Deck 65: Management of Patients With Neurologic Dysfunction

Question 1

A patient is being admitted to the neurologic ICU following an acute head injury that has resulted in cerebral edema. When planning this patients care, the nurse would expect to administer what priority medication?

A) Hydrochlorothiazide (HydroDIURIL)
B) Furosemide (Lasix)
C) Mannitol (Osmitrol)
D) Spirolactone (Aldactone)

Answer 1

Mannitol (Osmitrol)

Question 2

The nurse is providing care for a patient who is unconscious. What nursing intervention takes highest priority?

A) Maintaining accurate records of intake and output
B) Maintaining a patent airway
C) Inserting a nasogastric (NG) tube as ordered
D) Providing appropriate pain control

Answer 2

Maintaining a patent airway

Question 3

The nurse is caring for a patient in the ICU who has a brain stem herniation and who is exhibiting an altered level of consciousness. Monitoring reveals that the patients mean arterial pressure (MAP) is 60 $\mathrm{mm} \mathrm{Hg}$ with an intracranial pressure (ICP) reading of $5 \mathrm{~mm} \mathrm{Hg}$ . What is the nurses most appropriate action?

A) Position the patient in the high Fowlers position as tolerated.
B) Administer osmotic diuretics as ordered.
C) Participate in interventions to increase cerebral perfusion pressure.
D) Prepare the patient for craniotomy.

Answer 3

Participate in interventions to increase cerebral perfusion pressure.

Question 4

The nurse is caring for a patient who is postoperative following a craniotomy. When writing the plan of care, the nurse identifies a diagnosis of deficient fluid volume related to fluid restriction and osmotic diuretic use. What would be an appropriate intervention for this diagnosis?

A) Change the patients position as indicated.
B) Monitor serum electrolytes.
C) Maintain NPO status.
D) Monitor arterial blood gas (ABG) values.

Question 5

A patient with a documented history of seizure disorder experiences a generalized seizure. What nursing action is most appropriate?

A) Restrain the patient to prevent injury.
B) Open the patients jaws to insert an oral airway.
C) Place patient in high Fowlers position.
D) Loosen the patients restrictive clothing.

Question 6

A patient who has been on long-term phenytoin (Dilantin) therapy is admitted to the unit. In light of the adverse of effects of this medication, the nurse should prioritize which of the following in the patients plan of care?

A) Monitoring of pulse oximetry
B) Administration of a low-protein diet
C) Administration of thorough oral hygiene
D) Fluid restriction as ordered

Question 7

A nurse is admitting a patient with a severe migraine headache and a history of acute coronary syndrome. What migraine medication would the nurse question for this patient?

A) Rizatriptan (Maxalt)
B) Naratriptan (Amerge)
C) Sumatriptan succinate (Imitrex)
D) Zolmitriptan (Zomig)

Question 8

The nurse is caring for a patient with increased intracranial pressure (ICP). The patient has a nursing diagnosis of ineffective cerebral tissue perfusion. What would be an expected outcome that the nurse would document for this diagnosis?

A) Copes with sensory deprivation.
B) Registers normal body temperature.
C) Pays attention to grooming.
D) Obeys commands with appropriate motor responses.

Question 9

A patient exhibiting an altered level of consciousness (LOC) due to blunt-force trauma to the head is admitted to the ED. The physician determines the patients injury is causing increased intracranial pressure (ICP). The nurse should gauge the patients LOC on the results of what diagnostic tool?

A) Monro-Kellie hypothesis
B) Glasgow Coma Scale
C) Cranial nerve function
D) Mental status examination

Question 10

While completing a health history on a patient who has recently experienced a seizure, the nurse would assess for what characteristic associated with the postictal state?

A) Epileptic cry
B) Confusion
C) Urinary incontinence
D) Body rigidity

Question 11

A patient with increased ICP has a ventriculostomy for monitoring ICP. The nurses most recent assessment reveals that the patient is now exhibiting nuchal rigidity and photophobia. The nurse would be correct in suspecting the presence of what complication?

A) Encephalitis
B) CSF leak
C) Meningitis
D) Catheter occlusion

Question 12

The nurse is participating in the care of a patient with increased ICP. What diagnostic test is contraindicated in this patients treatment?

A) Computed tomography (CT) scan
B) Lumbar puncture
C) Magnetic resonance imaging (MRI)
D) Venous Doppler studies

Question 13

The nurse is caring for a patient who is in status epilepticus. What medication does the nurse know may be given to halt the seizure immediately?

