NRO

Question 1

A patient is scheduled for a myelogram and the nurse explains to the patient that this is an invasive procedure, which assesses for any lesions in the spinal cord. The nurse should explain that the preparation is similar to which of the following neurologic tests?
Lumbar puncture
MRI
Cerebral angiography
EEG

Answer 1

Lumbar puncture

Question 2

A patient is being admitted to the neurologic ICU following an acute head injury that has resulted in cerebral edema. When planning this patients care, the nurse would expect to administer what priority medication?
A) Hydrochlorothiazide (HydroDIURIL)
B) Furosemide (Lasix)
C) Mannitol (Osmitrol)
D) Spirolactone (Aldactone)

Answer 2

C) Mannitol (Osmitrol)

Question 3

The nurse is providing care for a patient who is unconscious. What nursing intervention takes highest priority?
A) Maintaining accurate records of intake and output
B) Maintaining a patent airway
C) Inserting a nasogastric (NG) tube as ordered
D) Providing appropriate pain control

Answer 3

B) Maintaining a patent airway

Question 4

A patient who has been on long-term phenytoin (Dilantin) therapy is admitted to the unit. In light of the adverse of effects of this medication, the nurse should prioritize which of the following in the patients plan of care?
Monitoring of pulse oximetry
Administration of a low-protein diet
Administration of thorough oral hygiene
Fluid restriction as ordered

Answer 4

Administration of thorough oral hygiene

Question 5

The nurse is caring for a patient with increased intracranial pressure (ICP). The patient has a nursing diagnosis of ineffective cerebral tissue perfusion. What would be an expected outcome that the nurse would document for this diagnosis?

Copes with sensory deprivation.
Registers normal body temperature.
Pays attention to grooming.
Obeys commands with appropriate motor responses.

Answer 5

Obeys commands with appropriate motor responses.

Question 6

While completing a health history on a patient who has recently experienced a seizure, the nurse would assess for what characteristic associated with the postictal state?
A) Epileptic cry
B) Confusion
C) Urinary incontinence
D) Body rigidity

Answer 6

B) Confusion

Question 7

A patient with increased ICP has a ventriculostomy for monitoring ICP. The nurses most recent assessment reveals that the patient is now exhibiting nuchal rigidity and photophobia. The nurse would be correct in suspecting the presence of what complication?
A) Encephalitis
B) CSF leak
C) Meningitis
D) Catheter occlusion

Answer 7

C) Meningitis

Question 8

The nurse is participating in the care of a patient with increased ICP. What diagnostic test is contraindicated in this patients treatment?
A) Computed tomography (CT) scan
B) Lumbar puncture
C) Magnetic resonance imaging (MRI)
D) Venous Doppler studies

Answer 8

B) Lumbar puncture

Question 9

The nurse is caring for a patient who is in status epilepticus. What medication does the nurse know may be given to halt the seizure immediately?
A) Intravenous phenobarbital (Luminal)
B) Intravenous diazepam (Valium)
C) Oral lorazepam (Ativan)
D) Oral phenytoin (Dilantin)

Answer 9

B) Intravenous diazepam (Valium)

Question 10

The nurse has created a plan of care for a patient who is at risk for increased ICP. The patients care plan should specify monitoring for what early sign of increased ICP?
A) Disorientation and restlessness
B) Decreased pulse and respirations
C) Projectile vomiting
D) Loss of corneal reflex

Answer 10

A) Disorientation and restlessness

Question 11

The neurologic ICU nurse is admitting a patient following a craniotomy using the supratentorial approach. How should the nurse best position the patient?
A) Position the patient supine.
B) Maintain head of bed (HOB) elevated at 30 to 45 degrees.
C) Position patient in prone position.
D) Maintain bed in Trendelenberg position.

Answer 11

B) Maintain head of bed (HOB) elevated at 30 to 45 degrees.

Question 12

Following a traumatic brain injury, a patient has been in a coma for several days. Which of the following statements is true of this patients current LOC?
A) The patient occasionally makes incomprehensible sounds.
B) The patients current LOC will likely become a permanent state.
C) The patient may occasionally make nonpurposeful movements.
D) The patient is incapable of spontaneous respirations.

Answer 12

C) The patient may occasionally make nonpurposeful movements.

