Question 1

A 17-year-old patient with a new onset of seizures is diagnosed with epilepsy.What should the nurse include in the patient teaching?

Accepted Answer

Sudden discontinuance of a medication can result in status epilepticus.A.Aspirin does not interfere with anticonvulsants-each drug has different interactions that should be checked and communicated to the patient.C.The schedule is also dependent on the drug-some may be needed only once or twice a day.D.Medications for epilepsy will most likely be needed lifelong.

Question 2

A patient with a newly diagnosed seizure disorder is being prepared for discharge.What medication should the nurse anticipate will be prescribed for the patient to prevent recurrent seizures?

Accepted Answer

Gabapentin is an anticonvulsant agent.D.Dexamethasone is a steroid.B.Haloperidol is an antipsychotic agent.A.Selegiline is used to treat Parkinson's disease.

Question 3

A patient is incontinent during a seizure and sleeps for several hours afterward.What type of seizure did the patient most likely experience?

Accepted Answer

Generalized tonic-clonic seizures follow a typical progression.Aura and loss of consciousness may or may not occur.The patient is often incontinent.Patients who experience a generalized seizure may sleep deeply for 30 minutes to several hours.A.C.Absence and simple partial seizures are not generally associated with incontinence.D.A patient in status epilepticus may be incontinent but would still be having a seizure and not sleeping.

Question 4

The nurse administers an analgesic to a patient with a headache.How should the nurse assess the patient's response to the medication?

Accepted Answer

A pain rating scale is the most objective measure of the patient's pain.A,B,and C may also be helpful but are not the primary data needed.Blood pressure and pulse may increase with acute pain but not with chronic pain.

Question 5

A patient in the post-ictal period after a seizure remembers smelling something like dead fish prior to the seizure.Which response by the nurse is best?

Accepted Answer

Some patients experience an aura or sensation that warns the patient that a seizure is about to occur.An aura may be a visual distortion,a noxious odor,or an unusual sound.Patients who experience an aura may have enough time to sit or lie down before the seizure starts,thereby minimizing the chance of injury.B.Treating the aura as a hallucination does not help the patient to get to safety.A.Commenting on a food item on the menu is not appropriate.D.Flashes of light can occur however a noxious odor can also be an aura.

Question 6

The nurse is caring for a patient brought to the emergency department after an automobile accident.The patient is fully conscious.For what early signs of increased intracranial pressure (ICP)should the nurse be alert?

Accepted Answer

Initial symptoms of increased ICP include restlessness,irritability,and decreased level of consciousness,because cerebral cortex function is impaired.If not intubated,the patient may hyperventilate,causing vasoconstriction as the body attempts to compensate.As the pressure increases,the oculomotor nerve may be compressed on the side of the impairment.C.Compression of the outermost fibers of the oculomotor nerve results in diminished reactivity and dilation of the pupil.As the fibers become increasingly compressed,the pupil stops reacting to light.If the compression continues,and the brain tissue exerts pressure on the opposite side of the brain from the injury,both pupils become fixed and dilated.B.Hypothermia is not a sign of IICP.A.Vital sign changes are a late indication of increasing ICP.

Question 7

A patient who has had a seizure is crying,saying life is over,and that working and driving will no longer be possible.Which response by the nurse is most appropriate?

Accepted Answer

Patients with poorly controlled seizures should not operate motor vehicles.If seizures can be well controlled with medication,then driving is possible.B.C.These are inappropriate statements until it is known how the patient responds to medication.D.Discontinuing the medication may be done after an extended seizure-free period but not after a month.

Question 8

The nurse is assisting with teaching a patient about tension headaches.Which explanation of tension headaches should the nurse provide?

Accepted Answer

Persistent contraction of the scalp,facial,cervical,and upper thoracic muscles can cause tension headaches.A cycle of muscle tension,muscle tenderness,and further muscle tension is established.B.A migraine headache is believed to be caused by cerebral vasoconstriction followed by vasodilation.A.Pain mediators in the periphery are associated with peripheral pain,not headaches.D.Blood sugar fluctuations can cause headaches related to diabetes,not stress.

Question 9

The nurse concludes that a patient's meningitis is improving.What activity did the patient perform for the nurse to come to this conclusion?

Accepted Answer

Ability to touch the chin to the chest indicates improvement in nuchal rigidity.A.B.D.An improvement in the patient's condition is not associated with the ability to dorsiflex the feet,sit up,drink water,or maintain a side-lying position in bed.

Question 10

While walking to the bathroom a patient begins having a generalized tonic-clonic seizure.What should the nurse do first?

