Chapter 66 Quiz

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Question #1

Which of the following teaching points is a priority in the management of symptoms for a client with Bell’s palsy?

A Encourage semiannual dental exams.

B Avoid stimuli that trigger pain.

C Use ophthalmic lubricant and protect the eye.

D Complete the course of antibiotics as prescribed.

Question #2

The nurse is caring for a client hospitalized with a severe exacerbation of myasthenia gravis. When administering medications to this client, what is a priority nursing action?

A Administer medications at exact intervals ordered.

B Give client plenty of fluids with medications.

C Document medication given and dose.

D Assess client’s reaction to new medication schedule.

Question #3

A nurse is caring for a client with a diagnosis of trigeminal neuralgia. Which activity is altered as a result of this diagnosis?

A chewing

B tasting

C smelling

D swallowing

Question #4

A nurse is providing education about migraine headaches to a community group. The cause of migraines has not been clearly demonstrated, but is related to vascular disturbances. A member of the group asks about familial tendencies. The nurse’s correct reply will be which of the following?

A Only secondary migraine headaches show a familial tendency.”

B There is a very weak familial tendency.

C No familial tendency has been demonstrated.”

D There is a strong familial tendency.”

Question #5

Cerebral edema peaks at which time point after intracranial surgery?

A 72 hours

B 12 hours

C 48 hours

D 24 hours

Question #6

A patient had a small pituitary adenoma removed by the transsphenoidal approach and has developed diabetes insipidus. What pharmacologic therapy will the nurse be administering to this patient to control symptoms?

A Furosemide (Lasix)

B Vasopressin

C Phenobarbital

D Mannitol

Question #7

A client experiences a seizure while hospitalized for appendicitis. During the postictal phase, the client is yelling and swings a closed fist at the nurse. Which is the appropriate action by the nurse?

A Administer lorazepam per orders.

B Apply oxygen via nasal cannula.

C Place the client in wrist restraints.

D Reorient the client while gently holding their arms.

Question #8

The nurse is completing an assessment on a client with myasthenia gravis. Which of the following historical recounting provides the most significant evidence regarding when the disorder began?

A Sensitivity to bright light

B Muscle spasms

C Drooping eyelids

D Shortness of breath

Question #9

The school nurse notes a 6-year-old running across the playground with friends. The child stops in mid-stride, freezing for a few seconds. Then the child resumes his progress across the playground. The school nurse suspects what in this child?

A A complex seizure

B A partial seizure

C An absence seizure

D A tonic-clonic seizure

Question #10

When performing a postoperative assessment on a client who has undergone surgery to manage increased intracranial pressure (ICP), a nurse notes an ICP reading of 0 mm Hg. Which action should the nurse perform first?

A Check the equipment.

B Document the reading because it reflects that the treatment has been effective.

C Contact the physician to review the care plan.

D Continue the assessment because no actions are indicated at this time.

Question #11

Which of the following drugs may be used after a seizure to maintain a seizure-free state?

A Valium

B Ativan

C Cerebyx

D Phenobarbital

Question #12

The nurse is caring for an 82-year-old client diagnosed with cranial arteritis. What is the prioritynursing intervention?

A Document signs and symptoms of inflammation.

B Administer corticosteroids as ordered.

C Give acetaminophen per orders.

D Assess for weight loss.

Question #13

A 30-year-old was diagnosed with amyotrophic lateral sclerosis (ALS). Which statement by the client would indicate a need for more teaching from the nurse?

A I will lose strength in my arms.”

B My children are at greater risk to develop this disease.”

C “I will have progressive muscle weakness.”

D I need to remain active for as long as possible.”

Question #14

A client with a brain tumor is complaining of a headache upon awakening. Which nursing action would the nurse take first?

A Administer morning dose of anticonvulsant.

B Administer Percocet as ordered.

C Complete a head-to-toe assessment.

D Elevate the head of the bed.

Question #15

A client with a traumatic brain injury is showing early signs of increasing intracranial pressure (ICP). While planning care for this client, what would be the priority expected outcome?

A Displays no signs or symptoms of infection

B Attains desired fluid balance

C Demonstrates optimal cerebral tissue perfusion

D Maintains a patent airway

Question #16

A client with a traumatic brain injury has developed increased intracranial pressure resulting in dibetes insipidus. While assessing the client, the nurse expects which of the following findings?

A Oliguria and serum hyperosmolarity

B Oliguria and decreased urine osmolality

C Excessive urine output and decreased urine osmolality

D Excessive urine output and serum hypo-osmolarity

Question #17

Which posture exhibited by abnormal flexion of the upper extremities and extension of the lower extremities?

A Flaccid

B Decerebrate

C Decorticate

D Normal

Question #18

When the nurse observes that the client has extension and external rotation of the arms and wrists and extension, plantar flexion, and internal rotation of the feet, she records the client’s posture as

A normal.

B decorticate.

C flaccid.

D decerebrate.

Question #19

A client is transferred to the intensive care unit after evacuation of a subdural hematoma. Which nursing intervention reduces the client’s risk of increased intracranial pressure (ICP)?