Question 13

The nurse is caring for a patient whose recent health history includes an altered LOC. What should be the nurses first action when assessing this patient?
A) Assessing the patients verbal response
B) Assessing the patients ability to follow complex commands
C) Assessing the patients judgment
D) Assessing the patients response to pain

Answer 13

A) Assessing the patients verbal response

Question 14

The nurse is caring for a patient with a brain tumor. What drug would the nurse expect to be ordered to reduce the edema surrounding the tumor?
Solumedrol
Dextromethorphan Dexamethasone
Furosemide

Answer 14

Dexamethasone

Question 15

A patient has experienced a seizure in which she became rigid and then experienced alternating muscle relaxation and contraction. What type of seizure does the nurse recognize?
A) Unclassified seizure
B) Absence seizure
C) Generalized seizure
D) Focal seizure

Answer 15

C) Generalized seizure

Question 16

When caring for a patient with increased ICP the nurse knows the importance of monitoring for possible secondary complications, including syndrome of inappropriate antidiuretic hormone (SIADH). What nursing interventions would the nurse most likely initiate if the patient developed SIADH?
A) Fluid restriction
B) Transfusion of platelets
C) Transfusion of fresh frozen plasma (FFP)
D) Electrolyte restriction

Answer 16

A) Fluid restriction

Question 17

The nurse is admitting a patient to the unit who is scheduled for removal of an intracranial mass. What diagnostic procedures might be included in this patients admission orders? Select all that apply.
A) Transcranial Doppler flow study
B) Cerebral angiography
C) MRI
D) Cranial radiography
E) Electromyelography (EMG)

Answer 17

A) Transcranial Doppler flow study
B) Cerebral angiography
C) MRI

Question 18

A neurologic nurse is reviewing seizures with a group of staff nurses. How should this nurse best describe the cause of a seizure?
A) Sudden electrolyte changes throughout the brain
B) A dysrhythmia in the peripheral nervous system
C) A dysrhythmia in the nerve cells in one section of the brain
D) Sudden disruptions in the blood flow throughout the brain

Answer 18

C) A dysrhythmia in the nerve cells in one section of the brain

Question 19

The nurse is caring for a patient who has undergone supratentorial removal of a pituitary mass. What medication would the nurse expect to administer prophylactically to prevent seizures in this patient?
A) Prednisone
B) Dexamethasone
C) Cafergot
D) Phenytoin

Answer 19

D) Phenytoin

Question 20

A hospital patient has experienced a seizure. In the immediate recovery period, what action best protects the patients safety?
A) Place the patient in a side-lying position.
B) Pad the patients bed rails.
C) Administer antianxiety medications as ordered.
D) Reassure the patient and family members.

Answer 20

A) Place the patient in a side-lying position.

Question 21

A patient with possible bacterial meningitis is admitted to the ICU. What assessment finding would the nurse expect for a patient with this diagnosis?
A) Pain upon ankle dorsiflexion of the foot
B) Neck flexion produces flexion of knees and hips
C) Inability to stand with eyes closed and arms extended without swaying
D) Numbness and tingling in the lower extremities

Answer 21

B) Neck flexion produces flexion of knees and hips

Question 22

The nurse is caring for a patient with multiple sclerosis (MS). The patient tells the nurse the hardest thing to deal with is the fatigue. When teaching the patient how to reduce fatigue, what action should the nurse suggest?
A) Taking a hot bath at least once daily
B) Resting in an air-conditioned room whenever possible
C) Increasing the dose of muscle relaxants
D) Avoiding naps during the day

Answer 22

B) Resting in an air-conditioned room whenever possible

Question 23

A patient with Guillain-Barr syndrome has experienced a sharp decline in vital capacity. What is the nurses most appropriate action?
A) Administer bronchodilators as ordered.
B) Remind the patient of the importance of deep breathing and coughing exercises.
C) Prepare to assist with intubation.
D) Administer supplementary oxygen by nasal cannula.

Answer 23

C) Prepare to assist with intubation.

Question 24

The nurse is working with a patient who is newly diagnosed with MS. What basic information should the nurse provide to the patient?

A) MS is a progressive demyelinating disease of the nervous system.
B) MS usually occurs more frequently in men.
C) MS typically has an acute onset.
D) MS is sometimes caused by a bacterial infection.

