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Neurological System

Total questions: 42

Worksheet time: 1hrs 24mins

Name
Class
Date
1.

The nurse is about to administer a contrast medium to the client undergoing diagnostic testing. Which question will the nurse first ask the client?

a)

"Are you allergic to iodine or shellfish?"

b)

"Are you in pain?"

c)

"Do you know what this test is for?"

d)

"Are you wearing any metal?"

2.

A client is admitted for evaluation of a cerebral tumor. Which clinical manifestations does the nurse assess this client for?

a)

Aphasia

b)

Hearing loss

c)

Behavior changes

d)

Nystagmus

e)

Hemiplegia

3.

The nurse is assessing a client who was recently diagnosed with a meningioma. Which statement indicates that the client correctly understands the diagnosis?

a)

"This is the worst type of brain tumor, and surgery is not an option."

b)

. "My tumor can be removed, but I can still have damage because of

pressure in my brain."

c)

"Even after the surgery, I will need chemotherapy to decrease the spread of the tumor."

d)

"Radiation is never used on brain tumors because of possible nerve

damage."

4.

What is the nurse’s most important intervention for a client having a tonic-clonic seizure?

a)

Insert a padded tongue blade to prevent the client from biting his tongue

b)

Time the duration of the seizure

c)

Note the origin of seizure activity

d)

Protect the client from further injury

5.

The nurse is caring for a client brought to the emergency department after an automobile accident. The patient is fully conscious. For what early signs of increasing intracranial pressure (ICP) should the nurse be alert?

a)

Bradycardia

b)

Decreased level of consciousness

c)

Hypothermia

d)

Pinpoint pupils

6.

The vital signs for a client with a possible head injury were on admission: blood pressure 128/72 mm Hg, pulse 90 beats/min, and respirations 66 breaths/min. Which vital sign assessment conducted four hours later most likely indicates the presence of increased intracranial pressure (ICP)?

a)

Blood pressure 172/68 mm Hg, pulse 42 beats/min, respirations 10 breaths/min

b)

Blood pressure 160/90 mm Hg, pulse 112 beats/min, respirations 16 breaths/min

c)

Blood pressure 130/72 mm Hg, pulse 50 beats/min, respirations 24 breaths/min

d)

Blood pressure 100/70 mm Hg, pulse 120 beats/min, respirations 30 breaths/min

7.

A client with a severe headache due to viral meningitis requests an opioid analgesic. What explanation about opioids should the nurse provide?

a)

“Opioid analgesics when administered increase intracranial pressure.”

b)

“Opioid analgesics could mask symptoms so it is used as a last resort for headaches.”

c)

“Acetaminophen (Tylenol) is more effective in treating meningitis-related headaches.”

d)

“Opioid analgesics are contraindicated in patients with meningitis.”

8.

A client admitted to the hospital with a subarachnoid hemorrhage has complaints of severe headache, nuchal rigidity, and projectile vomiting. The nurse knows lumbar puncture (LP) would be contraindicated in this client in which of the following circumstances?

a)

Vomiting continues

b)

Intracranial pressure (ICP) is increased

c)

The client needs mechanical ventilation

d)

Blood is anticipated in the cerebralspinal fluid (CSF)

9.

A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil (on the same side, the affected side). The physician orders mannitol for which of the following reasons?

a)

To prevent acute tubular necrosis

b)

To reduce intraocular pressure

c)

To draw water into the vascular system to increase blood pressure

d)

To promote osmotic diuresis to decrease ICP

10.

A client with subdural hematoma was given mannitol to decrease intracranial pressure (ICP). Which of the following results would best show the mannitol was effective?

a)

Urine output increases

b)

pupils are 8 mm and non-reactive

c)

Systolic blood pressure remains at 150 mm Hg

d)

BUN and creatinine levels return to normal

11.

Which of the following values is considered normal for ICP?

a)

25 mm Hg

b)

0 to 15 mm Hg

c)

35 to 45 mm Hg

d)

120/80 mm/Hg

12.

Which of the following symptoms may occur with a phenytoin level of 32 mg/dl?

a)

Tonic-clonic seizure

b)

Confusion and ataxia

c)

Sodium depletion

d)

Urinary Incontinence

13.

Which of the following signs and symptoms of increased ICP after head trauma would appear first?

a)

Bradycardia

b)

Restlessness and confusion

c)

Large amounts of very dilute urine

d)

Widened pulse pressure

14.

Problems with memory and learning would relate to which of the following lobes?

a)

Temporal

b)

Frontal

c)

Parietal

d)

Occipital

15.

