Neur0 NLE Practice Exam.docx

8/12/2019 Neur0 NLE Practice Exam.docx

1/10

1. A white female client is admitted to an acute care facility witha diagnosis of cerebrovascular accident (CVA). Her historyreveals bronchial asthma, exogenous obesity, and irondeficiency anemia. Which history finding is a risk factor for CVA?a. Caucasian raceb. Female sexc. Obesityd. Bronchial asthma

2. The nurse is teaching a female client with multiple sclerosis.

When teaching the client how to reduce fatigue, the nurseshould tell the client to:a. take a hot bath.b. rest in an air-conditioned roomc. increase the dose of muscle relaxants.d. avoid naps during the day

3. A male client is having a tonic-clonic seizures. What should thenurse do first?a. Elevate the head of the bed.b. Restrain the clients arms and legs.c. Place a tongue blade in the clients mouth.d. Take measures to prevent injury.

4. A female client with Guillain-Barr syndrome has paralysisaffecting the respiratory muscles and requires mechanicalventilation. When the client asks the nurse about the paralysis,how should the nurse respond?a. You may have difficulty believing this, but the paralysiscaused by this disease is temporary.b. Youll have to accept the fact that youre permanentlyparalyzed. However, you wont have any sensory loss.c. It mustbe hard to accept the permanency of your paralysis.d. Youll first regain use of your legs and then your arms.

5. The nurse is working on a surgical floor. The nurse must logroll amale client following a:a. laminectomy.b. thoracotomy.c. hemorrhoidectomy.d. cystectomy.

6. A female client with a suspected brain tumor is scheduled forcomputed tomography (CT). What should the nurse do whenpreparing the client for this test?a. Immobilize the neck before the client is moved onto astretcher.b. Determine whether the client is allergic to iodine, contrastdyes, or shellfish.c. Place a cap over the clients head.d. Administer a sedative as ordered.

7. During a routine physical examination to assess a male clientsdeep tendon reflexes, the nurse should make sure to:a. use the pointed end of the reflex hammer when striking theAchilles tendon.b. support the joint where the tendon is being tested.c. tap the tendon slowly and softlyd. hold the reflex hammer tightly.

8. A female client is admitted in a disoriented and restless stateafter sustaining a concussion during a car accident. Whichnursing diagnosis takes highest priority in this clients plan ofcare?a. Disturbed sensory perception (visual)b. Self-care deficient: Dressing/grooming

c. Impaired verbal communicationd. Risk for injury

9. A female client with amyotrophic lateral sclerosis (ALS) tells thenurse, Sometimes I feel so frustrated. I cant do anything withouthelp! This comment best supports which nursing diagnosis?a. Anxietyb. Powerlessnessc. Ineffective deniald. Risk for disuse syndrome

10. For a male client with suspected increased intracranialpressure (ICP), a most appropriate respiratory goal is to:a. prevent respiratory alkalosis.b. lower arterial pH.c. promote carbon dioxide elimination.d. maintain partial pressure of arterial oxygen (PaO2) above 80mm Hg

11. Nurse Maureen witnesses a neighbors husband sustain a fallfrom the roof of his house. The nurse rushes to the victim anddetermines the need to opens the airway in this victim by usingwhich method?a. Flexed position

b. Head tilt-chin liftc. Jaw thrust maneuverd. Modified head tilt-chin lift

12. The nurse is assessing the motor function of an unconsciousmale client. The nurse would plan to use which plan to use whichof the following to test the clients peripheral response to pain?a. Sternal rubb. Nail bed pressurec. Pressure on the orbital rimd. Squeezing of the sternocleidomastoid muscle

13. A female client admitted to the hospital with a neurologicalproblem asks the nurse whether magnetic resonance imagingmay be done. The nurse interprets that the client may beineligible for this diagnostic procedure based on the clientshistory of:a. Hypertensionb. Heart failurec. Prosthetic valve replacementd. Chronic obstructive pulmonary disorder

14. A male client is having a lumbar puncture performed. Thenurse would plan to place the client in which position?a. Side-lying, with a pillow under the hipb. Prone, with a pillow under the abdomenc. Prone, in slight-Trendelenburgs positiond. Side-lying, with the legs pulled up and head bent down onto

chest.

15. The nurse is positioning the female client with increasedintracranial pressure. Which of the following positions would thenurse avoid?a. Head mildlineb. Head turned to the sidec. Neck in neutral positiond. Head of bed elevated 30 to 45 degrees

16. A female client has clear fluid leaking from the nose followinga basilar skull fracture. The nurse assesses that this iscerebrospinal fluid if the fluid:


2/10

a. Is clear and tests negative for glucoseb. Is grossly bloody in appearance and has a pH of 6c. Clumps together on the dressing and has a pH of 7d. Separates into concentric rings and test positive of glucose

17. A male client with a spinal cord injury is prone toexperiencing autonomic dysreflexia. The nurse would avoidwhich of the following measures to minimize the risk ofrecurrence?a. Strict adherence to a bowel retraining program

b. Keeping the linen wrinkle-free under the clientc. Preventing unnecessary pressure on the lower limbsd. Limiting bladder catheterization to once every 12 hours

18. The nurse is caring for the male client who begins toexperience seizure activity while in bed. Which of the followingactions by the nurse would be contraindicated?a. Loosening restrictive clothingb. Restraining the clients limbsc. Removing the pillow and raising padded side railsd. Positioning the client to side, if possible, with the head flexedforward

19. The nurse is assigned to care for a female client with

complete right-sided hemiparesis. The nurse plans care knowingthat this condition:a. The client has complete bilateral paralysis of the arms andlegs.b. The client has weakness on the right side of the body,including the face and tongue.c. The client has lost the ability to move the right arm but is ableto walk independently.d. The client has lost the ability to move the right arm but is ableto walk independently.