A) Intravenous phenobarbital (Luminal)
B) Intravenous diazepam (Valium)
C) Oral lorazepam (Ativan)
D) Oral phenytoin (Dilantin)

Question 14

The nurse has created a plan of care for a patient who is at risk for increased ICP. The patients care plan should specify monitoring for what early sign of increased ICP?

A) Disorientation and restlessness
B) Decreased pulse and respirations
C) Projectile vomiting
D) Loss of corneal reflex

Question 15

The neurologic ICU nurse is admitting a patient following a craniotomy using the supratentorial approach. How should the nurse best position the patient?

A) Position the patient supine.
B) Maintain head of bed (HOB) elevated at 30 to 45 degrees.
C) Position patient in prone position.
D) Maintain bed in Trendelenberg position.

Question 16

A clinic nurse is caring for a patient diagnosed with migraine headaches. During the patient teaching session, the patient questions the nurse regarding alcohol consumption. What would the nurse be correct in telling the patient about the effects of alcohol?

A) Alcohol causes hormone fluctuations.
B) Alcohol causes vasodilation of the blood vessels.
C) Alcohol has an excitatory effect on the CNS.
D) Alcohol diminishes endorphins in the brain.

Question 17

A patient has developed diabetes insipidus after having increased ICP following head trauma. What nursing assessment best addresses this complication?

A) Vigilant monitoring of fluid balance
B) Continuous BP monitoring
C) Serial arterial blood gases (ABGs)
D) Monitoring of the patients airway for patency

Question 18

What should the nurse suspect when hourly assessment of urine output on a patient postcraniotomy exhibits a urine output from a catheter of $1,500 \mathrm{~mL}$ for two consecutive hours?

A) Cushing syndrome
B) Syndrome of inappropriate antidiuretic hormone (SIADH)
C) Adrenal crisis
D) Diabetes insipidus

Question 19

During the examination of an unconscious patient, the nurse observes that the patients pupils are fixed and dilated. What is the most plausible clinical significance of the nurses finding?

A) It suggests onset of metabolic problems.
B) It indicates paralysis on the right side of the body.
C) It indicates paralysis of cranial nerve $\mathrm{X}$ .
D) It indicates an injury at the midbrain level.

Question 20

Following a traumatic brain injury, a patient has been in a coma for several days. Which of the following statements is true of this patients current LOC?

A) The patient occasionally makes incomprehensible sounds.
B) The patients current LOC will likely become a permanent state.
C) The patient may occasionally make nonpurposeful movements.
D) The patient is incapable of spontaneous respirations.

Question 21

The nurse is caring for a patient with permanent neurologic impairments resulting from a traumatic head injury. When working with this patient and family, what mutual goal should be prioritized?

A) Achieve as high a level of function as possible.
B) Enhance the quantity of the patients life.
C) Teach the family proper care of the patient.
D) Provide community assistance.

Question 22

The nurse is providing care for a patient who is withdrawing from heavy alcohol use. The nurse and other members of the care team are present at the bedside when the patient has a seizure. In preparation for documenting this clinical event, the nurse should note which of the following?

A) The ability of the patient to follow instructions during the seizure.
B) The success or failure of the care team to physically restrain the patient.
C) The patients ability to explain his seizure during the postictal period.
D) The patients activities immediately prior to the seizure.

Question 23

The nurse is caring for a patient whose recent health history includes an altered LOC. What should be the nurses first action when assessing this patient?

A) Assessing the patients verbal response
B) Assessing the patients ability to follow complex commands
C) Assessing the patients judgment
D) Assessing the patients response to pain

Question 24

The nurse caring for a patient in a persistent vegetative state is regularly assessing for potential complications. Complications of neurologic dysfunction for which the nurse should assess include which of the following? Select all that apply.

A) Contractures
B) Hemorrhage
C) Pressure ulcers
D) Venous thromboembolism
E) Pneumonia

Question 25

The nurse is caring for a patient with a brain tumor. What drug would the nurse expect to be ordered to reduce the edema surrounding the tumor?

A) Solumedrol
B) Dextromethorphan
C) Dexamethasone
D) Furosemide

Question 26

The nurse is caring for a patient who sustained a moderate head injury following a bicycle accident. The nurses most recent assessment reveals that the patients respiratory effort has increased. What is the nurses most appropriate response?

A) Inform the care team and assess for further signs of possible increased ICP.
B) Administer bronchodilators as ordered and monitor the patients LOC.
C) Increase the patients bed height and reassess in 30 minutes.
D) Administer a bolus of normal saline as ordered.