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)

Pressure on the orbital rim

b)

Sternal rub

c)

Squeezing the clavicle

d)

Nail bed pressure

16.

The client is having a lumbar puncture performed. The nurse would plan to place the client in which position for the procedure?

a)

Side-lying, with pillow under the hip

b)

Prone, with a pillow under the abdomen.

c)

Side-lying, with legs pulled up and head bent down onto the chest

d)

Prone, in a slight Trendelenburg position

17.

A nurse is caring for the client with increased intracranial pressure. The nurse would note which of the following trends in vital signs if the ICP is rising?

a)

Decreasing temperature, increasing pulse, decreasing respirations, increasing blood pressure.

b)

Increasing temperature, increasing pulse, increasing respirations, decreasing blood pressure.

c)

Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure.

d)

Decreasing temperature, decreasing pulse, increasing respirations, decreasing blood pressure.

18.

The nurse is evaluating the status of a client who had a craniotomy 3 days ago. The nurse would suspect the client is developing meningitis as a complication of surgery if the client exhibits:

a)

A Glascow Coma Scale score of 15

b)

A positive Brudzinski’s sign

c)

A negative Kernig’s sign

d)

Absence of nuchal rigidity

19.

A client is arousing from a coma and keeps saying, “Just stop the pain.” The nurse responds based on the knowledge that the human body typically and automatically responds to pain first with attempts to:

a)

Escape the source of pain

b)

Divert attention from the source of pain.

c)

Tolerate the pain

d)

Decrease the perception of pain

20.

Which of the following would lead the nurse to suspect that a client with meningitis has developed disseminated intravascular coagulation (DIC)?

a)

Edema

b)

Hemorrhagic skin rash

c)

Dyspnea on exertion

d)

Cyanosis

21.

When interviewing the parents of a young child, a history of which of the following illnesses would lead the nurse to suspect pneumococcal meningitis?

a)

Septic arthritis

b)

Bladder infection

c)

Middle ear infection

d)

Fractured clavicle

22.

The nurse is assessing a child diagnosed with a brain tumor. Which of the following signs and symptoms would the nurse expect the child to demonstrate? (Select all that apply).

a)

Increased pulse

b)

Head tilt

c)

Vomiting

d)

Polydipsia

e)

Lethargy

23.

A lumbar puncture is performed on a child suspected of having bacterial meningitis. CSF is obtained for analysis. A nurse reviews the results of the CSF analysis and determines that which of the following results would verify the diagnosis?

a)

Cloudy CSF, decreased protein, and decreased glucose

b)

Cloudy CSF, elevated protein, and decreased glucose

c)

Clear CSF, elevated protein, and decreased glucose

d)

Clear CSF, decreased pressure, and elevated protein

24.

The nurse is planning care for a client with acute bacterial meningitis. Based on the mode of transmission of this infection, which of the following would be included in the plan of care?

a)

Maintain droplet precautions for at least 24 hours after the initiation of antibiotics

b)

No precautions are required as long as antibiotics have been started

c)

Maintain neutropenic precautions

d)

Maintain enteric precautions

25.

Which interventions are most likely to promote maximum self-care for a patient recovering from a stroke? (Select all that apply).

a)

Provide adaptive equipment as indicated

b)

Assess neurological function every shift

c)

Assist patient to track motor function and mobility levels

d)

Encourage participation in activities of daily living

e)

Educate patient on risks of repeat stroke

26.

While conducting a home care visit, the health care provider notes that the patient suddenly has trouble finding her words and is unable to move her left arm. Prioritize these interventions.

  1. call 911
  2. assess motor function
  3. assess vital signs
  4. assist client to lie down
  5. provide reassurance
a)

1, 4, 2, 3, 5

b)

4, 1, 3, 2, 5

c)

4, 3, 2, 1, 5

d)

1, 3, 2, 4, 5

27.

A patient who is diagnosed with Parkinson disease (PD) states, “I can’t tie my shoelaces anymore.” The healthcare provider recognizes that this patient’s problem is due to a deficiency in which of these neurotransmitters?

a)

Norepinephrine

b)

Dopamine

c)

Glutamate

d)

Seratonin

28.

Which of these assessment findings should the healthcare provider expect to identify as an early clinical characteristic of multiple sclerosis (MS)?

a)

Clonus

b)

Muscle atrophy

c)

Dementia

d)

Vision loss

e)

Fatigue

29.