20. The client with a brain attack (stroke) has residual dysphagia.When a diet order is ini tiated, the nurse avoids doing which ofthe following?a. Giving the client thin liquidsb. Thickening liquids to the consistency of oatmealc. Placing food on the unaffected side of the mouthd. Allowing plenty of time for chewing and swallowing

21. The nurse is assessing the adaptation of the female client tochanges in functional status after a brain attack (stroke). Thenurse assesses that the client is adapting most successfully if theclient:a. Gets angry with family if they interrupt a taskb. Experiences bouts of depression and i rritabilityc. Has difficulty with using modified feeding utensilsd. Consistently uses adaptive equipment in dressing self

22. Nurse Kristine is trying to communicate with a client with brainattack (stroke) and aphasia. Which of the following actions bythe nurse would be least helpful to the client?a. Speaking to the client at a slower rateb. Allowing plenty of time for the client to respondc. Completing the sentences that the client cannot finishd. Looking directly at the client during attempts at speech

23. A female client has experienced an episode of myastheniccrisis. The nurse would assess whether the client has precipitatingfactors such as:a. Getting too little exerciseb. Taking excess medication

c. Omitting doses of medicationd. Increasing intake of fatty foods

24. The nurse is teaching the female client with myasthenia graviabout the prevention of myasthenic and cholinergic crises. Thenurse tells the client that this is most effectively done by:a. Eating large, well-balanced mealsb. Doing muscle-strengthening exercisesc. Doing all chores early in the day while less fatiguedd. Taking medications on time to maintain therapeutic blood

levels

25. A male client with Bells palsy asks the nurse what has causedthis problem. The nurses response is based on an understandingthat the cause is:a. Unknown, but possibly includes ischemia, viral infection, or anautoimmune problemb. Unknown, but possibly includes long-term tissue malnutritionand cellular hypoxiac. Primary genetic in origin, triggered by exposure to meningitisd. Primarily genetic in origin, triggered by exposure toneurotoxins

26. The nurse has given the male client with Bells palsy

instructions on preserving muscle tone in the face andpreventing denervation. The nurse determines that the clientneeds additional information if the client states that he or shewill:a. Exposure to cold and draftsb. Massage the face with a gentle upward motionc. Perform facial exercisesd. Wrinkle the forehead, blow out the cheeks, and whistle

27. Female client is admitted to the hospital with a diagnosis ofGuillain-Barre syndrome. The nurse inquires during the nursingadmission interview if the client has history of:a. Seizures or trauma to the brainb. Meningitis during the last 5 yearsc. Back injury or trauma to the spinal cordd. Respiratory or gastrointestinal infection during the previousmonth.

28. A female client with Guillian-Barre syndrome has ascendingparalysis and is intubated and receiving mechanical ventilation.Which of the following strategies would the nurse incorporate inthe plan of care to help the client cope with this illness?a. Giving client full control over care decisions and restrictingvisitorsb. Providing positive feedback and encouraging active range ofmotionc. Providing information, giving positive feedback, andencouraging relaxationd. Providing intravaneously administered sedatives, reducing

distractions and limiting visitors

29. A male client has an impairment of cranial nerve II. Specificto this impairment, the nurse would plan to do which of thefollowing to ensure client to ensure client safety?a. Speak loudly to the clientb. Test the temperature of the shower waterc. Check the temperature of the food on the delivery tray.d. Provide a clear path for ambulation without obstacles

30. A female client has a neurological deficit involving the limbicsystem. Specific to this type of deficit, the nurse would documen


3/10

which of the following information related to the clientsbehavior.a. Is disoriented to person, place, and timeb. Affect is flat, with periods of emotional labilityc. Cannot recall what was eaten for breakfast today

d. Demonstrate inability to add and subtract; does not knowwho is president


4/10

1. Answer C. Obesity is a risk factor for CVA. Other risk factors include a history of ischemic episodes, cardiovascular disease, diabetes mellitus, atherosclerosis of the cranial vessels, hypertension, polycythemia, smoking,hypercholesterolemia, oral contraceptive use, emotional stress, family history of CVA, and advancing age. The clients race, sex, and bronchial asthma arent risk fac tors for CVA.

2. Answer B. Fatigue is a common symptom in clients with multiple sclerosis. Lowering the body temperature by resting in an air-conditioned room may relieve fatigue; however, extreme cold should be avoided. A hotbath or shower can increase body temperature, producing fatigue. Muscle relaxants, prescribed to reduce spasticity, can cause drowsiness and fatigue. Planning for frequent rest periods and naps can relieve fatigue.Other measures to reduce fatigue in the client with multiple sclerosis include treating depression, using occupational therapy to learn energy conservation techniques, and reducing spasticity.