A Encouraging oral fluid intake

B Administering a stool softener as ordered

C Suctioning the client once each shift

D Elevating the head of the bed 90 degrees

Question #20

A nurse is continually monitoring a client with a traumatic brain injury for signs of increasing intracranial pressure. The cranial vault contains brain tissue, blood, and cerebrospinal fluid; an increase in any of the components causes a change in the volume of the others. This hypothesis is called which of the following?

A Monro-Kellie

B Cushing’s

C Dawn phenomenon

D Hashimoto’s disease

Question #21

A client undergoes a craniotomy with supratentorial surgery to remove a brain tumor. On the first postoperative day, the nurse notes the absence of a bone flap at the operative site. How should the nurse position the client’s head?

A Elevated 30 degrees

B Elevated no more than 10 degrees

C Turned onto the operative side

D Flat

Question #22

A nurse is providing care to a client with a brain tumor. The client has experienced seizures as a result of the tumor. Which area would be a priority for this client?

A Safety

B Activity

C Skin care

D Self-care

Question #23

The nurse is caring for a patient postoperatively after intracranial surgery for the treatment of a subdural hematoma. The nurse observes an increase in the patient’s blood pressure from the baseline and a decrease in the heart rate from 86 to 54. The patient has crackles in the bases of the lungs. What does the nurse suspect is occurring?

A Increase in cerebral perfusion pressure

B Infection

C Exacerbation of uncontrolled hypertension

D Increased ICP

Question #24

The school nurse notes a 6-year-old running across the playground with his friends. The child stops in midstride, freezing for a few seconds. Then the child resumes his progress across the playground. The school nurse suspects what in this child?

A An absence seizure

B myoclonic seizure

C A partial seizure

D A tonic-clonic seizure

Question #25

To meet the sensory needs of a client with viral meningitis, the nurse should:

A minimize exposure to bright lights and noise.

B increase environmental stimuli.

C promote an active range of motion

D avoid physical contact between the client and family members.

Question #26

A nurse is assessing a client who has been in a motor vehicle collision. The client directly and accurately answers questions. The nurse notes a contusion to the client’s forehead; the client reports a headache. Assessing the client’s pupils, what reaction would confirm increasing intracranial pressure?

A constricted response

B equal response

C unequal response

D rapid response

Question #27

An older client complains of a constant headache. A physical examination shows papilledema. What may the symptoms indicate in this client?

A Epilepsy

B Hypostatic pneumonia

C Brain tumor

D Trigeminal neuralgia

Question #28

The nurse is taking care of a client with a history of headaches. The nurse takes measures to reduce headaches and administer medications. Which appropriate nursing interventions may be provided by the nurse to such a client?

A Apply warm or cool cloths to the forehead or back of the neck

B Use pressure-relieving pads or a similar type of mattress

C Maintain hydration by drinking eight glasses of fluid a day

D Perform the Heimlich maneuver

Question #29

A client with neurological infection develops cerebral edema from syndrome of inappropriate antidiuretic hormone (SIADH). Which is an important nursing action for this client?

A Administering prescribed antipyretics

B Hyperoxygenation before and after tracheal suctioning

C Restricting fluid intake and hydration

D Maintaining adequate hydration

Question #30

A nurse is monitoring a client for increasing intracranial pressure (ICP). Early signs of increased ICP include:

A diminished responsiveness.

B decreasing blood pressure.

C elevated temperature.

D pupillary changes.

Question #31

A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize?

A You must report ringing in your ears immediately.”

B You must restrict your fluid intake.”

C You must avoid coughing, sneezing, and blowing your nose.”

D You must lie flat for 24 hours after surgery.”

Question #32

The nurse is educating a patient with a seizure disorder. What nutritional approach for seizure management would be beneficial for this patient?

A Low in fat

B At least 50% carbohydrate

C Restricts protein to 10% of daily caloric intake

D High in protein and low in carbohydrate

Question #33

A nurse is assessing a patient’s urinary output as an indicator of diabetes insipidus. The nurse knows that an hourly output of what volume over 2 hours may be a positive indicator?

A 100 to 150 mL/h

B 50 to 100 mL/h

C More than 200 mL/h

D 150 to 200 mL/h

Question #34

The nurse is caring for a patient with an altered LOC. What is the first priority of treatment for this patient?

A Positioning to prevent complications

B Determination of the cause

C Maintenance of a patent airway

D Assessment of pupillary light reflexes

Question #35

The nurse is caring for a client immediately after supratentorial intracranial surgery. The nurse performs the appropriate action by placing the patient in the

A prone position with the head turned to the unaffected side

B Trendelenburg position.

C supine position with the head slightly elevated.

D dorsal recumbent position.

Question #36

The nurse is aware that burr holes may be used in neurosurgical procedures. Which of the following is a reason why a neurosurgeon may choose to create a burr hole in a patient?

A Visualization of a hemorrhage

B Access for intravenous (IV) fluids

C To assess visual acuity

D Aspiration of a brain abscess

Question #37

A nurse working on a medical-surgical floor walks into a patient’s room to find the patient with an altered level of consciousness (LOC). Which of the following nursing diagnoses would be the first priority for the plan of care?

