Post Test NEURO

Question 1

1. When assessing a patient with a possible stroke, the nurse finds that the patients aphasia started 3.5 hours previously and the blood pressure is 170/92 mm Hg. Which of these orders by the health care provider should the nurse question?
   a. Infuse normal saline at 75 mL/hr.
   b. Keep head of bed elevated at least 30 degrees.
   c. Administer tissue plasminogen activator (tPA) per protocol.
   d. Titrate labetolol (Normodyne) drip to keep BP less than 140/90 mm Hg.

Answer 1

d. Titrate labetolol (Normodyne) drip to keep BP less than 140/90 mm Hg.

Question 2

2. A patient with a history of several transient ischemic attacks (TIAs) arrives in the emergency department with hemiparesis and dysarthria that started 2 hours previously. The nurse anticipates the need to prepare the patient for
   a. surgical endarterectomy.
   b. transluminal angioplasty.
   c. intravenous heparin administration.
   d. tissue plasminogen activator (tPA) infusion.

Answer 2

d. tissue plasminogen activator (tPA) infusion.

Question 3

3. The nurse identifies the nursing diagnosis of impaired verbal communication for a patient with expressive aphasia. An appropriate nursing intervention to help the patient communicate is to
   a. have the patient practice facial and tongue exercises.
   b. ask simple questions that the patient can answer with yes or no.
   c. develop a list of words that the patient can read and practice reciting.
   d. prevent embarrassing the patient by changing the subject if the patient does not respond

Answer 3

b. ask simple questions that the patient can answer with yes or no.

Question 4

4. A patient has a stroke affecting the right hemisphere of the brain. Based on knowledge of the effects of right brain damage, the nurse establishes a nursing diagnosis of
   a. impaired physical mobility related to right hemiplegia.
   b. risk for injury related to denial of deficits and impulsiveness.
   c. impaired verbal communication related to speech-language deficits.
   d. ineffective coping related to depression and distress about disability

Answer 4

b. risk for injury related to denial of deficits and impulsiveness.

Question 5

5. When caring for a patient with left-sided homonymous hemianopsia resulting from a stroke, which intervention should the nurse include in the plan of care during the acute period of the stroke?
   a. Apply an eye patch to the left eye.
   b. Approach the patient from the left side.
   c. Place objects needed for activities of daily living on the patients right side.
   d. Reassure the patient that the visual deficit will resolve as the stroke progresses

Answer 5

c. Place objects needed for activities of daily living on the patients right side.

Question 6

6. Thenurse identifies the nursing diagnosis of imbalanced nutrition: less than body requirements related to impaired self-feeding ability for a patient with right-sided hemiplegia. Which intervention should be included in the plan of care?
   a. Provide a wide variety of food choices.
   b. Provide oral care before and after meals.
   c. Assist the patient to eat with the left hand.
   d. Teach the patient the chin-tuck technique

Answer 6

c. Assist the patient to eat with the left hand.

Question 7

7. A 32-year-old patient has a stroke resulting from a ruptured aneurysm and subarachnoid hemorrhage. Which intervention will be included in the care plan?
   a. Applying intermittent pneumatic compression stockings
   b. Assisting to dangle on edge of bed and assess for dizziness
   c. Encouraging patient to cough and deep breathe every 4 hours
   d. Inserting an oropharyngeal airway to prevent airway obstruction

Answer 7

a. Applying intermittent pneumatic compression stockings

Question 8

8. A patient who has had a stroke has a new order to attempt oral feedings. The nurse should assess the gag reflex and then
   a. order a varied pureed diet.
   b. assess the patients appetite.
   c. assist the patient into a chair.
   d. offer the patient a sip of juice

Answer 8

c. assist the patient into a chair.

