Neurological Disorders NCLEX Practice | Quiz #2: 50 7.

The client diagnosed with atrial fibrillation has experienced a

1. A 68-year-old male patient who had a left-sided stroke is transient ischemic attack (TIA). Which medication would the
admitted to the hospital. The patient has right-sided weakness nurse anticipate being ordered for the client on discharge?
and is unable to perform activities of daily living without A. A thrombolytic medication
assistance. The nurse is providing oral hygiene to the patient B. A beta-blocker medication
and is preparing to use a padded tongue blade to open the C. An anti-hyperuricemic medication
patient’s mouth. Which nursing measure is inappropriate when
D. An oral anticoagulant medication
providing oral hygiene to the patient who had a stroke?
8. Which client would the nurse identify as being most at risk
A. Placing the client on the back with a small pillow under the
for experiencing a CVA?
head.
A. A 39-year-old pregnant female.
B. Keeping portable suctioning equipment at the bedside.
B. A 67-year-old Caucasian male.
C. Opening the client’s mouth with a padded tongue blade.
C. An 84-year-old Japanese female.
D. Cleaning the client’s mouth and teeth with a toothbrush.
D. A 55-year-old African American male.
2. A 64-year-old client with a history of hypertension is
admitted to the emergency department with sudden onset 9. Which assessment data would indicate to the nurse that the
right-sided weakness, facial droop, and difficulty speaking. client would be at risk for a hemorrhagic stroke?
Which nursing intervention is the highest priority in the initial A. A blood glucose level of 480 mg/dl.
management of this client? B. A right-sided carotid bruit.
A. Prepare to administer recombinant tissue plasminogen C. A blood pressure of 220/120 mmHg.
activator (rt-PA). D. The presence of bronchogenic carcinoma.
B. Discuss the precipitating factors that caused the symptoms. 10. The nurse and unlicensed assistive personnel (UAP) are
C. Schedule for A STAT computer tomography (CT) scan of caring for a client with right-sided paralysis. Which action by
the head. the UAP requires the nurse to intervene?
D. Notify the speech pathologist for an emergency A. The assistant places a gait belt around the client’s waist
consultation. prior to ambulating.
3. A client arrives in the emergency department with an B. The assistant places the client on the back with the client’s
ischemic stroke and receives tissue plasminogen activator (t- head to the side.
PA) administration. Which is the priority nursing assessment? C. The assistant places her hand under the client’s right axilla
A. Time of onset of current stroke to help him/her move up in bed.
B. Complete physical and history D. The assistant praises the client for attempting to perform
C. Current medications ADL’s independently.
D. Upcoming surgical procedures 11. A client admitted to the hospital with a subarachnoid
4. During the first 24 hours after thrombolytic therapy for hemorrhage has complaints of severe headache, nuchal
ischemic stroke, the primary goal is to control the client’s: rigidity, and projectile vomiting. The nurse knows lumbar
puncture (LP) would be contraindicated in this client in which of
A. Pulse
the following circumstances?
B. Respirations
A. Vomiting continues.
C. Blood pressure
B. Intracranial pressure (ICP) is increased.
D. Temperature
C. The client needs mechanical ventilation.
5. What is a priority nursing assessment in the first 24 hours
D. Blood is anticipated in the cerebrospinal fluid (CSF).
after admission of the client with a thrombotic stroke?
12. A client with a subdural hematoma becomes restless and
A. Cholesterol level
confused, with dilation of the ipsilateral pupil. The physician
B. Pupil size and pupillary response orders mannitol for which of the following reasons?
C. Bowel sounds A. To reduce intraocular pressure.
D. Echocardiogram B. To prevent acute tubular necrosis.
6. What is the expected outcome of thrombolytic drug therapy? C. To promote osmotic diuresis to decrease ICP.
A. Increased vascular permeability D. To draw water into the vascular system to increase blood
B. Vasoconstriction pressure.
C. Dissolved emboli
D. Prevention of hemorrhage

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13. A client with subdural hematoma was given mannitol to 20. The client is having a lumbar puncture performed. The
decrease intracranial pressure (ICP). Which of the following nurse would plan to place the client in which position for the
results would best show the mannitol was effective? procedure?