3. Answer D. Protecting the client from injury is the immediate priority during a seizure. Elevating the head of the bed would have no e ffect on the clients condition or safety. Restraining the clients arms and legs couldcause injury. Placing a tongue blade or other object in the clients mouth could damage the teeth.

4. Answer A. The nurse should inform the client that the paralysis that accompanies Guillain-Barr syndrome is only temporary. Return of motor function begins proximally and extends distally in the legs.

5. Answer A.The client who has had spinal surgery, such as laminectomy, must be logrolled to keep the spinal column straight when turning. The client who has had a thoracotomy or cystectomy may turn himself or maybe assisted into a comfortable position. Under normal circumstances, hemorrhoidectomy is an outpatient procedure, and the client may resume normal activities immediately after surgery.

6. Answer B.Because CT commonly involves use of a contrast agent, the nurse should determine whether the client is allergic to iodine, contrast dyes, or shellfish. Neck immobilization is necessary only if the client has asuspected spinal cord injury. Placing a cap over the clients head may lead to misinterpretation of test results; instead, th e hair should be combed smoothly. The physician orders a sedative only if the client cant be

expected to remain still during the CT scan.

7.Answer B.To prevent the attached muscle from contracting, the nurse should support the joint where the tendon is being tested. The nurse should use the flat, not pointed, end of the reflex hammer when striking theAchilles tendon. (The pointed end is used to strike over small areas, such as the thumb placed over the biceps tendon.) Tapping the tendon slowly and softly wouldnt provoke a deep tendon reflex response. The nurseshould hold the reflex hammer loosely, not tightly, between the thumb and fingers so it can swing in an arc.

8. Answer D. Because the client is disoriented and restless, the most important nursing diagnosis is risk for injury. Although the other options may be appropriate, theyre secondary because they dont immediate ly affectthe clients health or safety.

9.Answer B. This comment best supports a nursing diagnosis of Powerlessness because ALS may lead to locked- in syndrome, characterized by an active and functioning mind locked in a body that cant perform evensimple daily tasks. Although Anxiety and Risk for disuse syndrome may be diagnoses associated with ALS, the clients comment specifically refers to an inability to act autonomously. A diagnosis of Ineffective denialwould be indicated if the client didnt seem to perceive the personal relevance of symptoms or danger.

10.Answer C.The goal of treatment is to prevent acidemia by eliminating carbon dioxide. That is because an acid environment in the brain causes cerebral vessels to dilate and therefore increases ICP. Preventingrespiratory alkalosis and lowering arterial pH may bring about acidosis, an undesirable condition in this case. It isnt necessary to maintain a PaO2 as high as 80 mm Hg; 60 mm Hg will adequately oxygenate most clients.

11.Answer C. If a neck injury is suspected, the jaw thrust maneuver is used to open the airway. The head tiltchin lift maneuver produces hyperextension of the neck and could cause complications if a neck injury ispresent. A flexed position is an inappropriate position for opening the airway.

12. Answer B.Motor testing in the unconscious client can be done only by testing response to painful stimuli. Nail bed pressure tests a basic peripheral response. Cerebral responses to pain are tested using sternal rub,placing upward pressure on the orbital rim, or squeezing the clavicle or sternocleidomastoid muscle.

13. Answer C. The client having a magnetic resonance imaging scan has all metallic objects removed because of the magnetic field generated by the device. A careful history is obtained to determine whether anymetal objects are inside the client, such as orthopedic hardware, pacemakers, artificial heart valves, aneurysm clips, or intrauterine devices. These may heat up, become dislodged, or malfunction during this procedure.The client may be ineligible if significant risk exists.

14. Answer D. The client undergoing lumbar puncture is positioned lying on the side, with the legs pulled up to the abdomen and the head bent down onto the chest. This position helps open the spaces between thevertebrae.

15. Answer B.The head of the client with increased intracranial pressure should be positioned so the head is in a neutral midline position. The nurse should avoid flexing or extending the clients neck or turning the headside to side. The head of the bed should be raised to 30 to 45 degrees. Use of proper positions promotes venous drainage from the cranium to keep intracranial pressure down.

16. Answer D.Leakage of cerebrospinal fluid (CSF) from the ears or nose may accompany basilar skull fracture. CSF can be distinguished from other body fluids because the drainage will separate into bloody and yellowconcentric rings on dressing material, called a halo sign. The fluid also tests positive for glucose.


5/10

17. Answer D.The most frequent cause of autonomic dysreflexia is a distended bladder. Straight catheterization should be done every 4 to 6 hours, and foley catheters should be checked frequently to prevent kinks inthe tubing. Constipation and fecal impaction are other causes, so maintaining bowel regularity is important. Other causes include stimulation of the skin from tactile, thermal, or painful stimuli. The nurse administers careto minimize risk in these areas.