Question 9

9. A patient who has right-sided weakness after a stroke is attempting to use the left hand for feeding and other activities. The patients wife insists on feeding and dressing him, telling the nurse, I just dont like to see him struggle. Which nursing diagnosis is most appropriate for the patient?
   a. Situational low self-esteem related to increasing dependence on others
   b. Interrupted family processes related to effects of illness of a family member
   c. Disabled family coping related to inadequate understanding by patients spouse
   d. Impaired nutrition: less than body requirements related to hemiplegia and aphasia

Answer 9

c. Disabled family coping related to inadequate understanding by patients spouse

Question 10

10. Several weeks after a stroke, a patient has urinary incontinence resulting from an impaired awareness of bladder fullness. For an effective bladder training program, which nursing intervention will be best to include in the plan of care?
    a. Limit fluid intake to 1200 mL daily to reduce urine volume.
    b. Assist the patient onto the bedside commode every 2 hours.
    c. Perform intermittent catheterization after each voiding to check for residual urine.
    d. Use an external condom catheter to protect the skin and prevent embarrassment

Answer 10

b. Assist the patient onto the bedside commode every 2 hours.

Question 11

11. Apatient who has a history of a transient ischemic attack (TIA) has an order for aspirin 160 mg daily. When the nurse is administering the medications, the patient says, I dont need the aspirin today. I dont have any aches or pains. Which action should the nurse take?
    a. Document that the aspirin was refused by the patient.
    b. Tell the patient that the aspirin is used to prevent aches.
    c. Explain that the aspirin is ordered to decrease stroke risk
    d. Call the health care provider to clarify the medication order.

Answer 11

c. Explain that the aspirin is ordered to decrease stroke risk

Question 12

12. A patient is admitted to the hospital with dysphasia and right-sided weakness that resolves in a few hours. The nurse will anticipate teaching the patient about
    a. alteplase (tPA).
    b. aspirin (Ecotrin).
    c. warfarin (Coumadin).
    d. nimodipine (Nimotop)

Answer 12

b. aspirin (Ecotrin).

Question 13

13. A patient with a left-sided brain stroke suddenly bursts into tears when family members visit. The nurse should
    a. use a calm voice to ask the patient to stop the crying behavior.
    b. explain to the family that depression is normal following a stroke.
    c. have the family members leave the patient alone for a few minutes.
    d. teach the family that emotional outbursts are common after strokes

Answer 13

d. teach the family that emotional outbursts are common after strokes

Question 14

14. The nurse obtains all of the following information about a 65-year-old patient in the clinic. When developing a plan to decrease stroke risk, which risk factor is most important for the nurse to address?
    a. The patient has a daily glass of wine to relax.
    b. The patient is 25 pounds above the ideal weight.
    c. The patient works at a desk and relaxes by watching television.
    d. The patients blood pressure (BP) is usually about 180/90 mm Hg

Answer 14

d. The patients blood pressure (BP) is usually about 180/90 mm Hg

Question 15

15. A patient with sudden-onset right-sided weakness has a CT scan and is diagnosed with an intracerebral hemorrhage. Which information about the patient is most important to communicate to the health care provider?
    a. The patients speech is difficult to understand.
    b. The patients blood pressure is 144/90 mm Hg.
    c. The patient takes a diuretic because of a history of hypertension.
    d. The patient has atrial fibrillation and takes warfarin (Coumadin).

Answer 15

d. The patient has atrial fibrillation and takes warfarin (Coumadin).

Question 16

16. A patient with right-sided weakness that started 90 minutes earlier is admitted to the emergency department and all theses diagnostic tests are ordered. Which test should be done first?
    a. Electrocardiogram (ECG)
    b. Complete blood count (CBC)
    c. Chest radiograph (Chest x-ray)
    d. Noncontrast computed tomography (CT) scan

Answer 16

d. Noncontrast computed tomography (CT) scan

Question 17

17. A patient with a stroke has progressive development of neurologic deficits with increasing weakness and decreased level of consciousness (LOC). Which nursing diagnosis has the highest priority for the patient?
    a. Impaired physical mobility related to weakness
    b. Disturbed sensory perception related to brain injury
    c. Risk for impaired skin integrity related to immobility
    d. Risk for aspiration related to inability to protect airway

Answer 17

d. Risk for aspiration related to inability to protect airway

Question 18

18. A patient who has had a subarachnoid hemorrhage is being cared for in the intensive care unit. Which information about the patient is most important to communicate to the health care provider?
    a. The patients blood pressure is 90/50 mm Hg.
    b. The patient complains about having a stiff neck.
    c. The cerebrospinal fluid (CSF) report shows red blood cells (RBCs).
    d. The patient complains of an ongoing severe headache

Answer 18

a. The patients blood pressure is 90/50 mm Hg

Question 19

19. Which of these nursing actions included in the care of a patient who has been experiencing stroke symptoms for 60 minutes can the nurse delegate to an LPN/LVN?
    a. Assess the patients gag and cough reflexes.
    b. Determine when the stroke symptoms began.
    c. Administer the prescribed clopidogrel (Plavix).
    d. Infuse the prescribed IV metoprolol (Lopressor)

Answer 19

c. Administer the prescribed clopidogrel (Plavix).