A Risk of injury related to decreased LOC

B Risk for impaired skin integrity related to prolonged immobility

C Ineffective airway clearance related to altered LOC

D Deficient fluid volume related to inability to take fluids by mouth

Question #38

The initial sign of increasing intracranial pressure (ICP) includes

A herniation.

B vomiting.

C decreased level of consciousness.

D headache.

Question #39

Which phase of a migraine headache usually lasts less than an hour?

A Postdrome

B Aura

C Headache

D Premonitory

Question #40

A client is sitting in a chair and begins having a tonic-clonic seizure. The most appropriate nursing response is to:

A carefully move the client to a flat surface and turn him on his side.

B allow the client to remain in the chair but move all objects out of his way.

C hold the client’s arm still to keep him from hitting anything.

D place an oral airway in the client’s mouth to maintain an open airway.

Question #41

After a transsphenoidal adenohypophysectomy, a client is likely to undergo hormone replacement therapy. A transsphenoidal adenohypophysectomy is performed to treat which type of cancer?

A Pituitary carcinoma

B Laryngeal carcinoma

C Colorectal carcinoma

D Esophageal carcinoma

Question #42

A patient 3 days postoperative from a craniotomy informs the nurse, “I feel something trickling down the back of my throat and I taste something salty.” What priority intervention does the nurse initiate?

A Notify the physician of a possible cerebrospinal fluid leak.

B Give the patient some mouthwash to gargle with.

C Ask the patient to cough to observe the sputum color and consistency.

D Request an antihistamine for the postnasal drip.

Question #43

When educating a patient about the use of antiseizure medication, what should the nurse inform the patient is a result of long-term use of the medication in women?

A Osteoporosis

B Obesity

C Anemia

D Osteoarthritis

Question #44

What does the nurse recognize as the earliest sign of serious impairment of brain circulation related to increasing ICP?

A Lethargy and stupor

B Bradycardia

C A bounding pulse

D Hypertension

Question #45

A client with neurologic infection develops cerebral edema from syndrome of inappropriate antidiuretic hormone (SIADH). Which is an important nursing action for this client?

A Maintaining adequate hydration

B Administering prescribed antipyretics

C Restricting fluid intake and hydration

D Hyperoxygenation before and after tracheal suctioning

Question #46

Which method is used to help reduce intracranial pressure?

A Keeping the head of bed flat

B Using a cervical collar

C Extreme hip flexion, with the hip supported by pillows

D Rotating the neck to the far right with neck support

Question #47

A client is admitted for scheduled gamma-knife radiosurgery, in the treatment of a brain tumor. Which nursing measure is primary in the postsurgical care of this client?

A Time, distance, and shielding against radiation

B Assessing skull dressing for excess drainage

C Assess neurological findings.

D Maintain airway via artificial ventilation.

Question #48

Following a generalized seizure in a client, which nursing assessment is a priority for detailing the event?

A The client cried out before the seizure began.

B Seizure began at 1300 hours.

C Seizure was 1 minute in duration including tonic-clonic activity.

D Sleeping quietly after the seizure

Question #49

A client is exhibiting signs of increasing intracranial pressure (ICP). Which intravenous solution (IV) would the nurse anticipate hanging?

A Half-normal saline (0.45% NSS)

B Mannitol

C Dextrose 5% in water (D5W)

D One-third normal saline (0.33% NSS)

Question #50

A nurse is working on a neurological unit with a nursing student who asks the difference between primary and secondary headaches. The nurse’s correct response will include which of the following statements?

A secondary headache is located in the frontal area.”

B A migraine headache is an example of a secondary headache.”

C A secondary headache is one for which no organic cause can be identified.”

D A secondary headache is associated with an organic cause, such as a brain tumor.”

Question #51

After a seizure, the nurse should place the patient in which of the following positions to prevent complications?

A Semi-Fowler’s, to promote breathing

B Supine, to rest the muscles of the extremities

C Side-lying, to facilitate drainage of oral secretions

D High Fowler’s, to prevent aspiration

Question #52

A patient is admitted to the hospital with an ICP reading of 20 mm Hg and a mean arterial pressure of 90 mm Hg. What would the nurse calculate the CPP to be?

A 70 mm Hg

B 50 mm Hg

C 60 mm Hg

D 80 mm Hg

Question #53

The nurse is caring for a client with a ventriculostomy. Which assessment finding demonstrates effectiveness of the ventriculostomy?

A Cerebral perfusion pressure (CPP) is 21 mm Hg.

B Increased ICP is 12 mm Hg.

C mean arterial pressure (MAP) is equal to the intracranial pressure (ICP).

D The pupils are dilated and fixed.

Question #54

A client is receiving hypothermic treatment for uncontrolled fever related to increased intracranial pressure (ICP). Which assessment finding requires immediate intervention?

A Shivering

B Capillary refill of 2 seconds

C Urine output of 100 mL/hr

D Cool, dry skin

Question #55

Which medication classification is used preoperatively to decrease the risk of postoperative seizures?

A Corticosteroids

B Antianxiety

C Diuretics

D Anticonvulsants

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