Question 27

A patient has a poor prognosis after being involved in a motor vehicle accident resulting in a head injury. As the patients ICP increases and condition worsens, the nurse knows to assess for indications of approaching death. These indications include which of the following?

A) Hemiplegia
B) Dry mucous membranes
C) Signs of internal bleeding
D) Loss of brain stem reflexes

Question 28

A patient has experienced a seizure in which she became rigid and then experienced alternating muscle relaxation and contraction. What type of seizure does the nurse recognize?

A) Unclassified seizure
B) Absence seizure
C) Generalized seizure
D) Focal seizure

Question 29

When caring for a patient with increased ICP the nurse knows the importance of monitoring for possible secondary complications, including syndrome of inappropriate antidiuretic hormone (SIADH). What nursing interventions would the nurse most likely initiate if the patient developed SIADH?

A) Fluid restriction
B) Transfusion of platelets
C) Transfusion of fresh frozen plasma (FFP)
D) Electrolyte restriction

Question 30

The nurse is admitting a patient to the unit who is scheduled for removal of an intracranial mass. What
Diagnostic procedures might be included in this patients admission orders? Select all that apply.

A) Transcranial Doppler flow study
B) Cerebral angiography
C) MRI
D) Cranial radiography
E) Electromyelography (EMG)

Question 31

A patient is recovering from intracranial surgery performed approximately 24 hours ago and is complaining of a headache that the patient rates at 8 on a 10-point pain scale. What nursing action is most appropriate?

A) Administer morphine sulfate as ordered.
B) Reposition the patient in a prone position.
C) Apply a hot pack to the patients scalp.
D) Implement distraction techniques.

Question 32

A patient is recovering from intracranial surgery that was performed using the transsphenoidal approach. The nurse should be aware that the patient may have required surgery on what neurologic structure?

A) Cerebellum
B) Hypothalamus
C) Pituitary gland
D) Pineal gland

Question 33

A patient is postoperative day 1 following intracranial surgery. The nurses assessment reveals that the patients LOC is slightly decreased compared with the day of surgery. What is the nurses best response to this assessment finding?

A) Recognize that this may represent the peak of post-surgical cerebral edema.
B) Alert the surgeon to the possibility of an intracranial hemorrhage.
C) Understand that the surgery may have been unsuccessful.
D) Recognize the need to refer the patient to the palliative care team.

Question 34

A school nurse is called to the playground where a 6-year-old girl has been found unresponsive and staring into space, according to the playground supervisor. How would the nurse document the girls activity in her chart at school?

A) Generalized seizure
B) Absence seizure
C) Focal seizure
D) Unclassified seizure

Question 35

A neurologic nurse is reviewing seizures with a group of staff nurses. How should this nurse best describe the cause of a seizure?

A) Sudden electrolyte changes throughout the brain
B) A dysrhythmia in the peripheral nervous system
C) A dysrhythmia in the nerve cells in one section of the brain
D) Sudden disruptions in the blood flow throughout the brain

Question 36

The nurse is caring for a patient who has undergone supratentorial removal of a pituitary mass. What medication would the nurse expect to administer prophylactically to prevent seizures in this patient?

A) Prednisone
B) Dexamethasone
C) Cafergot
D) Phenytoin

Question 37

A hospital patient has experienced a seizure. In the immediate recovery period, what action best protects the patients safety?

A) Place the patient in a side-lying position.
B) Pad the patients bed rails.
C) Administer antianxiety medications as ordered.
D) Reassure the patient and family members.

Question 38

A nurse is caring for a patient who experiences debilitating cluster headaches. The patient should be taught to take appropriate medications at what point in the course of the onset of a new headache?

A) As soon as the patients pain becomes unbearable
B) As soon as the patient senses the onset of symptoms
C) Twenty to 30 minutes after the onset of symptoms
D) When the patient senses his or her symptoms peaking

Question 39

A nurse is collaborating with the interdisciplinary team to help manage a patients recurrent headaches. What aspect of the patients health history should the nurse identify as a potential contributor to the patients headaches?

A) The patient leads a sedentary lifestyle.
B) The patient takes vitamin $\mathrm{D}$ and calcium supplements.
C) The patient takes vasodilators for the treatment of angina.
D) The patient has a pattern of weight loss followed by weight gain.

Question 40

An adult patient has sought care for the treatment of headaches that have become increasingly severe and frequent over the past several months. Which of the following questions addresses potential etiological factors? Select all that apply?

A) Are you exposed to any toxins or chemicals at work?
B) How would you describe your ability to cope with stress?
C) What medications are you currently taking?
D) When was the last time you were hospitalized?
E) Does anyone else in your family struggle with headaches?