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HEALTH AMBASSADORS UNIVERSITY School of Nursing Review FREE TUTORIALS

Sept. 1, 2013 NEURO-EENT

1. (01-90-300-758) Part of the neurologic assessment for increased intracranial pressure includes taking vital signs. Which of the following signs is associated with increased intracranial pressure? a. Rapid pulse b. Widening pulse pressure c. Pulse deficit d. Decrease in systolic arterial pressure 2. (04-94-43-19). In planning care for a newborn with a surgical repair of a myelomeningocele, the nurse should be aware that this child is prone to developing which of the following? a. Osteomyelitis b. Decubitus c. Otitis media d. Hydrocephalus 3. (14-83-47-435) Which of the following activities would the nurse MOST probably use to prevent disuse atrophy in a patient who has recently experienced a stroke? a. Active range of motion. b. Passive range of motion. c. Isometric exercises. d. Resistant exercises. 4. (7-05-201-53) A child who was intubated after craniotomy now shows signs of decreased LOC. The physicain orders manual ventilation to keep the CO2 between 25 and 29mmHg and the PAO2 between 80 and 100mmHg. The nurse understands the purpose of this order is to: a. Vasoconstrict cerebral capillaries b. Prevent atelectasis c. Lower the arousal level d. Produce hyperoxygenation of the brain 5. (87-02, 390-53) Jerry is a 17-year-old boy who suffers a head injury in a gymnastics accident. He is immediately taken to the emergency room. When the nurse takes a nursing history, which of the following would be indicative of the most serious head injury? a. complaints of a persistent headache b. amnesia and unconsciousness for 10 minutes c. a large contusion of the scalp d. complaints of nausea 6. (87-02, 390-54) The physician orders meperidine (Demerol), 50 mg IM q 4 hours as necessary for pain for a patient who has a head injury. The nurse should a. administer the medication only when the client specifically asks for it b. administer the medication every 4 hours if the client has any complaints of headache c. question the physician about the advisability of administering the medication d. administer the medication as ordered, provided that the blood pressure is above 120/70 7. (87-02, 390-55) When performing a neurologic check, which of the following choices should the nurse recognize as an early sign of increased intracranial pressure? a. Increased lethargy, rising blood pressure, bradycardia, and depressed respirations b. Coma, rising blood pressure, tachycardia, and depressed respirations c. Hypotension, bradycardia, apprehension, and Cheyne-Stokes respirations d. None of these 8. A 65-year-old client has been admitted with a left-hemisphere brain attack (stroke). Which behavior change would the nurse expect to find? A) Impulsive, unsafe activity. C) Spatial perceptual deficits. B) Errors in word choices. D) Motor deficits on the left side. 9. A client is admitted with a right-sided stroke in evolution. Which nursing diagnosis would take priority when planning care? A) Alteration in sensory perception. C) High risk for impaired skin integrity. B) Ineffective airway clearance. D) Impaired mobility. 10. A client who had a brain attack (stroke) is having difficulty with dysphagia. Which intervention by the nurse is most likely to assist the client? A) Asking the client to speak slowly. B) Placing food in the unaffected side of the mouth. C) Increasing fluid intake. D) Increasing fiber in the diet. A stroke client-Mr. Lacey 65 years old was confined for three days. His condition condition has improved. He is now conscious but has right-sided hemiparesis and aphasia.

HEALTH AMBASSADORS UNIVERSITY School of Nursing Review FREE TUTORIALS

Sept. 1, 2013 NEURO-EENT

11. (01-90-294-697). Mr. Lacey is diagnosed as having association aphasia. The nursing staff assigns one nurse to be his primary nurse plans that unmeaningful sensory stimuli should be limited. The reason for instituting this plan is that unmeaningful stimuli will cause Mr. Lacey to a. associate the wrong word with the wrong article, person, or action b. have intense fear that leads to isolation and/ or disorientation c. be too challenged and become overactive d. feel that those in his environment will expect too much of him 12. (01-90-295-699). Mr. Lacey becomes increasingly frustrated with his inabilities to speak and to help himself. One day, he starts crying after unsuccessfully trying to tell the nurse something. Which reaction by the nurse demonstrates the greatest understanding of Mr. Laceys feelings? a. Ignoring Mr. Laceys tears and telling him that you can wait while he tries to explain again b. Recognizing that the tears are a result of the pathology, and telling him that it is all right to cry c. Telling him that you can understand how hard it must be not being able to speak and that you will return when he is feeling better d. Telling him that you can understand how difficult it is for him, but he is improving because last week he was incapable of any speech 13. Ask client to stand with feet together and arms resting at the sides, first with eyes open, and then closed. This best describes what test? a. Romberg test c. Heel-to-toe walking test b. Walking gait test d. Toe or heel walking test Brian Santos, age 9 years old is brought to the emergency room. He fell off his bicycle and struck his head on the pavement. Following examination by a physician, he is admitted to the hospital for observation. 14. The nurse is assigned to observe for Brian for any change in his neurologic status. Which one of the following is a sign of increased intracranial pressure? a. rapid response of the pupils to light b. a decrease in body temperature c. a rise in the blood pressure d. an increase in awareness of his surroundings 15. The nurse is asked to check Brians level of consciousness. Which one of the following questions would be most appropriate for this evaluation? a. what is your name? b. what is the number of this hospital room? c. what is the name of this hospital? d. what time is it? 16. The nurse is asked to use the Glasgow Coma scale to determine Brians level of consciousness. Which one of the following is a correct interpretation of the Glasgow coma scale? a. a total of 15 indicates a serious change in the level of consciousness b. the lower the number, the deeper the coma c. the higher the number, the deeper the coma d. a positive response to painful stimuli indicates damage to the brain stem CASE: Hilda Franklin, age 33, is a known epileptic whose seizures are controlled by phenytoin (Dilantin). She is receiving IV heparin sodium and oral warfarin sodium (Coumadin) concurrently for a partial occlusion of the left common carotid artery. 17. (03-93-292-96). Mrs. Franklin expresses concern about why she needs both heparin and Coumadin. The nurses explanation is based on knowledge that the plan: a. Immediately provides maximum protection against clot formation b. Allows clot dissolution and prevents new clot formation c. Permits the administration of smaller doses of each drug d. Provides anticoagulant intravenously until the oral drug reaches its peak effect 18. (03-93-292-97). After Mrs. Franklin has received IV heparin sodium for 3 days, the drug is discontinued. The nurse continues to observe the client closely during the early days of treatment with Coumadin because: a. Coumadin action is greater in clients with epilepsy b. Seizures increase the metabolic degradation rate of Coumadin c. Coumadin affects the metabolism of phenytoin d. Phenytoin increases the clotting potential 19. (03-93-292-98). Mrs. Franklin is being discharged from the hospital at the end of the week. When discussing problems that relate to adverse effects of Coumadin, the nurse should tell her to consult with the physician if she experiences the problem of:

