Deck 47: Care of Critically Ill Patients With Neurologic Problems

Question 1

A client who has had a stroke with left-sided hemiparesis has been referred to a rehabilitation center.The client asks,"Why do I need rehabilitation?" How does the nurse respond?

A) "Rehabilitation will reverse any physical deficits caused by the stroke."
B) "If you do not have rehabilitation, you may never walk again."
C) "Rehabilitation will help you function at the highest level possible."
D) "Your doctor knows best and has ordered this treatment for you."

Answer 1

"Rehabilitation will help you function at the highest level possible."

Question 2

A client has experienced a stroke resulting in damage to Wernicke's area.Which clinical manifestation does the nurse monitor for?

A) Inability to comprehend spoken words
B) Communication with rote speech only
C) Slurred speech
D) Inability to make sounds

Answer 2

Inability to comprehend spoken words

Question 3

The nurse is caring for a client admitted to the intensive care unit after incurring a basilar skull fracture.Which complication of this injury does the nurse monitor for?

A) Aspiration
B) Hemorrhage
C) Pulmonary embolus
D) Myocardial infarction

Answer 3

Hemorrhage

Question 4

The nurse is caring for a client who has experienced a stroke.Which nursing intervention for nutrition does the nurse implement to prevent complications from cranial nerve IX impairment?

A) Turn the client's plate around halfway through the meal.
B) Place the client in high Fowler's position.
C) Order a clear liquid diet for the client.
D) Verbalize the placement of food on the client's plate.

Question 5

A client who had a stroke combs her hair only on the right side of her head and washes only the right side of her face.How does the nurse interpret these actions?

A) Poor left-sided motor control
B) Paralysis or contractures on the right side
C) Limited visual perception of the left fields
D) Unawareness of the existence of her left side

Question 6

A client who has a head injury is transported to the emergency department.Which assessment does the emergency department nurse perform immediately?

A) Pupil response
B) Motor function
C) Respiratory status
D) Short-term memory

Question 7

The nurse is caring for a client who had a stroke.Which nursing intervention does the nurse implement during the first 72 hours to prevent complications?

A) Administer prescribed analgesics to promote pain relief.
B) Cluster nursing procedures together to avoid fatiguing the client.
C) Monitor neurologic and vital signs closely to identify early changes in status.
D) Position with the head of the bed flat to enhance cerebral perfusion.

Question 8

A client who has a severe head injury is placed in a drug-induced coma.The client's husband states,"I do not understand.Why are you putting her into a coma?" How does the nurse respond?

A) "These drugs will prevent her from experiencing pain when positioning or suctioning is required."
B) "This medication will help her remain cooperative and calm during the painful treatments."
C) "This medication will decrease the activity of her brain so that additional damage does not occur."
D) "This medication will prevent her from having a seizure and will reduce the need for monitoring intracranial pressure."

Question 9

The nurse is assessing a client who had a stroke in the right cerebral hemisphere.Which neurologic deficit does the nurse assess for in this client?

A) Impaired proprioception
B) Aphasia
C) Agraphia
D) Impaired olfaction

Question 10

The nurse is preparing to administer prescribed mannitol (Osmitrol)to a client with a severe head injury.Which precaution does the nurse take before administering this medication?

A) Draw up the medication using a filtered needle.
B) Have injectable naloxone (Narcan) prepared and ready at the bedside.
C) Prepare to hyperventilate the client before drug administration.
D) Discontinue a barbiturate-induced coma before drug administration.

Question 11

A client who had a stroke is receiving clopidogrel (Plavix).Which adverse effect does the nurse monitor for in this client?

A) Repeated syncope
B) New-onset confusion
C) Spontaneous ecchymosis
D) Abdominal distention

Question 12

The nurse notes that the left arm of a client who has experienced a brain attack is in a contracted,fixed position.Which complication of this position does the nurse monitor for in this client?

A) Shoulder subluxation
B) Flaccid hemiparesis
C) Pathologic fracture
D) Neglect syndrome

Question 13

A client who had a brain attack was admitted to the intensive care unit yesterday.The nurse observes that the client is becoming lethargic and is unable to articulate words when speaking.What does the nurse do next?

A) Check the client's blood pressure and apical heart rate.
B) Elevate the back rest to 30 degrees and notify the health care provider.
C) Place the client in a supine position with a flat back rest, and observe.
D) Assess the client's white blood cell count and differential.

Question 14

The nurse is obtaining a health history for a client admitted to the hospital after experiencing a brain attack.Which disorder does the nurse identify as a predisposing factor for an embolic stroke?