Answer 24

A) MS is a progressive demyelinating disease of the nervous system.

Question 25

The nurse is creating a plan of care for a patient who has a recent diagnosis of MS. Which of the following should the nurse include in the patients care plan?

A) Encourage patient to void every hour.
B) Order a low-residue diet.
C) Provide total assistance with all ADLs.
D) Instruct the patient on daily muscle stretching.

Answer 25

D) Instruct the patient on daily muscle stretching.

Question 26

A male patient presents to the clinic complaining of a headache. The nurse notes that the patient is guarding his neck and tells the nurse that he has stiffness in the neck area. The nurse suspects the patient may have meningitis. What is another well-recognized sign of this infection?
A) Negative Brudzinskis sign
B) Positive Kernigs sign
C) Hyperpatellar reflex
D) Sluggish pupil reaction

Answer 26

B) Positive Kernigs sign

Question 27

The nurse caring for a patient diagnosed with Guillain-Barr syndrome is planning care with regard to the clinical manifestations associated this syndrome. The nurses communication with the patient should reflect the possibility of what sign or symptom of the disease?
A) Intermittent hearing loss
B) Tinnitus
C) Tongue enlargement
D) Vocal paralysis

Answer 27

D) Vocal paralysis

Question 28

The nurse is preparing to provide care for a patient diagnosed with myasthenia gravis. The nurse should know that the signs and symptoms of the disease are the result of what?
A) Genetic dysfunction
B) Upper and lower motor neuron lesions
C) Decreased conduction of impulses in an upper motor neuron lesion
D) A lower motor neuron lesion

Answer 28

D) A lower motor neuron lesion

Question 29

A middle-aged woman has sought care from her primary care provider and undergone diagnostic testing that has resulted in a diagnosis of MS. What sign or symptom is most likely to have prompted the woman to seek care?
A) Cognitive declines
B) Personality changes
C) Contractures
D) Difficulty in coordination

Answer 29

D) Difficulty in coordination

Question 30

A nurse is planning the care of a 28-year-old woman hospitalized with a diagnosis of myasthenia gravis. What approach would be most appropriate for the care and scheduling of diagnostic procedures for this patient?
A) All at one time, to provide a longer rest period
B) Before meals, to stimulate her appetite
C) In the morning, with frequent rest periods
D) Before bedtime, to promote rest

Answer 30

C) In the morning, with frequent rest periods

Question 31

The nurse is caring for a patient who is hospitalized with an exacerbation of MS. To ensure the patients safety, what nursing action should be performed?
A) Ensure that suction apparatus is set up at the bedside.
B) Pad the patients bed rails.
C) Maintain bed rest whenever possible.
D) Provide several small meals each day.

Answer 31

A) Ensure that suction apparatus is set up at the bedside.

Question 32

A 33-year-old patient presents at the clinic with complaints of weakness, incoordination, dizziness, and loss of balance. The patient is hospitalized and diagnosed with MS. What sign or symptom, revealed during the initial assessment, is typical of MS?
A) Diplopia, history of increased fatigue, and decreased or absent deep tendon reflexes
B) Flexor spasm, clonus, and negative Babinskis reflex
C) Blurred vision, intention tremor, and urinary hesitancy
D) Hyperactive abdominal reflexes and history of unsteady gait and episodic paresthesia in both legs

Answer 32

C) Blurred vision, intention tremor, and urinary hesitancy

Question 33

The nurse is developing a plan of care for a patient with Guillain-Barr syndrome. Which of the following interventions should the nurse prioritize for this patient?
A) Using the incentive spirometer as prescribed
B) Maintaining the patient on bed rest
C) Providing aids to compensate for loss of vision
D) Assessing frequently for loss of cognitive function

Answer 33

A) Using the incentive spirometer as prescribed

Question 34

A 69-year-old patient is brought to the ED by ambulance because a family member found him lying on the floor disoriented and lethargic. The physician suspects bacterial meningitis and admits the patient to the ICU. The nurse knows that risk factors for an unfavorable outcome include what? Select all that apply.
A) Blood pressure greater than 140/90 mm Hg
B) Heart rate greater than 120 bpm
C) Older age
D) Low Glasgow Coma Scale
E) Lack of previous immunizations