18. Answer B.Nursing actions during a seizure include providing for privacy, loosening restrictive clothing, removing the pillow and raising side rails in the bed, and placing the client on one side with the head flexedforward, if possible, to allow the tongue to fall forward and facilitate drainage. The limbs are never restrained because the strong muscle contractions could cause the client harm. If the client is not in bed when seizureactivity begins, the nurse lowers the client to the floor, if possible, protects the head from injury, and moves furniture that may injure the client. Other aspects of care are as described for the client who is in bed.

19. Answer B. Hemiparesis is a weakness of one side of the body that may occur after a stroke. Complete hemiparesis is weakness of the face and tongue, arm, and leg on one side. Complete bilateral paralysis does notoccur in this condition. The client with right-sided hemiparesis has weakness of the right arm and leg and needs assistance with feeding, bathing, and ambulating.

20. Answer A.Before the client with dysphagia is started on a diet, the gag and swallow reflexes must have returned. The client is assisted with meals as needed and is given ample time to chew and swallow. Food isplaced on the unaffected side of the mouth. Liquids are thickened to avoid aspiration.

21. Answer D. Clients are evaluated as coping successfully with lifestyle changes after a brain attack (stroke) if they make appropriate lifestyle alterations, use the assistance of others, and have appropriate socialinteractions. Options A, B, and C are not adaptive behaviors.

22. Answer C. Clients with aphasia after brain attack (stroke) often fatigue easily and have a short attention span. General guidelines when trying to communicate with the aphasic client include speaking more slowly

and allowing adequate response time, listening to and watching attempts to communicate, and trying to put the client at ease with a caring and understanding manner. The nurse would avoid shouting (because theclient is not deaf), appearing rushed for a response, and letting family members provide all the responses for the client.

23. Answer C. Myasthenic crisis often is caused by undermedication and responds to the administration of cholinergic medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon). Cholinergic crisis (theopposite problem) is caused by excess medication and responds to withholding of medications. Too little exercise and fatty food intake are incorrect. Overexertion and overeating possibly could trigger myastheniccrisis.

24. Answer D. Clients with myasthenia gravis are taught to space out activities over the day to conserve energy and restore muscle strength. Taking medications correctly to maintain blood levels that are not too low ortoo high is important. Muscle-strengthening exercises are not helpful and can fatigue the client. Overeating is a cause of exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and emotionalstress.

25. Answer A. Bells palsy is a one-sided facial paralysis from compression of the facial nerve. The exact cause is unknown, but may include vascular ischemia, infection, exposure to viruses such as herpes zoster or herpessimplex, autoimmune disease, or a combination of these factors.

26. Answer A.Prevention of muscle atrophy with Bells palsy is accomplished with facial massage, facial exercises, and electrical stimulation of the nerves. Exposure to cold or drafts is avoided. Local application of heatto the face may improve blood flow and provide comfort.

27. Answer D. Guillain-Barr syndrome is a clinical syndrome of unknown origin that involves cranial and peripheral nerves. Many clients report a history of respiratory or gastrointestinal infection in the 1 to 4 weeks beforethe onset of neurological deficits. Occasionally, the syndrome can be triggered by vaccination or surgery.

28. Answer C. The client with Guillain-Barr syndrome experiences fear and anxiety from the ascending paralysis and sudden onset of the disorder. The nurse can alleviate these fears by providing accurate informationabout the clients condition, giving expert care and positive feedback to the client, and encouraging relaxation and distraction. The family can become involved with selected care activities and provide diversion forthe client as well.

29. Answer D.Cranial nerve II is the optic nerve, which governs vision. The nurse can provide safety for the visually impaired client by clearing the path of obstacles when ambulating. Testing the shower watertemperature would be useful if there were an impairment of peripheral nerves. Speaking loudly may help overcome a deficit of cranial nerve VIII (vestibulocochlear). Cranial nerve VII (facial) and IX (glossopharyngeal)control taste from the anterior two thirds and posterior third of the tongue, respectively.

30. Answer B. The limbic system is responsible for feelings (affect) and emotions. Calculation ability and knowledge of current events relates to function of the frontal lobe. The cerebral hemispheres, with specific regionalfunctions, control orientation. Recall of recent events is controlled by the hippocampus.


6/10

1. If a male client experienced a cerebrovascular accident(CVA) that damaged the hypothalamus, the nurse wouldanticipate that the client has problems with:a. body temperature control.b. balance and equilibrium.c. visual acuity.d. thinking and reasoning.

2. A female client admitted to an acute care facility after a caraccident develops signs and symptoms of increased intracranialpressure (ICP). The client is intubated and placed on mechanical

ventilation to help reduce ICP. To prevent a further rise in ICPcaused by suctioning, the nurse anticipates administering whichdrug endotracheally before suctioning?a. phenytoin (Dilantin)b. mannitol (Osmitrol)c. lidocaine (Xylocaine)d. furosemide (Lasix)

3. After striking his head on a tree while falling from a ladder, ayoung man age 18 is admitted to the emergency department.Hes unconscious and his pupils are nonreactive. Whichintervention would be the most dangerous for the client?a. Give him a barbiturate.b. Place him on mechanical ventilation.c. Perform a lumbar puncture.d. Elevate the head of his bed.