A. Urine output increases. A. Side-lying, with legs pulled up and head bent down onto the
B. Pupils are 8 mm and nonreactive. chest.
C. Systolic blood pressure remains at 150 mm Hg. B. Side-lying, with a pillow under the hip.
D. BUN and creatinine levels return to normal. C. Prone, in a slight Trendelenburg’s position.
14. Which of the following values is considered normal for D. Prone, with a pillow under the abdomen.
ICP? 21. A nurse is assisting with caloric testing of the
A. 0 to 15 mm Hg oculovestibular reflex of an unconscious client. Cold water is
B. 25 mm Hg injected into the left auditory canal. The client exhibits eye
conjugate movements toward the left followed by a rapid
C. 35 to 45 mm Hg
nystagmus toward the right. The nurse understands that this
D. 120/80 mm Hg indicates the client has:
15. Which of the following symptoms may occur with a A. A cerebral lesion
phenytoin level of 32 mg/dl?
B. A temporal lesion
A. Ataxia and confusion
C. An intact brainstem
B. Sodium depletion
D. Brain death
C. Tonic-clonic seizure
22. The nurse is caring for the client with increased intracranial
D. Urinary incontinence pressure. The nurse would note which of the following trends in
16. Which of the following signs and symptoms of increased vital signs if the ICP is rising?
ICP after head trauma would appear first? A. Increasing temperature, increasing pulse, increasing
A. Bradycardia respirations, decreasing blood pressure.
B. Large amounts of very dilute urine B. Increasing temperature, decreasing pulse, decreasing
C. Restlessness and confusion respirations, increasing blood pressure.
D. Widened pulse pressure C. Decreasing temperature, decreasing pulse, increasing
17. Problems with memory and learning would relate to which respirations, decreasing blood pressure.
of the following lobes? D. Decreasing temperature, increasing pulse, decreasing
A. Frontal respirations, increasing blood pressure..
B. Occipital 23. The nurse is evaluating the status of a client who had a
C. Parietal craniotomy 3 days ago. The nurse would suspect the client is
D. Temporal developing meningitis as a complication of surgery if the client
exhibits:
18.While cooking, your client couldn’t feel the temperature of a
hot oven. Which lobe could be dysfunctional? A. A negative Kernig’s sign.
A. Frontal B. A positive Brudzinski’s sign.
B. Occipital C. Absence of nuchal rigidity.
C. Parietal D. A Glascow Coma Scale score of 15.
D. Temporal 24. A client is arousing from a coma and keeps saying, “Just
stop the pain.” The nurse responds based on the knowledge
19. The nurse is assessing the motor function of an that the human body typically and automatically responds to
unconscious client. The nurse would plan to use which of the pain first with attempts to:
following to test the client’s peripheral response to pain?
A. Tolerate the pain.
A. Sternal rub
B. Decrease the perception of pain.
B. Pressure on the orbital rim
C. Escape the source of pain.
C. Squeezing the sternocleidomastoid muscle
D. Divert attention from the source of pain.
D. Nail bed pressure
25. During the acute stage of meningitis, a 3-year-old child is
restless and irritable. Which of the following would be most
appropriate to institute?