Question 20

20. After receiving change-of-shift report on the following four patients, which patient should the nurse see first?
    a. A patient with right-sided weakness who has an infusion of tPA prescribed
    b. A patient who has atrial and a new order for warfarin (Coumadin)
    c. A patient who experienced a transient ischemic attack yesterday who has a dose of aspirin due
    d. A patient with a subarachnoid hemorrhage 2 days ago who has nimodipine (Nimotop) scheduled

Answer 20

a. A patient with right-sided weakness who has an infusion of tPA prescribed

Question 21

21. The nurse is caring for a patient with carotid artery narrowing who has just returned after having left carotid artery angioplasty and stenting. Which assessment information is of most concern to the nurse?
    a. The pulse rate is 104 beats/min.
    b. The patient has difficulty talking.
    c. The blood pressure is 142/88 mm Hg
    d. There are fine crackles at the lung bases

Answer 21

b. The patient has difficulty talking.

Question 22

22. A patient with left-sided hemiparesis arrives by ambulance to the emergency department. Which action should the nurse take first?
    a. Check the respiratory rate.
    b. Monitor the blood pressure.
    c. Send the patient for a CT scan.
    d. Obtain the Glasgow Coma Scale score

Answer 22

a. Check the respiratory rate.

Question 23

23. After teaching a patient about management of migraine headaches, the nurse determines that the teaching has been effective when the patient says,
    a. I will take the (Topamax) as soon as any headaches start.
    b. I should avoid taking aspirin and sumatriptan (Imitrex) at the same time.
    c. I will try to lie down someplace dark and quiet when the headaches begin.
    d. A glass of wine might help me relax and prevent headaches from developing

Answer 23

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

Question 24

24. When a patient is experiencing a cluster headache, the nurse will plan to assess for
    a. nuchal rigidity.
    b. projectile vomiting.
    c. unilateral eyelid swelling.
    d. throbbing, bilateral facial pain

Answer 24

c. unilateral eyelid swelling.

Question 25

25. A patient has a tonic-clonic seizure while the nurse is in the patients room. Which action should the nurse take?
    a. Insert an oral airway during the seizure to maintain a patent airway.
    b. Restrain the patients arms and legs to prevent injury during the seizure.
    c. Avoid touching the patient to prevent further nervous system stimulation.
    d. Time and observe and record the details of the seizure and postictal state

Answer 25

d. Time and observe and record the details of the seizure and postictal state

Question 26

26. 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?
    a. You may want to contact the Epilepsy Foundation for assistance.
    b. You might benefit from some psychologic counseling at this time.
    c. The Department of Vocational Rehabilitation can help with work retraining.
    d. Most patients with epilepsy are well controlled with anti-seizure medications

Answer 26

d. Most patients with epilepsy are well controlled with anti-seizure medications

Question 27

27. Which action will the nurse take when evaluating a patient who is taking phenytoin (Dilantin) for adverse effects of the medication?
    a. Inspect the oral mucosa.
    b. Listen to the lung sounds.
    c. Auscultate the bowel tones.
    d. Check pupil reaction to light

Answer 27

a. Inspect the oral mucosa.

Question 28

28. 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?
    a. Atonic
    b. Partial
    c. Absence
    d. Myoclonic

Answer 28

a. Atonic

Question 29

29. When obtaining a health history and physical assessment for a patient with possible multiple sclerosis (MS), the nurse should
    a. assess for the presence of chest pain.
    b. inquire about any urinary tract problems.
    c. inspect the skin for rashes or discoloration.
    d. question the patient about any increase in libido

Answer 29

b. inquire about any urinary tract problems.

