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 Complete the course of antibiotics as prescribed.

C Use ophthalmic lubricant and protect the eye.

D Avoid stimuli that trigger pain.

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 Assess client’s reaction to new medication schedule.

D Document medication given and dose.

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 swallowing

B chewing

C smelling

D tasting

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 There is a strong familial tendency.”

B No familial tendency has been demonstrated.”

C There is a very weak familial tendency.

D Only secondary migraine headaches show a familial tendency.”

Question #5

Cerebral edema peaks at which time point after intracranial surgery?

A 48 hours

B 24 hours

C 12 hours

D 72 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 Phenobarbital

B Furosemide (Lasix)

C Mannitol

D Vasopressin

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 Place the client in wrist restraints.

B Reorient the client while gently holding their arms.

C Administer lorazepam per orders.

D Apply oxygen via nasal cannula.

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 Shortness of breath

B Sensitivity to bright light

C Muscle spasms

D Drooping eyelids

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 tonic-clonic seizure

B A complex seizure

C A partial seizure

D An absence 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 Document the reading because it reflects that the treatment has been effective.

B Contact the physician to review the care plan.

C Check the equipment.

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 Phenobarbital

B Ativan

C Cerebyx

D Valium

Question #12

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

A Administer corticosteroids as ordered.

B Document signs and symptoms of inflammation.

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

C “I will have progressive muscle weakness.”

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

Question #14

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

A Elevate the head of the bed.

B Administer Percocet as ordered.

C Complete a head-to-toe assessment.

D Administer morning dose of anticonvulsant.

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 Maintains a patent airway

C Attains desired fluid balance

D Demonstrates optimal cerebral tissue perfusion

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 Excessive urine output and decreased urine osmolality

C Oliguria 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 flaccid.

B decorticate.

C decerebrate.

D normal.

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 Elevating the head of the bed 90 degrees

B Encouraging oral fluid intake

C Suctioning the client once each shift

D Administering a stool softener as ordered

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 Cushing’s

B Monro-Kellie

C Hashimoto’s disease

D Dawn phenomenon

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 Flat

B Elevated 30 degrees

C Turned onto the operative side

D Elevated no more than 10 degrees

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 Self-care

B Safety

C Activity

D Skin 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 Exacerbation of uncontrolled hypertension

B Increased ICP

C Infection

D Increase in cerebral perfusion pressure

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 promote an active range of motion

B increase environmental stimuli.

C minimize exposure to bright lights and noise.

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 unequal response

C rapid response

D equal 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 Trigeminal neuralgia

C Brain tumor

D Hypostatic pneumonia

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 Perform the Heimlich maneuver

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

C Maintain hydration by drinking eight glasses of fluid a day

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

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 Restricting fluid intake and hydration

B Administering prescribed antipyretics

C Maintaining adequate hydration

D Hyperoxygenation before and after tracheal suctioning

Question #30

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

A decreasing blood pressure.

B diminished responsiveness.

C pupillary changes.

D elevated temperature.

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 lie flat for 24 hours after surgery.”

B You must report ringing in your ears immediately.”

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

D You must restrict your fluid intake.”

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 150 to 200 mL/h

B 50 to 100 mL/h

C More than 200 mL/h

D 100 to 150 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 Maintenance of a patent airway

B Assessment of pupillary light reflexes

C Determination of the cause

D Positioning to prevent complications

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 Trendelenburg position.

B dorsal recumbent position.

C supine position with the head slightly elevated.

D prone position with the head turned to the unaffected side

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 Aspiration of a brain abscess

B To assess visual acuity

C Access for intravenous (IV) fluids

D Visualization of a hemorrhage

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 Deficient fluid volume related to inability to take fluids by mouth

D Ineffective airway clearance related to altered LOC

Question #38

The initial sign of increasing intracranial pressure (ICP) includes

A headache.

B vomiting.

C decreased level of consciousness.

D herniation.

Question #39

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

A Aura

B Headache

C Postdrome

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

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

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

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

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 Colorectal carcinoma

B Laryngeal carcinoma

C Esophageal carcinoma

D Pituitary 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 Ask the patient to cough to observe the sputum color and consistency.

C Give the patient some mouthwash to gargle with.

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 Obesity

B Osteoporosis

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 A bounding pulse

B Hypertension

C Bradycardia

D Lethargy and stupor

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 Administering prescribed antipyretics

B Hyperoxygenation before and after tracheal suctioning

C Restricting fluid intake and hydration

D Maintaining adequate hydration

Question #46

Which method is used to help reduce intracranial pressure?

A Keeping the head of bed flat

B Using a cervical collar

C Rotating the neck to the far right with neck support

D Extreme hip flexion, with the hip supported by pillows

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 Assessing skull dressing for excess drainage

B Maintain airway via artificial ventilation.

C Time, distance, and shielding against radiation

D Assess neurological findings.

Question #48

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

A Sleeping quietly after the seizure

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

C Seizure began at 1300 hours.

D The client cried out before the seizure began.

Question #49

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

A Mannitol

B Dextrose 5% in water (D5W)

C Half-normal saline (0.45% NSS)

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

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

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

Question #51

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

A Side-lying, to facilitate drainage of oral secretions

B Semi-Fowler’s, to promote breathing

C Supine, to rest the muscles of the extremities

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 80 mm Hg

B 60 mm Hg

C 70 mm Hg

D 50 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 mean arterial pressure (MAP) is equal to the intracranial pressure (ICP).

C Increased ICP is 12 mm Hg.

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 Cool, dry skin

C Urine output of 100 mL/hr

D Capillary refill of 2 seconds

Question #55

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

A Antianxiety

B Anticonvulsants

C Corticosteroids

D Diuretics

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