A. Limiting conversation with the child.
B. Allowing the child to play in the bathtub.
C. Keeping extraneous noise to a minimum.
D. Performing treatments quickly.
26. Which of the following would lead the nurse to suspect that 32. Which of the following assessment data indicated nuchal
a child with meningitis has developed disseminated rigidity?
intravascular coagulation? A. Positive Kernig’s sign
A. Hemorrhagic skin rash B. Negative Brudzinski’s sign
B. Edema C. Positive homan’s sign
C. Cyanosis D. Negative Kernig’s sign
D. Dyspnea on exertion 33. Meningitis occurs as an extension of a variety of bacterial
27. When interviewing the parents of a 2-year-old child, a infections due to which of the following conditions?
history of which of the following illnesses would lead the nurse A. Congenital anatomic abnormality of the meninges.
to suspect pneumococcal meningitis? B. Lack of acquired resistance to the various etiologic
A. Bladder infection organisms.
B. Middle ear infection C. Occlusion or narrowing of the CSF pathway.
C. Fractured clavicle D. Natural affinity of the CNS to certain pathogens.
D. Septic arthritis 34. Which of the following pathologic processes is often
Incorrect associated with aseptic meningitis?
28. The nurse is assessing a child diagnosed with a brain A. Ischemic infarction of cerebral tissue.
tumor. Which of the following signs and symptoms would the B. Childhood diseases of viral causation such as mumps.
nurse expect the child to demonstrate? Select all that apply. C. Brain abscesses caused by a variety of pyogenic
A. Increased appetite organisms.
B. Vomiting D. Cerebral ventricular irritation from a traumatic brain injury.
C. Polydipsia 35. You are preparing to admit a patient with a seizure
D. Lethargy disorder. Which of the following actions can you delegate to
E. Head tilt LPN/LVN?
F. Increased pulse A. Complete admission assessment.
29. A lumbar puncture is performed on a child suspected of B. Place a padded tongue blade at the bedside.
having bacterial meningitis. CSF is obtained for analysis. A C. Set up oxygen and suction equipment.
nurse reviews the results of the CSF analysis and determines D. Pad the side rails before the patient arrives.
which of the following results would verify the diagnosis? 36. If a male client experienced a cerebrovascular accident
A. Cloudy CSF, decreased protein, and decreased glucose. (CVA) that damaged the hypothalamus, the nurse would
B. Cloudy CSF, elevated protein, and decreased glucose. anticipate that the client has problems with:
C. Clear CSF, elevated protein, and decreased glucose. A. Body temperature control
D. Clear CSF, decreased pressure, and elevated protein. B. Balance and equilibrium
30. A nurse is planning care for a child with acute bacterial C. Visual acuity
meningitis. Based on the mode of transmission of this infection, D. Thinking and reasoning
which of the following would be included in the plan of care? 37. A female client admitted to an acute care facility after a car
A. No precautions are required as long as antibiotics have accident develops signs and symptoms of increased
been started. intracranial pressure (ICP). The client is intubated and placed
B. Maintain enteric precautions. on mechanical ventilation to help reduce ICP. To prevent a
C. Maintain respiratory isolation precautions for at least 24 further rise in ICP caused by suctioning, the nurse anticipates
hours after the initiation of antibiotics. administering which drug endotracheally before suctioning?
D. Maintain neutropenic precautions. A. phenytoin (Dilantin)
31. A nurse is reviewing the record of a child with increased B. mannitol (Osmitrol)
ICP and notes that the child has exhibited signs of decerebrate C. lidocaine (Xylocaine)
posturing. On assessment of the child, the nurse would expect D. furosemide (Lasix)
to note which of the following if this type of posturing was
present?
A. Abnormal flexion of the upper extremities and extension of
the lower extremities.
B. Rigid extension and pronation of the arms and legs.
C. Rigid pronation of all extremities.
D. Flaccid paralysis of all extremities.
38. After striking his head on a tree while falling from a ladder, 44. A male client has an impairment of cranial nerve II. Specific
a young man age 18 is admitted to the emergency department. to this impairment, the nurse would plan to do which of the
He’s unconscious and his pupils are nonreactive. Which following to ensure the client to ensure client safety?
intervention would be the most dangerous for the client? A. Speak loudly to the client.