Question 30

30. 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?
    a. MS symptoms may be worse after the pregnancy.
    b. Women with MS frequently have premature labor.
    c. Symptoms of MS are likely to become worse during pregnancy.
    d. MS is associated with a slightly increased risk for congenital defects

Answer 30

a. MS symptoms may be worse after the pregnancy.

Question 31

31. A patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching?
    a. Recommendation to drink at least 3 to 4 L daily
    b. Need to avoid driving or operating heavy machinery
    c. How to draw up and administer injections of the medication
    d. Use of contraceptive methods other than oral contraceptives

Answer 31

c. How to draw up and administer injections of the medication

Question 32

32. Which information about a patient with MS indicates that the nurse should consult with the health care provider before giving the prescribed dose of fampridine (Ampyra)?
    a. The patient has relapsing-remitting MS.
    b. The patient enjoys walking for relaxation.
    c. The patient has an increased creatinine level.
    d. The patient complains of pain with neck flexion

Answer 32

c. The patient has an increased creatinine level.

Question 33

33. A patient with multiple sclerosis (MS) has urinary retention caused by a flaccid bladder. Which action will the nurse plan to take?
    a. Teach the patient how to use the Cred method.
    b. Decrease the patients fluid intake in the evening.
    c. Suggest the use of incontinence briefs for nighttime use only.
    d. Assist the patient to the commode every 2 hours during the day

Answer 33

a. Teach the patient how to use the Cred method.

Question 34

34. A patient with Parkinsons disease has a nursing diagnosis of impaired physical mobility related to bradykinesia. Which action will the nurse include in the plan of care?
    a. Instruct the patient in activities that can be done while lying or sitting.
    b. Suggest that the patient rock from side to side to initiate leg movement.
    c. Have the patient take small steps in a straight line directly in front of the feet.
    d. Teach the patient to keep the feet in contact with the floor and slide them forward

Answer 34

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

Question 35

35. A patient has a new prescription for bromocriptine (Parlodel) to control symptoms of Parkinsons disease. Which information obtained by the nurse may indicate a need for a decrease in the dose?
    a. The patient has a chronic dry cough.
    b. The patient has four loose stools in a day.
    c. The patient develops a deep vein thrombosis.
    d. The patients blood pressure is 90/46 mm Hg

Answer 35

d. The patients blood pressure is 90/46 mm Hg

Question 36

36. When teaching a patient with myasthenia gravis (MG) about management of the disease, the nurse advises the patient to
    a. perform physically demanding activities in the morning.
    b. anticipate the need for weekly plasmapheresis treatments.
    c. do frequent weight-bearing exercise to prevent muscle atrophy.
    d. protect the extremities from injury due to poor sensory perception

Answer 36

a. perform physically demanding activities in the morning.

Question 37

37. A patient who is seen in the outpatient clinic complains of restless legs syndrome. Which of the following over-the-counter medications that the patient is taking routinely should the nurse discuss with the patient?
    a. multivitamin (Stresstabs)
    b. acetaminophen (Tylenol)
    c. ibuprofen (Motrin, Advil)
    d. diphenhydramine (Benadryl)

Answer 37

d. diphenhydramine (Benadryl)

Question 38

38. A patient with amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care?
    a. Assist with active range of motion
    b. Observe for agitation and paranoia.
    c. Give muscle relaxants as needed to reduce spasms.
    d. Use simple words and phrases to explain procedures

Answer 38

a. Assist with active range of motion

Question 39

39. A 42-year-old patient who was adopted at birth is diagnosed with early Huntingtons disease (HD). When teaching the patient, spouse, and children about this disorder, the nurse will provide information about the
    a. use of levodopa-carbidopa (Sinemet) to help reduce HD symptoms.
    b. need to take prophylactic antibiotics to decrease the risk for pneumonia.
    c. lifestyle changes such as increased exercise that delay disease progression.
    d. availability of genetic testing to determine the HD risk for the patients children

Answer 39

d. availability of genetic testing to determine the HD risk for the patients children

Question 40

40. A patient is seen in the health clinic with symptoms of a stooped posture, shuffling gait, and pill rollingtype tremor. The nurse will anticipate teaching the patient about
    a. oral corticosteroids.
    b. antiparkinsonian drugs.
    c. the purpose of electroencephalogram (EEG) testing.
    d. preparation for magnetic resonance imaging (MRI).