4. When obtaining the health history from a male client withretinal detachment, the nurse expects the client to report:a. light flashes and floaters in front of the eye.b. a recent driving accident while changing lanes.c. headaches, nausea, and redness of the eyes.d. frequent episodes of double vision.

5. Which nursing diagnosis takes highest priority for a client withParkinsons crisis?a. Imbalanced nutrition: Less than body requirementsb. Ineffective airway clearancec. Impaired urinary eliminationd. Risk for injury

6. To encourage adequate nutritional intake for a female clientwith Alzheimers disease, the nurse should:a. stay with the client and encourage him to eat.b. help the client fill out his menu.c. give the client privacy during meals.d. fill out the menu for the client.

7. The nurse is performing a mental status examination on a maleclient diagnosed with subdural hematoma. This test assesseswhich of the following?a. Cerebellar functionb. Intellectual functionc. Cerebral functiond. Sensory function

8. Shortly after admission to an acute care facility, a male client

with a seizure disorder develops status epilepticus. The physicianorders diazepam (Valium) 10 mg I.V. stat. How soon can thenurse administer a second dose of diazepam, if needed andprescribed?a. In 30 to 45 secondsb. In 10 to 15 minutesc. In 30 to 45 minutesd. In 1 to 2 hours

9. A female client complains of periorbital aching, tearing,blurred vision, and photophobia in her right eye.Ophthalmologic examination reveals a small, irregular,nonreactive pupila condition resulting from acute irisinflammation (iritis). As part of the clients therapeutic regimen,

the physician prescribes atropine sulfate (Atropisol), two drops of0.5% solution in the right eye twice daily. Atropine sulfate belongsto which drug classification?a. Parasympathomimetic agentb. Sympatholytic agentc. Adrenergic blockerd. Cholinergic blocker

10. Emergency medical technicians transport a 27-year-old ironworker to the emergency department. They tell the nurse, He

fell from a two-story building. He has a large contusion on his leftchest and a hematoma in the left parietal area. He has acompound fracture of his left femur and hes comatose. Weintubated him and hes maintaining an arterial oxygensaturation of 92% by pulse oximeter with a manual-resuscitationbag. Which intervention by the nurse has the highest priority?a. Assessing the left legb. Assessing the pupilsc. Placing the client in Trendelenburgs positiond. Assessing level of consciousness

11. An auto mechanic accidentally has battery acid splashed inhis eyes. His coworkers irrigate his eyes with water for 20 minutes,and then take him to the emergency department of a nearbyhospital, where he receives emergency care for corneal injury.

The physician prescribes dexamethasone (Maxidex OphthalmicSuspension), two drops of 0.1% solution to be instilled initially intothe conjunctival sacs of both eyes every hour; and polymyxin Bsulfate (Neosporin Ophthalmic), 0.5% ointment to be placed inthe conjunctival sacs of both eyes every 3 hours.Dexamethasone exerts its therapeutic effect by:a. increasing the exudative reaction of ocular tissue.b. decreasing leukocyte infiltration at the site of ocularinflammation.c. inhibiting the action of carbonic anhydrase.d. producing a miotic reaction by stimulating and contractingthe sphincter muscles of the iris.

12. Nurse April is caring for a client who underwent a lumbarlaminectomy 2 days ago. Which of the following findings shouldthe nurse consider abnormal?a. More back pain than the first postoperative dayb. Paresthesia in the dermatomes near the woundsc. Urine retention or incontinenced. Temperature of 99.2 F (37.3 C)

13. After an eye examination, a male client is diagnosed withopen-angle glaucoma. The physician prescribes pilocarpineophthalmic solution (Pilocar), 0.25% gtt i, OU q.i.d. Based on thisprescription, the nurse should teach the client or a familymember to administer the drug by:a. instilling one drop of pilocarpine 0.25% into both eyes daily.b. instilling one drop of pilocarpine 0.25% into both eyes fourtimes daily.

c. instilling one drop of pilocarpine 0.25% into the right eye daily.d. instilling one drop of pilocarpine 0.25% into the left eye fourtimes daily.

14. A female client whos paralyzed on the left side has beenreceiving physical therapy and attending teaching sessionsabout safety. Which behavior indicates that the clientaccurately understands safety measures related to paralysis?a. The client leaves the side rails down.b. The client uses a mirror to inspect the skin.c. The client repositions only after being reminded to do so.d. The client hangs the left arm over the side of the wheelchair.


7/10

15. A male client in the emergency department has a suspectedneurologic disorder. To assess gait, the nurse asks the client totake a few steps; with each step, the clients feet make a halfcircle. To document the clients gait, the nurse should use whichterm?a. Ataxicb. Dystrophicc. Helicopodd. Steppage

16. A client, age 22, is admitted with bacterial meningitis. Whichhospital room would be the best choice for this client?a. A private room down the hall from the nurses stationb. An isolation room three doors from the nurses stationc. A semiprivate room with a 32-year-old client who has viralmeningitisd. A two-bed room with a client who previously had bacterialmeningitis

17. A physician diagnoses a client with myasthenia gravis,prescribing pyridostigmine (Mestinon), 60 mg P.O. every 3 hours.Before administering this anticholinesterase agent, the nursereviews the clients history. Which preexisting condition wouldcontraindicate the use of pyridostigmine?a. Ulcerative colitis

b. Blood dyscrasiac. Intestinal obstructiond. Spinal cord injury

18. A female client is admitted to the facility for investigation ofbalance and coordination problems, including possibleMnires disease. When assessing this client, the nurse expectsto note:a. vertigo, tinnitus, and hearing loss.b. vertigo, vomiting, and nystagmusc. vertigo, pain, and hearing impairment.d. vertigo, blurred vision, and fever.