HEALTH AMBASSADORS UNIVERSITY School of Nursing Review FREE TUTORIALS

Sept. 1, 2013 NEURO-EENT

a. Increased transient ischemic attacks b. Excess menstrual flow c. Swelling of ankles d. Decreased ability to concentrate 20. (03-93-292-99). Mrs. Franklin telephones the clinic nurse after her weekly prothrombin test to find out if her oral anticoagulant dosage is to be changed. She mentions that her sleeping medication is gone, but she plans to get more when she comes for her appointment in 3 days. The nurse tells her to come for a refill today because: a. Absence of sleep may precipitate seizures b. Discontinuance of the drug may affect the prothrombin level c. She may have withdrawal symptoms because she has been taking sleeping medications for 3 weeks d. Control of seizures is dependent on the combined action of phenytoin (Dilantin) and the sleeping medications Mrs. Crane, 30 years old, has symptoms of diplopia, fatigue, slight vertigo, and a lack of coordination. After a neurological work up she is diagnosed as having multiple sclerosis. 21. The main goal of nursing care for Mrs. Crane during the acute phase of the disease should be to: a. promote rest c. maintain normal functioning b. prevent constipation d. encourage activities of daily living. 22. Mrs. Crane is noted to be having mood swings. In deciding what approach to use with her, the nursing stag should recognize that this: a. is probably the result of an underlying mental disorder b. indicates that Mrs. Crane is having difficulty accepting her diagnosis. c. May be a result of pathology and involvement of the limbic system in the disease. d. Indicates that Mrs. Cranes intellectual capacity has been compromised. 23. Mrs. Crane question the nurse concerning the usual course of multiple sclerosis. Which would be the best reply by the nurse? a. Each individual is very different; we cannot tell what will happen. b. I know you are worried, but it is too soon to predict what will happen. c. Usually, acute episodes like this are followed by remissions, which may last a long time d. The future will take care of itself; lets concentrate on the present. 24. As Mrs. Cranes condition improves, it is most important that she be given guidance in: a. developing a program of exercise b. learning to handle stressful situations. c. Seeking vocational rehabilitation d. Limiting her activities to those that are absolutely necessary. 25. (01-90-304-796). As Mrs. Thompsons condition improves, it is most important that she given guidance in a. performing range of motion exercises c. seeking vocational rehabilitation b. developing a healthy life-style d. limiting her activities to those that are absolutely necessary 26. (03-93-286-11) The nurse should be aware that artherosclerosis of blood vessels leading to the brain may not become evident until there is an extremely severe blockage or until a stroke occurs because collateral blood circulation supplied through the: a. Circle of Willis. c. The bicarotid trunk. b. Jugular vessels. d. Hypothalamic-hypophyseal portal system 27. The nursing care plan states Observe for early sings of increased intracranial pressure (IIP). Early symptoms of IIP include. a. widening pulse pressure and dilated pupils b. rising blood pressure and bradycardia c. elevated temperature and decerebrate posturing d. restlessness and change in level of consciousness. 28. "The Romberg test assesses what cranial nerve? a. CN V c. CN IX b. CN VII d. CN VIII 29. The school nurse assesses a 6-year-old boy fell head first while playing. Which of the following findings is the most reliable indicator of a change in the childs intracranial pressure? (589-84) a. Change in sensorium c. Nausea and vomiting b. Tachycardia d. Pulmonary rales 30. Smart check to verify possible stroke is: a. Let the patient stick out his tongue. c. Check for body movement. b. Check for a widened pulse pressure. d. Let the move head both sides.