Answer 40

b. antiparkinsonian drugs.

Question 41

41. 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?
    a. Refer the patient for stress counseling.
    b. Ask the patient to keep a headache diary.
    c. Suggest the use of muscle-relaxation techniques.
    d. Teach about the effectiveness of the triptan drugs.

Answer 41

b. Ask the patient to keep a headache diary.

Question 42

42. A hospitalized patient complains of a moderate bilateral headache that radiates from the base of the skull. Which of these prescribed PRN medications should the nurse administer initially?
    a. lorazepam (Ativan)
    b. acetaminophen (Tylenol)
    c. morphine sulfate (Roxanol)
    d. butalbital and aspirin (Fiorinal)

Answer 42

b. acetaminophen (Tylenol)

Question 43

43. A patient tells the nurse about using acetaminophen (Tylenol) several times every day for recurrent bilateral headaches. Which action will the nurse plan to take first?
    a. Discuss the need to stop taking the acetaminophen.
    b. Suggest the use of biofeedback for headache control.
    c. Teach the patient about magnetic resonance imaging (MRI).
    d. Describe the use of botulism toxin (BOTOX) for headaches.

Answer 43

a. Discuss the need to stop taking the acetaminophen.

Question 44

44. The health care provider is considering the use of sumatriptan (Imitrex) for a patient with migraine headaches. Which information obtained by the nurse is most important to report to the health care provider?
    a. The patient has at least 1 to 2 cups of coffee daily.
    b. The patient has had migraine headaches for 30 years.
    c. The patient has a history of a recent acute myocardial infarction.
    d. The patient has been taking topiramate (Topamax) for 2 months.

Answer 44

c. The patient has a history of a recent acute myocardial infarction.

Question 45

45. The nurse witnesses a patient with a seizure disorder as the patient suddenly jerks the arms and legs, falls to the floor, and regains consciousness immediately. It will be most important for the nurse to
    a. assess the patient for a possible head injury.
    b. give the scheduled dose of divalproex (Depakote).
    c. document the timing and description of the seizure.
    d. notify the patients health care provider about the seizure.

Answer 45

a. assess the patient for a possible head injury.

Question 46

46. Which of these prescribed interventions will the nurse implement first for a hospitalized patient who is experiencing continuous tonic-clonic seizures?
    a. Give phenytoin (Dilantin) 100 mg IV.
    b. Monitor level of consciousness (LOC).
    c. Obtain computed tomography (CT) scan.
    d. Administer lorazepam (Ativan) 4 mg IV

Answer 46

d. Administer lorazepam (Ativan) 4 mg IV

Question 47

47. When the home health RN is planning care for a patient with a seizure disorder, which nursing action can be delegated to an LPN/LVN?
    a. Make referrals to appropriate community agencies.
    b. Place medications in the home medication organizer.
    c. Teach the patient and family how to manage seizures.
    d. Assess for use of medications that may precipitate seizures

Answer 47

b. Place medications in the home medication organizer.

Question 48

48. Which information about a patient who is being treated with carbidopa/levodopa (Sinemet) for Parkinsons disease is most important for the nurse to report to the health care provider?
    a. Shuffling gait
    b. Tremor at rest
    c. Cogwheel rigidity of limbs
    d. Uncontrolled head movement

Answer 48

d. Uncontrolled head movement

Question 49

49. A patient with Parkinsons disease has decreased tongue mobility and an inability to move the facial muscles. Which nursing diagnosis is of highest priority?
    a. Activity intolerance
    b. Self-care deficit: toileting
    c. Ineffective self-health management
    d. Imbalanced nutrition: less than body requirements

Answer 49

d. Imbalanced nutrition: less than body requirements

Question 50

50. When the nurse is assessing a patient with myasthenia gravis, which action will be most important to take?
    a. Check pupillary size.
    b. Monitor grip strength.
    c. Observe respiratory effort.
    d. Assess level of consciousness.

Answer 50

c. Observe respiratory effort.

Question 51

51. Following a thymectomy, a patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first?
    a. Auscultate the patients bowel sounds.
    b. Notify the patients health care provider.
    c. Administer the prescribed PRN antiemetic drug.
    d. Give the scheduled dose of prednisone (Deltasone)

Answer 51

b. Notify the patients health care provider.