19. A male client with a conductive hearing disorder caused byankylosis of the stapes in the oval window undergoes astapedectomy to remove the stapes and replace the impairedbone with a prosthesis. After the stapedectomy, the nurse shouldprovide which client instruction?a. Lie in bed with your head elevated, and refrain from blowingyour nose for 24 hours.b. Try to ambulate independently after about 24 hours.c. Shampoo your hair every day for 10 days to help prevent earinfection.d. Dont fly in an airplane, climb to high altitudes, make suddenmovements, or expose yourself to loud sounds for 30 days.

20. Nurse Oliver is monitoring a client for adverse reactions todantrolene (Dantrium). Which adverse reaction is most

common?a. Excessive tearingb. Urine retentionc. Muscle weaknessd. Slurred speech

21. The nurse is monitoring a male client for adverse reactions toatropine sulfate (Atropine Care) eyedrops. Systemic absorptionof atropine sulfate through the conjunctiva can cause whichadverse reaction?a. Tachycardiab. Increased salivationc. Hypotensiond. Apnea

22. A male client is admitted with a cervical spine injury sustainedduring a diving accident. When planning this clients care, thenurse should assign highest priority to which nursing diagnosis?a. Impaired physical mobilityb. Ineffective breathing patternc. Disturbed sensory perception (tactile)d. Self-care deficient: Dressing/grooming

23. A male client has a history of painful, continuous musclespasms. He has taken several skeletal muscle relaxants withoutexperiencing relief. His physician prescribes diazepam (Valium), 2mg P.O. twice daily. In addition to being used to relieve painfulmuscle spasms, diazepam also is recommended for:a. long-term treatment of epilepsy.b. postoperative pain management of laminectomy clients.c. postoperative pain management of diskectomy clientsd. treatment of spasticity associated with spinal cord lesions.

24. A female client who was found unconscious at home isbrought to the hospital by a rescue squad. In the intensive careunit, the nurse checks the clients oculocephalic (dolls eye)response by:a. introducing ice water into the external auditory canal.

b. touching the cornea with a wisp of cotton.c. turning the clients head suddenly while holding the eyelidsopen.d. shining a bright light into the pupil.

25. While reviewing a clients chart, the nurse notices that thefemale client has myasthenia gravis. Which of the followingstatements about neuromuscular blocking agents is true for aclient with this condition?a. The client may be less sensitive to the effects of aneuromuscular blocking agent.b. Succinylcholine shouldnt be used; pancuronium may be usedin a lower dosage.c. Pancuronium shouldnt be used; succinylcholine may be usedin a lower dosage.d. Pancuronium and succinylcholine both require cautiousadministration.

26. A male client is color blind. The nurse understands that thisclient has a problem with:a. rods.b. cones.c. lens.d. aqueous humor.

27. A female client who was trapped inside a car for hours aftera head-on collision is rushed to the emergency department withmultiple injuries. During the neurologic examination, the client

responds to painful stimuli with decerebrate posturing. Thisfinding indicates damage to which part of the brain?a. Diencephalonb. Medullac. Midbraind. Cortex

28. The nurse is assessing a 37-year-old client diagnosed withmultiple sclerosis. Which of the following symptoms would thenurse expect to find?a. Vision changesb. Absent deep tendon reflexesc. Tremors at restd. Flaccid muscles


8/10

29. The nurse is caring for a male client diagnosed with acerebral aneurysm who reports a severe headache. Whichaction should the nurse perform?a. Sit with the client for a few minutes.b. Administer an analgesic.c. Inform the nurse manager.d. Call the physician immediately.

30. During recovery from a cerebrovascular accident (CVA), afemale client is given nothing by mouth, to help preventaspiration. To determine when the client is ready for a liquid diet,the nurse assesses the clients swallowing ability once each shift.This assessment evaluates:a. cranial nerves I and II.b. cranial nerves III and V.c. cranial nerves VI and VIII.d. cranial nerves IX and X.

1. Answer A. The bodys thermostat is located in the hypothalamus; therefore, injury to that area can cause problems of body temperaturecontrol. Balance and equilibrium problems are related to cerebellar damage. Visual acuity problems would occur following occipital oroptic nerve injury. Thinking and reasoning problems are the result of injury to the cerebrum.

2. Answer C.Administering lidocaine via an endotracheal tube may minimize elevations in ICP caused by suctioning. Although mannitoland furosemide may be given to reduce ICP, theyre administered parenterally, not endotracheally. Phenytoin doesnt reduce ICP directlybut may be used to abolish seizures, which can increase ICP. However, phenytoin isnt administered endotracheally.