Accepted Answer

The prime objective in caring for a patient experiencing a seizure is to prevent injury.Maintain a patent airway,and if possible,turn the patient on his or her side to prevent aspiration if vomiting occurs.Do not force an airway or anything else into the patient's mouth once the seizure has begun.C.D.Assessment and privacy are important,but airway always takes priority.A.Reducing stimuli will not help once the seizure has begun.

Question 11

The vital signs for a client with a possible head injury were on admission: blood pressure 128/72 mm Hg,pulse 90 beats/min,and respirations 66 breaths/min.Which vital sign assessment conducted four hours later most likely indicates the presence of increased intracranial pressure (ICP)?

Accepted Answer

Vital sign changes are a late indication of increasing ICP.Cushing's response is a classic late sign of increased ICP.Cushing's response (or Cushing's triad)is characterized by bradycardia,bradypnea,and arterial hypertension (increasing systolic blood pressure while diastolic blood pressure remains the same),resulting in widening pulse pressure.B.These vital signs indicate tachycardia.C.These vital signs indicate tachypnea.C.These vital signs indicate both tachycardia and tachypnea.

Question 12

A patient with a cerebral injury is experiencing increased intracranial pressure (ICP).Which intervention should the nurse use to help prevent further increasing intracranial pressure?

Accepted Answer

The nurse should space care activities to provide rest between each disturbance.C.Clustering care may raise ICP.B.Stimulation can also raise ICP.A.Avoiding touch is not necessary.

Question 13

The nurse is caring for a patient admitted to the emergency department with massive trauma to the right frontal lobe of the brain.Which data should the nurse collect related to the location of the injury?

Accepted Answer

The cerebral cortex,and therefore the frontal lobe,is involved in thinking,learning,and memory.A.B.D.Olfactory sense,pupils,and EOMs are controlled by cranial nerves.

Question 14

A patient arriving in the emergency department with a bullet wound to the left frontal lobe is comatose.What should the nurse make a priority for this patient?

Accepted Answer

Remember the ABCs: airway is always the first priority.A.C.D.Fluid balance,body temperature,and neurological status are important however are not helpful if the patient does not have a patent airway.

Question 15

The nurse is determining care for a patient with acute migraine headaches.What should the nurse teach the patient to do first in order to determine a plan of care for the headaches?

Accepted Answer

The patient can identify aggravating factors by keeping a headache diary for a time,recording the time of day the headache occurs,foods eaten or other aggravating factors,description of the pain,identification of associated symptoms such as nausea or visual disturbances,and other factors related to headache symptoms.B.C.Avoiding foods or lights and noise might be helpful,but they do not help identify factors causing headaches.D.Avoiding analgesics is unrealistic.

Question 16

A student under a great deal of stress develops a severe tension headache and goes to the school clinic.What strategy should the nurse teach the student for dealing with the onset of headaches in the future?

Accepted Answer

Relaxation exercises help treat and may help stop a headache before it becomes severe.D.Distraction is good for some types of pain but less so for headaches.C.Vitamin C and zinc are good for wound healing.A.Aerobic exercise may promote general health and help the student to deal with stress but will not help once the headache has begun.

Question 17

A patient recovering from surgery to remove a brain tumor is found jerking rhythmically in the bed and unresponsive to verbal stimuli.What should the nurse do first?

Accepted Answer

The prime objective in caring for a patient experiencing a seizure is to prevent injury to the patient.A.B.Once the patient's safety has been assured,another nurse can be called to assist and the physician can be notified if necessary.C.Holding the patient increases the risk of injury.

Question 18

A patient who was in an industrial accident has had a sudden increase in intracranial pressure and is being prepared for placement of an emergency subarachnoid bolt.Which action should the nurse make a priority at this time?

Accepted Answer

The patient is unlikely to be able to sign a consent form,and it must be signed for surgery to begin.B.Bathing is not a priority.A.D.Belongings and further questioning can be taken care of after the patient is in surgery.

Question 19

A patient with a severe headache due to viral meningitis requests an opioid analgesic.What explanation about opioids should the nurse provide?

Accepted Answer

Opioids are habit forming and are used only as a last resort for headaches.A.C.They do not increase intracranial pressure,and they are not contraindicated for other reasons.D.Tylenol is much less effective than an opioid.

Question 20

The nurse is assessing a patient recovering from a tonic-clonic seizure.Which finding indicates a need for immediate nursing intervention?

Accepted Answer

Gurgling respirations and frothy sputum indicate aspiration,and a clear airway is a priority.A.B.Difficulty arousing and incontinence of urine are not uncommon findings after a tonic-clonic seizure.D.Belligerence is a concern but is not life threatening.

Quiz 48: Nursing Care of Patients With Central Nervous System Disorders