A. Give him a barbiturate. B. Test the temperature of the shower water.
B. Place him on mechanical ventilation. C. Check the temperature of the food on the delivery tray.
C. Perform a lumbar puncture. D. Provide a clear path for ambulation without obstacles.
D. Elevate the head of his bed. 45. A female client has a neurological deficit involving the
39. When obtaining the health history from a male client with limbic system. Specific to this type of deficit, the nurse would
retinal detachment, the nurse expects the client to report: document which of the following information related to the
A. Light flashes and floaters in front of the eye. client’s behavior.
B. A recent driving accident while changing lanes. A. Is disoriented to person, place, and time.
C. Headaches, nausea, and redness of the eyes. B. Affect is flat, with periods of emotional lability.
D. Frequent episodes of double vision. C. Cannot recall what was eaten for breakfast today.
40. Which nursing diagnosis takes highest priority for a client D. Demonstrate inability to add and subtract; does not know
with Parkinson’s crisis? who is the president.
A. Imbalanced nutrition: Less than body requirements 46. A client is admitted with a diagnosis of Sturge-Weber
B. Ineffective airway clearance syndrome. Which of the following information would you expect
to find in this client?
C. Impaired urinary elimination
A. It is a dysfunction of the trigeminal nerve causing a severe
D. Risk for injury
sharp pain in the nose, lips, gums, or across the cheeks.
41. The nurse has given the male client with Bell’s palsy
B. It is a non-progressive neurological disorder of the seventh
instructions on preserving muscle tone in the face and
cranial nerve causing paralysis of one of the sides of the face.
preventing denervation. The nurse determines that the client
needs additional information if the client states that he or she C. It is a rare degenerative brain disorder characterized by
will: sudden development of progressive neurological and
neuromuscular symptoms.
A. Wrinkle the forehead, blow out the cheeks, and whistle.
D. It is a neurocutaneous disorder with angiomas causing
B. Massage the face with a gentle upward motion.
abnormalities in the skin, brain, and eyes from birth.
C. Perform facial exercises.
47. A client is admitted to the emergency room with a spinal
D. Exposure to cold and drafts. cord injury. The client is complaining of lightheadedness,
42. A female client is admitted to the hospital with a diagnosis flushed skin above the level of the injury, and headache. The
of Guillain-Barre syndrome. The nurse inquires during the client’s blood pressure is 160/90 mm Hg. Which of the
nursing admission interview if the client has a history of: following is a priority action for the nurse to take?
A. Seizures or trauma to the brain. A. Loosen tight clothing or accessories
B. Meningitis during the last five (5 years). B. Assess for any bladder distention
C. Back injury or trauma to the spinal cord. C. Raise the head of the bed
D. Respiratory or gastrointestinal infection during the previous D. Administer antihypertensive
month. 48. A client who had a stroke is seen bumping into things on
43. A female client with Guillain-Barre syndrome has the side and is having difficulty picking up the beginning of the
ascending paralysis and is intubated and receiving mechanical next line of what he is reading. The client is experiencing which
ventilation. Which of the following strategies would the nurse of the following conditions?
incorporate in the plan of care to help the client cope with this A. Visual neglect
illness?
B. Astigmatism
A. Giving the client full control over care decisions and
C. Blepharitis
restricting visitors.
D. Homonymous Hemianopsia
B. Providing positive feedback and encouraging active range
of motion.
C. Providing information, giving positive feedback and
encouraging relaxation.
D. Providing intravenously administered sedatives, reducing
distractions and limiting visitors.
49. Which of the following medical treatments should the nurse
anticipate administering to a client with increased intracranial
pressure due to brain hemorrhage, except?
A. acetaminophen (Tylenol)
B. dexamethasone (Decadron)
C. mannitol (Osmitrol)
D. phenytoin (Dilantin)
E. nitroglycerin (Nitrostat)
50. Which of the following symptoms would you expect to a
client with a phenytoin level of 35 mg/dL?
A. Ataxia
B. Potassium deficit
C. Neglect syndrome
D. Tetraplegia