3. Answer C. The clients history and assessment suggest that he may have increased intracranial pressure (ICP). If this is the case, lumbarpuncture shouldnt be done because it can quickly decompress the central nervous system and, thereby, cause additional damage. Aftera head injury, barbiturates may be given to prevent seizures; mechanical ventilation may be required if breathing deteriorates; andelevating the head of the bed may be used to reduce ICP.

4. Answer A. The sudden appearance of light flashes and floaters in front of the affected eye is characteristic of retinal detachment.Difficulty seeing cars in another driving lane suggests gradual loss of peripheral vision, which may indicate glaucoma. Headache, nausea,

and redness of the eyes are signs of acute (angle-closure) glaucoma. Double vision is common in clients with cataracts.

5.Answer B.In Parkinsons crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. A client confinedto bed during such a crisis is at risk for aspiration and pneumonia. Also, excessive drooling increases the risk of airway obstruction. Becauseof these concerns, the nursing diagnosis of Ineffective airway clearance takes highest priority. Although the other options also areappropriate, they arent immediately life-threatening.

6. Answer A. Staying with the client and encouraging him to feed himself will ensure adequate food intake. A client with Alzheimersdisease can forget how to eat. Allowing privacy during meals, filling out the menu, or helping the client to complete the menu doesntensure adequate nutritional intake.

7.Answer C. The mental status examination assesses functions governed by the cerebrum. Some of these are orientation, attention span,judgment, and abstract reasoning. Intellectual functioning isnt the only cerebral activity. Cerebellar function testing assesses coordination,equilibrium, and fine motor movement. Sensory function testing involves assessment of pain, light-touch sensation, and temperaturediscrimination.

8. Answer B.When used to treat status epilepticus, diazepam may be given every 10 to 15 minutes, as needed, to a maximum dose of 30mg. The nurse can repeat the regimen in 2 to 4 hours, if necessary, but the total dose shouldnt exceed 100 mg in 24 hours. The nurse mustnot administer I.V. diazepam faster than 5 mg/minute. Therefore, the dose cant be repeated in 30 to 45 seconds because the f irst dosewouldnt have been administered completely by that time. Waiting longer than 15 minutes to repeat the dose would increase the clientsrisk of complications associated with status epilepticus.

9. Answer D. Atropine sulfate is a cholinergic blocker. It isnt a parasympathomimetic agent, a sympatholytic agent, or an adrenergicblocker.

10. Answer A. In the scenario, airway and breathing are established so the nurses next priority should be circulation. With a compoundfracture of the femur, there is a high risk of profuse bleeding; therefore, the nurse should assess the site. Neurologic assessment is asecondary concern to airway, breathing, and circulation. The nurse doesnt have enough data to warrant putting the client inTrendelenburgs position.

11. Answer B.Dexamethasone exerts its therapeutic effect by decreasing leukocyte infiltration at the site of ocular inflammation. This

reduces the exudative reaction of diseased tissue, lessening edema, redness, and scarring. Dexamethasone and other anti-inflammatoryagents dont inhibit the action of carbonic anhydrase or produce any typeof miotic reaction.

12. Answer C.Urine retention or incontinence may indicate cauda equina syndrome, which requires immediate surgery. An increase inpain on the second postoperative day is common because the long-acting local anesthetic, which may have been injected duringsurgery, will wear off. While paresthesia is common after surgery, progressive weakness or paralysis may indicate spinal nerve compression.A mild fever is also common after surgery but is considered significant only if it reaches 101 F (38.3 C).

13. Answer B. The abbreviation "gtt" stands for drop, "i" is the apothecary symbol for the number 1, OU signifies both eyes, and "q.i.d." meansfour times a day. Therefore, one drop of pilocarpine 0.25% should be instilled into both eyes four times daily.

14. Answer B.Using a mirror enables the client to inspect all areas of the skin for signs of breakdown without the help of staff or familymembers. The client should keep the side rails up to help with repositioning and to prevent falls. The paralyzed client should takeresponsibility for repositioning or for reminding the staff to assist with it, if needed. A client with left-side paralysis may not realize that the leftarm is hanging over the side of the wheelchair. However, the nurse should call this to the clients attention because the arm can get


9/10

caught in the wheel spokes or develop impaired circulation from being in a dependent position for too long.

15. Answer C. A helicopod gait is an abnormal gait in which the clients feet make a half circle with each step. An ataxic gait is staggeringand unsteady. In a dystrophic gait, the client waddles with the legs far apart. In a steppage gait, the feet and toes raise high off the floorand the heel comes down heavily with each step.

16. Answer B. A client with bacterial meningitis should be kept in isolation for at least 24 hours after admission and, during the initial acutephase, should be as close to the nurses station as possible to allow maximal observation. Placing the client in a room with a client who hasviral meningitis may cause harm to both clients because the organisms causing viral and bacterial meningitis differ; either client maycontract the others disease. Immunity to bacterial meningitis cant be acquired; therefore, a client who previously had bacterial meningitisshouldnt be put at risk by rooming with a client who has just been diagnosed with this disease.

