain damage with no recollection of a head injury
c. develops decreased level of consciousness and a headache within 48 hours of a head injury
d. has an immediate loss of consciousness with a brief lucid interval followed by decreasing level of consciousness

c. develops decreased level of consciousness and a headache within 48 hours of a head injury

The nurse plans care for the patient with increased intracranial pressure with the knowledge that the best way to position the patient is to
a. keep the head of the bed flat
b. elevate the head of the bed to 30 degrees
c. maintain patient of the left side with the head supported on a pillow
d. use a continuous rotation bed to continuously change patient position

b. elevate the head of the bed to 30 degrees

A patient with intracranial pressure monitoring has pressure of 12 mm Hg. The nurse understands that this pressure reflects
a. a severe decrease in cerebral perfusion pressure
b. an alteration in the production of cerebrospinal fluid
c. the loss of autoregulatory control of intracranial pressure.
d. a normal balance between brain tissue, blood, and cerebrospinal fluid

d. a normal balance between brain tissue, blood, and cerebrospinal fluid

Vasogenic cerebral edema increases intracranial pressure by
a. shifting fluid in the gray matter
b. altering the endothelial lining of cerebral capillaries
c. leaking molecules from the intracellular fluid to the capillaries

b. altering the endothelial lining of cerebral capillaries

A patient's eyes jerk while the patient looks to the left. You will record this finding as
a. nystagmus
b. CN VI palsy
c. oculocephalia
d. ophthalmic dyskinesia

a. nystagmus

A patient seen in the outpatient clinic complains of restless legs syndrome. What common over-the-counter medications that the patient is taking routinely should the nurse discuss with the patient?

diphenhydramine (Benadryl)
Rational: Antihistamines can aggravate restless legs syndrome.

A 42-year-old patient who was adopted at birth is diagnosed with early Huntington's disease (HD). When teaching the patient, spouse, and children about this disorder, the nurse will provide information about the availability of genetic testing to determine ...?

the HD risk for the patient's children.
Rational: Genetic testing is available to determine whether an asymptomatic individual has the HD gene. The patient and family should be informed of the benefits and problems associated with genetic testing.

A hospitalized patient complains of a moderate bilateral headache that radiates from the base of the skull. Which PRN medication should the nurse administer initially?

acetaminophen (Tylenol)
Rational: The patient's symptoms are consistent with a tension headache, and initial therapy usually involves a nonopioid analgesic such as acetaminophen, sometimes combined with a sedative or muscle relaxant.

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