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A nurse performs a neurologic assessment on a client with a brain tumor. Which of the following findings should indicate to the nurse cranial nerve involvement? A: Dysphagia B: Positive Babinski sign C: Decreased deep tendon reflexes D: Ataxia - Answer A: Dysphagia
(Difficulty swallowing may occur as a result of the cranial nerves IX -glossopharyngeal & V -vagus
nerve.) A nurse is assessing a client who was just admitted to the hospital for observation following a closed- head injury. Which of the following is the most essential nursing assessment to detect early signs of a worsening condition? A: Vital signs B: Body posture C: LOC D: Focal neurological exam - Answer C: LOC A bolus of mannitol (Osmitrol) is ordered for a client with a closed-head injury showing manifestations of increasing intracranial pressure. Prior to administration, assessment shows: UO 40 mL/hr, apical HR 88/min, and the pupils equal and reactive. The client is sleepy but easily aroused. After administering mannitol to the client, which of the following should indicate to the nurse that the medication is having the desired effect? A: UO is 100 mL/hr. B: Pupils are dilated
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C: HR is 62/min D: Client is difficult to rouse - Answer A: UO is 100 mL/hr. (osmotic diuretic used to ↑ UO and ↓ cerebral edema) A nurse is caring for a client who is post-op following a craniotomy to evacuate a subdural hematoma. The nurse notes the client's UO is greater each hour than the previous hour; from 1800 to 1900 the UO was 200 mL, from 1900 to 2000 the UO was 400 mL, and from 2000 to 2100 the UO was 600 mL. The nurse informs the surgeon and anticipates that the lab value that will be prescribed at this time is: A: Blood Urea Nitrogen B: Blood sugar C: Urine ketones D: Specific gravity - Answer D: Specific gravity A nurse is reading the results of a lumbar puncture (LP) performed on a client suspected of having bacterial meningitis. Which of the following findings should the nurse recognize as being consistent with this diagnosis? A: Elevated glucose B: Elevated protein C: Presence of RBC D: Presence of D-dimer - Answer B: Elevated protein (typically CSF has a higher proportion of glucose than protein, an elevated protein is consistent with meningitis) A client has been diagnosed with acute angle closure glaucoma. The nurse should expect the client to report
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A: Sensory warning that a seizure is imminent. B: Continuous seizure state in which seizures occur in rapid succession. C: Period of sleepiness following the seizure, during which arousal is difficult. D: Brief loss of consciousness accompanied by staring. - Answer A: Sensory warning that a seizure is imminent. (client may report hearing bells, seeing lights or smelling something) A client has undergone surgical repair via scleral buckling of a detached retina of the left eye with an injection of a gas bubble. The nurse should anticipate that the surgeon will prescribe the client to assume which postoperative position? A: Semi-fowler's position while wearing shaded dilation glasses B: Prone position with operated eye up. C: Left lateral position with the eye shield on the left eye. D: Trendelnburg position without a pillow. - Answer B: Prone position with operated eye up. In which of the following positions should a nurse place a client following a craniotomy for evacuation of a subdural hematoma of the frontal lobe? A: Supine
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B: Prone C: Semi-fowlers D: Sims - Answer C: Semi-fowlers (head midline and the HOB elevated 30, allowing blood flow to the brain while allowing venous drainage, ↓ risk of IOP) A nurse is assessing a client who is reporting a sore throat, pressure in the ear, decreased hearing, and mild dizziness. The client has been treating himself for a cold for 1 week. The nusre should expect an alteration of which of the following structures? A: The temporomandibular joint B: The inner ear C: The external ear D: The middle ear - Answer D: The middle ear A nurse is educating a client who was just dianosed with open angle glaucoma about the condition. Which of the following information should the nurse include in the teaching? (Select all that apply) A: Do not take cold medications that contain pseudoephedrine. B: Expect impaired night vision. C: Glasses will be necessary to correct the accompanying presbyopia. D: Driving may be dangerous due to loss of peripheral vision.