17. Answer C. Anticholinesterase agents such as pyridostigmine are contraindicated in a client with a mechanical obstruction of theintestines or urinary tract, peritonitis, or hypersensitivity to anticholinesterase agents. Ulcerative colitis, blood dyscrasia, and spinal cord injurydont contraindicate use of the drug.

18.Answer A. Mnires disease, an inner ear disease, is characterized by the symptom triad of vertigo, tinnitus, and hearing loss. Thecombination of vertigo, vomiting, and nystagmus suggests labyrinthitis. Mnires disease rarely causes pain, blu rred vision, or fever.

19.Answer D. For 30 days after a stapedectomy, the client should avoid air travel, sudden movements that may cause trauma, andexposure to loud sounds and pressure changes (such as from high altitudes). Immediately after surgery, the client should lie flat with thesurgical ear facing upward; nose blowing is permitted but should be done gently and on one side at a time. The clients firstattempt atpostoperative ambulation should be supervised to prevent falls caused by vertigo and light-headedness. The client must avoidshampooing and swimming to keep the dressing and the ear dry.

20. Answer C.The most common adverse reaction to dantrolene is muscle weakness. The drug also may depress liver function or causeidiosyncratic hepatitis. Muscle weakness is rarely severe enough to cause slurring of speech, drooling, and enuresis. Although excessive

tearing and urine retention are adverse reactions associated with dantrolene use, they arent as common as muscle weakness

21.Answer A. Systemic absorption of atropine sulfate can cause tachycardia, palpitations, flushing, dry skin, ataxia, and confusion. Tominimize systemic absorption, the client should apply digital pressure over the punctum at the inner canthus for 2 to 3 minutes after instillingthe drops. The drug also may cause dry mouth. It isnt known to cause hypotension or apnea.

22. Answer B.Because a cervical spine injury can cause respiratory distress, the nurse should take immediate action to maintain a patentairway and provide adequate oxygenation. The other options may be appropriate for a client with a spinal cord injuryparticularly duringthe course of recoverybut dont take precedence over a diagnosis of Ineffective breathing pattern.

23. Answer D.In addition to relieving painful muscle spasms, diazepam also is recommended for treatment of spasticity associated withspinal cord lesions. Diazepams use is limited by its central nervous system effects and the tolerance that develops with prolonged use. Theparenteral form of diazepam can treat status epilepticus, but the drugs sedating properties make it an unsuitable choice for long-termmanagement of epilepsy. Diazepam isnt an analgesic agent.

24. Answer C. To elicit the oculocephalic response, which detects cranial nerve compression, the nurse turns the clients head suddenlywhile holding the eyelids open. Normally, the eyes move from side to side when the head is turned; in an abnormal response, the eyesremain fixed. The nurse introduces ice water into the external auditory canal when testing the oculovestibular response; normally, theclients eyes deviate to the side of ice water introduction. The nurse touches the clients cornea with a wisp of cotton to elicit the cornealreflex response, which reveals brain stem function; blinking is the normal response. Shining a bright light into the clients pupil helps evaluatebrain stem and cranial nerve III functions; normally, the pupil responds by constricting.

25. Answer D. The nurse must cautiously administer pancuronium, succinylcholine, and any other neuromuscular blocking agent to a clientwith myasthenia gravis. Such a client isnt less sensitive to the effects of a neuromuscular blocking agent. Either succinylcholine orpancuronium can be administered in the usual adult dosage to a client with myasthenia gravis.

26. Answer B. Cones provide daylight color vision, and their stimulation is interpreted as color. If one or more types of cones are absent ordefective, color blindness occurs. Rods are sensitive to low levels of illumination but cant discriminate color. The lens is responsible forfocusing images. Aqueous humor is a clear watery fluid and isnt involved with color perception.

27. Answer C.Decerebrate posturing, characterized by abnormal extension in response to painful stimuli, indicates damage to the

midbrain. With damage to the diencephalon or cortex, abnormal flexion (decorticate posturing) occurs when a painful stimulus is applied.Damage to the medulla results in flaccidity.

28. Answer A.Vision changes, such as diplopia, nystagmus, and blurred vision, are symptoms of multiple sclerosis. Deep tendon reflexesmay be increased or hyperactivenot absent. Babinskis sign may be positive. Tremors at rest arent characteristic of multiple sclerosis;however, intentional tremors, or those occurring with purposeful voluntary movement, are common in clients with multiple sclerosis.Affected muscles are spastic, rather than flaccid.

29. Answer D. The headache may be an indication that the aneurysm is leaking. The nurse should notify the physician immediately. Sittingwith the client is appropriate but only after the physician has been notified of the change in the clients condition. The physician will decidewhether or not administration of an analgesic is indicated. Informing the nurse manager isnt necessary.

30. Answer D. Swallowing is a motor function of cranial nerves IX and X. Cranial nerves I, II, and VIII dont possess motor functions. The motorfunctions of cranial nerve III include extraocular eye movement, eyelid elevation, and pupil constriction. The motor function of cranialnerve V is chewing. Cranial nerve VI controls lateral eye movement.


10/10

Neur0 NLE Practice Exam.docx

Documents

Transcript of Neur0 NLE Practice Exam.docx