Answer 34

B) Heart rate greater than 120 bpm
C) Older age
D) Low Glasgow Coma Scale

Question 35

The critical care nurse is caring for 25-year-old man admitted to the ICU with a brain abscess. What is a priority nursing responsibility in the care of this patient?
A) Maintaining the patients functional independence
B) Providing health education
C) Monitoring neurologic status closely
D) Promoting mobility

Answer 35

C) Monitoring neurologic status closely

Question 36

The nurse is caring for a 77-year-old woman with MS. She states that she is very concerned about the progress of her disease and what the future holds. The nurse should know that elderly patients with MS are known to be particularly concerned about what variables? Select all that apply.
A) Possible nursing home placement
B) Pain associated with physical therapy
C) Increasing disability
D) Becoming a burden on the family
E) Loss of appetite

Answer 36

A) Possible nursing home placement
C) Increasing disability
D) Becoming a burden on the family

Question 37

You are the clinic nurse caring for a patient with a recent diagnosis of myasthenia gravis. The patient has begun treatment with pyridostigmine bromide (Mestinon). What change in status would most clearly suggest a therapeutic benefit of this medication?
A) Increased muscle strength
B) Decreased pain
C) Improved GI function
D) Improved cognition

Answer 37

A) Increased muscle strength

Question 38

The critical care nurse is admitting a patient in myasthenic crisis to the ICU. The nurse should prioritize what nursing action in the immediate care of this patient?
A) Suctioning secretions
B) Facilitating ABG analysis
C) Providing ventilatory assistance
D) Administering tube feedings

Answer 38

C) Providing ventilatory assistance

Question 39

The nurse caring for a patient in ICU diagnosed with Guillain-Barr syndrome should prioritize monitoring for what potential complication?
A) Impaired skin integrity
B) Cognitive deficits
C) Hemorrhage
D) Autonomic dysfunction

Answer 39

D) Autonomic dysfunction

Question 40

The nurse is teaching a patient with Guillain-Barr syndrome about the disease. The patient asks how he can ever recover if demyelination of his nerves is occurring. What would be the nurses best response?
A) Guillain-Barr spares the Schwann cell, which allows for remyelination in the recovery phase of the disease.
B) In Guillain-Barr, Schwann cells replicate themselves before the disease destroys them, so remyelination is possible.
C) I know you understand that nerve cells do not remyelinate, so the physician is the best one to answer your question.
D) For some reason, in Guillain-Barr, Schwann cells become activated and take over the remyelination process.

Answer 40

A) Guillain-Barr spares the Schwann cell, which allows for remyelination in the recovery phase of the disease.

Question 41

A patient diagnosed with myasthenia gravis has been hospitalized to receive plasmapheresis for a myasthenic exacerbation. The nurse knows that the course of treatment for plasmapheresis in a patient with myasthenia gravis is what?

Answer 41

B) Determined by the patients response

Question 42

A) Every day for 1 week
B) Determined by the patients response
C) Alternate days for 10 days
D) Determined by the patients weight

Answer 42

B) Determined by the patients response

Question 43

A patient diagnosed with MS has been admitted to the medical unit for treatment of an MS exacerbation. Included in the admission orders is baclofen (Lioresal). What should the nurse identify as an expected outcome of this treatment?
A) Reduction in the appearance of new lesions on the MRI
B) Decreased muscle spasms in the lower extremities
C) Increased muscle strength in the upper extremities
D) Decreased severity and duration of exacerbations

Answer 43

B) Decreased muscle spasms in the lower extremities

Question 44

A patient with MS has been admitted to the hospital following an acute exacerbation. When planning the patients care, the nurse addresses the need to enhance the patients bladder control. What aspect of nursing care is most likely to meet this goal?
A) Establish a timed voiding schedule.
B) Avoid foods that change the pH of urine.
C) Perform intermittent catheterization q6h.
D) Administer anticholinergic drugs as ordered.

Answer 44

A) Establish a timed voiding schedule.

Question 45

A patient with MS has developed dysphagia as a result of cranial nerve dysfunction. What nursing action should the nurse consequently perform?
A) Arrange for the patient to receive a low residue diet.
B) Position the patient upright during feeding.
C) Suction the patient following each meal.
D) Withhold liquids until the patient has finished eating.

Answer 45

B) Position the patient upright during feeding.