A) Seizures
B) Psychotropic drug use
C) Atrial fibrillation
D) Cerebral aneurysm

Question 15

A client who first experienced symptoms related to a confirmed thrombotic stroke 2 hours ago is brought to the intensive care unit.Which prescribed medication does the nurse prepare to administer?

A) Tissue plasminogen activator
B) Heparin sodium
C) Gabapentin (Neurontin)
D) Warfarin (Coumadin)

Question 16

The nurse is caring for a client who has a moderate head injury.The client's sister asks,"Will my brother return to his normal functioning level when his brain heals?" How does the nurse respond?

A) "You should expect a full recovery in all ways by the time of discharge."
B) "Usually, someone with this type of injury returns to baseline within 6 months."
C) "Your brother may experience many changes in personality and cognitive abilities."
D) "Learning complex new skills may be more difficult, but you can expect other functions to return to normal."

Question 17

The nurse is teaching bladder training to a client who is incontinent after a stroke.Which instruction does the nurse include in this client's teaching?

A) "Decrease your oral intake of fluids to 1 liter per day."
B) "Use a Foley catheter at night to prevent accidents."
C) "Plan to use the commode every 2 hours during the day."
D) "Hold your bladder as long as possible to restore bladder tone."

Question 18

The nurse is caring for an 80-year-old client who presented to the emergency department in a coma.Which question does the nurse ask the client's family to help determine whether the coma is related to a brain attack?

A) "How many hours does your mother usually sleep at night?"
B) "Did your mother complain recently of weakness in her lower extremities?"
C) "Is any history of seizures known among your mother's immediate family?"
D) "Does your mother drink any alcohol or take any medications?"

Question 19

The nurse is caring for a client who is immobile from a recent stroke.Which intervention does the nurse implement to prevent complications in this client?

A) Position the client with the unaffected side down.
B) Apply sequential compression stockings.
C) Instruct the client to turn the head from side to side.
D) Teach the client to touch and use both sides of the body.

Question 20

A client with aphasia presents to the emergency department with a suspected brain attack.Which clinical manifestation leads the nurse to suspect that this client has had a thrombotic stroke?

A) Two episodes of speech difficulties in the last month
B) Sudden loss of motor coordination
C) A grand mal seizure 2 months ago
D) Chest pain and nuchal rigidity

Question 21

A client is admitted for evaluation of a cerebral tumor.Which clinical manifestations does the nurse assess this client for?

A) Hemiplegia
B) Aphasia
C) Hearing loss
D) Behavior changes
E) Nystagmus

Question 22

The nurse is planning the discharge of a client who has sustained a moderate head injury and is experiencing personality and behavior changes.The client's wife states,"I am concerned about how different he is.What can I do to help with the transition back to our home?" How does the nurse respond?

A) "Be firm and let him know when his behavior is unacceptable."
B) "Minimizing the number of visitors will help stabilize his personality."
C) "Developing a routine will help provide him with a structured environment."
D) "He will return to his normal emotional functioning in 6 to 12 months."

Question 23

The nurse is caring for a client who is disoriented as the result of a stroke.Which action does the nurse implement to help orient this client?

A) Ask the family to bring in pictures familiar to the client.
B) Turn on the television to a 24-hour news station.
C) Maintain a calm and quite environment by minimizing visitors.
D) Provide auditory and visual stimulation simultaneously.

Question 24

The nurse is assessing a client who was recently diagnosed with a meningioma.Which statement indicates that the client correctly understands the diagnosis?

A) "This is the worst type of brain tumor, and surgery is not an option."
B) "My tumor can be removed, but I can still have damage because of pressure in my brain."
C) "Even after the surgery, I will need chemotherapy to decrease the spread of the tumor."
D) "Radiation is never used on brain tumors because of possible nerve damage."

Question 25

A client with a head injury is being given midazolam (Versed)while on mechanical ventilation.Which action does the nurse implement for this client?

A) Monitor for seizures.
B) Assess for urinary output.
C) Provide a clear liquid diet.
D) Administer an analgesic.

Question 26

The nurse is preparing to administer a prescribed dose of intravenous dexamethasone (Decadron)to a client after craniotomy.The pharmacy supplies dexamethasone 40 mcg in 20 mL normal saline to be administered over 15 minutes.The nurse sets the IV pump at a rate of _____ mL/hr.

Question 27

The nurse assesses periorbital edema and ecchymosis around both eyes of a client who is 6 hours postoperative for craniotomy.Which intervention does the nurse implement for this client?

A) Position the client with the head of the bed flat.
B) Apply an ice pack to the affected area.
C) Assess arterial blood pressure.
D) Notify the health care provider.