Which of the following statements made by a patient diagnosed with multiple sclerosis (MS) would alert the healthcare provider that the patient requires additional instruction about the disease? Choose all answers that apply:

a)

“A hot bath in the evenings will help relax my muscles and relieve pain.”

b)

“It’s important for me to inspect my skin daily make sure there aren’t any injuries.”

c)

“Use of stress reduction strategies can decrease the severity of my symptoms.”

d)

“Regular exercise can help reduce fatigue and help improve my sense of balance.”

e)

“I will avoid foods that are high in fiber to prevent problems with my bowels.”

30.

A client with an old C6 spinal cord injury complains of suddenly being too warm, with nasal congestion and a very red face. What is your next assessment?

a)

temperature

b)

blood pressure

c)

input and output for previous 8 hours

d)

bowel for impaction

31.

The nurse is caring for a client complaining of intense headaches with increasing pain for the past one month. A MRI is ordered. In reviewing the client’s information, which piece of information is of concern?

a)

client is a diabetic

b)

client is allergic to shellfish

c)

client has no IV access

d)

client has a cardiac pacemaker

32.

One week ago a client was involved in a motor vehicle crash (MVC) and was brought to the Emergency Department (ED). In the emergency department the client received two stitches to the forehead and was sent home. Today the client’s spouse notes the client “acts like he is drunk” and cannot control his right foot and arm. What does this scenario suggest?

a)

Absence seizure

b)

Meningitis

c)

Meniere’s Disease

d)

Subdrual hematoma

33.

The nurse is caring for a client with myasthenia gravis. What is the most important teaching that is essential for this client’s care?

a)

setting the alarm clock for medication times

b)

sit up to eat and use the tongue thrust chin tuck

c)

rigorous monitoring of intake and output

d)

use of sweeping gaze when walking

34.

The client is admitted with period of unobserved loss of consciousness and now has an EEG scheduled this am. Which of the following should the nurse implement first?

a)

administer meds but hold anticonvulsants

b)

hold sedatives, but allow client to have breakfast and take other medication

c)

give additional fluids and some caffeine prior to the test.

d)

NPO for 6 hours prior to EEG and hold their medication

35.

The nurse is discharging a client after a concussion. Which of the following should be reported? A. difficulty waking up B. headache (3/10 on the pain scale) C. bruising on knees and elbows D. achy feeling all over

a)

bruising on knees and elbows

b)

difficulty waking up

c)

achy feeling all over

d)

headache 3/10 on pain scale

36.

The nurse is caring for a client with a closed head injury. Which of the following would contribute to intracranial hypertension?

a)

elevating the head of the bed

b)

hypoventilation

c)

hypernatremia

d)

quiet darkened environment

37.

The nurse is caring for a client and wants to assess the neurologic function. Which of the following will give the most information?

a)

level of consciousness

b)

doll’s eye’s reflex

c)

Babinski reflex

d)

reaction to painful stimuli

38.

A client experiences an episode of Bell's palsy and complains about increasing clumsiness. The nurse should prepare the client for which diagnostic study(ies) to determine the cause of the assessment findings?

a)

Oculovestibular reflex

b)

Cerebral angiography

c)

Lumbar puncture (LP)

d)

Electroencephalogram (EEG)

e)

Computed tomography (CT)

39.

A clients with Parkinson's disease is experiencing tremors, rigidity, and bradykinesia. The nurse anticipates that the physician will prescribe which medication to control these symptoms?

a)

Phenytoin (Dilantin)

b)

Carbidopa-levodopa (Sinemet)

c)

Pyridostigmine (Mestinon)

d)

Warfarin (Coumadin)

40.

A client recovering from a craniotomy complains of a "runny nose". Which of the following nursing actions should be immediately implemented?

a)

Notify the physician

b)

Provide the client with soft tissues

c)

Monitor the client for signs of a cold

d)

Pack nostrils with 2x2 gauze

41.

A client with trigeminal neuralgia asks a nurse what can be done to minimize the episodes of pain. The nurse's response is based on an understanding that the symptoms can be triggered by:

a)

Infection or stress

b)

Excessive watering of the eyes or nasal stuffiness

c)

Sensations of pressure or extreme temperature

d)

Hypoglycemia and fatigue

42.

The nurse makes a home-care visit to a client with Bell's palsy. Which statement by the client requires clarification by the nurse?

a)

"I should wear dark glasses when I go out"

b)

"I should gently massage my face"

c)

"I should wear an eye patch at night"

d)

"I should stay on a liquid diet"