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D: Self-care dependency - Answer A: Aspiration (priority because it could lead to choking) A nurse explains to a family of a client recently diagnosed with amyotrophic lateral sclerosis (ALS) that early manifestations typically include: A: Sensory dysfunction B: Weakness of the distal extremities C: Decreased cognitive functioning D: Altered temperature regulation - Answer B: Weakness of the distal extremities A nurse in a clinic is providing teaching to an adolescent client who has been diagnosed with swimmer's ear, or external otitis for the 3rd time in 2 months. The nurse should instruct the client to: A: dry the ear with a cotton swab after swimming. B: Instill hydrogen peroxide into the ear after swimming. C: Instill diluted alcohol into the ear after swimming. D: Dry the ear with a twisted paper towel wick after swimming. - Answer C: Instill diluted alcohol into the ear after swimming. A nurse is caring for a client who was admitted secondary to transient ischemic attacks (TIA). The goal of therapy for the client is: A: Reversal of disability B: Reduction of cerebral bleeding C: Reduction in cerebral edema D: Prevention of a cerebrovascular accident. - Answer D: Prevention of a cerebrovascular accident
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When assessing a client who reports mastoiditis, it is best for the nurse to use which of the following techniques? A: Palpation B: Inspection C: Ototscopic examination D: The weber test - Answer A: Palpation A nurse is assessing an unconscious client. The nurse notes that the client has a rhythmical breathing pattern of increasing depth and a rate alternating with periods of apnea. The nurse should document that the client is having: A: Ataxic respirations B: Cheyne-Stokes respirations C: Apneustic respirations D: Kussmaul respirations - Answer B: Cheyne-Stokes respirations An unconscious client assumes a decerebrate position in response to any noxious stimuli. When drawing a blood sample, the nurse should expect the client to: A: Rigidly extend all four extremities. B: Internally flex the arms and extend the legs. C: Tightly curl into a fetal positon. D: Internally rotate the arms and legs. - Answer A: Rigidly extend all four extremities.
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D: Turn the client on his side. - Answer B: Ease the client to the floor if standing or seated. A nurse is admitting a female client to have surgery to repair an unruptured arteriovenous malformation (AVM). The AVM was discovered after the client reported recurrent headaches and MRI was completed. Which of the following factors is helpful in regard to the nurse anticipating the client's other neurological manifestations? A: Baseline visual acuity B: Age of the client C: Duration of the manifestations D: Location of the AVM - Answer D: Location of the AVM A client with myopia asks the nurse about the possibility of LASIK surgery. The nurse tells the client that which of the following is a commonly experienced side effect following LASIK surgery? A: Eyelid tics and twitching B: Photosensitivity C: Excessive tearing D: Halos and glaring while driving at night - Answer D: Halos and glaring while driving at night A client with diabetic retinopathy returns to the post-op unit after laser photocoagulation surgery for subretinal hemorrhages. Which of the following post-op prescriptions from the provider should the nurse anticipate receiving? A: Full liquid diet for 24 hrs B: Hydrocodone (Vicodin) 1 tablet PO every 4 hrs PRN for pain.
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C: Bed rest in supine positon D: Docusate sodium (Colace) 100 mg PO twice daily - Answer D: Docusate sodium (Colace) 100 mg PO twice daily (reduces straining during defecation) A client with suspected cervical disc herniation is to undergo a MRI exam of the cervical vertebrae. The nurse assesses the client for any pre-existing conditions that would contraindicate having an MRI. The nurse should notify the provider regarding the client's ability to have ann MRI if the client has a history of: A: A titanium implant of the ankle B: Claustrophobia C: A contrast dye allergy D: An automatic internal defibrillator placement - Answer D: An automatic internal defibrillator placement A nurse obtains frequent vital signs of a client who is at risk for IOP. The previous vital signs were a BP of 120/70 mm Hg and a HR of 92/min. The nurse should be concerned if the next set of vital signs obtained are a: A: BP of 160/65 mm Hg and HR of 68/min. B: BP of 140/100 mm Hg and HR of 68/min. C: BP of 150/100 mm Hg and HR of 112/min. D: BP of 80/40 mm Hg and HR of 112/min. - Answer A: BP of 160/65 mm Hg and HR of 68/min.
