Chapter 53 reveiw.pdf

1. The nurse is caring for a male patient with Parkinson's disease. Vital signs are pulse 82 beats/min, blood pressure 134/90 mm Hg, respirations 18 breaths/min, oxygen saturation 97%. The patient is taking carbidopa/levodopa three times a day and entacapone with each dose of carbidopa/l...

1. The nurse is caring for a male patient with Parkinson's disease. Vital signs are pulse 82 beats/min, blood pressure 134/90 mm Hg, respirations 18 breaths/min, oxygen saturation 97%. The patient is taking carbidopa/levodopa three times a day and entacapone with each dose of carbidopa/levodopa. Which foods can the patient ingest before or with his drugs to prevent nausea and assist with proper drug absorption? Select all that apply. 1. Scrambled eggs, bacon, grapefruit juice 2. Oatmeal, orange juice, toast with butter and jam 3. Cheeseburger, French fries, vanilla milk shake 4. Steak sandwich, green salad, iced tea 5. Banana, granola, rice milk 6. Spaghetti with tomato sauce, salad, and sparkling water  2. A 52-year-old female patient is diagnosed with Parkinson's disease. Which drug will the healthcare provider likely prescribe initially to improve her muscular coordination? 1. carbidopa/levodopa 2. pramipexole 3. riluzole 4. entacapone  3. A 70-year-old man with Parkinson's disease is taking carbidopa/levodopa and entacapone. The nursing assistant noted that his urine is dark yellow despite an adequate fluid intake. What is the best first action of the nurse? 1. Ask the patient how much fluid he is drinking. 2. Order a BUN/creatinine measurement. 3. Check the chart for a recent complete blood count (CBC). 4. Evaluate the patient's skin and sclerae.  4. A patient newly diagnosed with amyotrophic lateral sclerosis (ALS) will be started on riluzole. Which element of his history is most important to relay to the healthcare provider? 1. He drinks a glass of wine every evening with dinner. 2. Alanine aminotransferase (ALT) level is 300 units per liter. 3. He had exertional asthma when he played basketball in high school. 4. He is having difficulty swallowing.  5. Which laboratory results are most important to monitor for a patient who is taking dopamine agonists? Select all that apply. 1. Complete blood counts 2. Liver function studies 3. Glucose 4. Potassium 5. Urinalysis 6. Ammonia levels  6. Which nursing interventions are most important before giving donepezil (Aricept)? Select all that apply. 1. Obtain an accurate weight. 2. Complete an Alzheimer's Disease Assessment Scale. 3. Obtain a 12-lead ECG. 4. Obtain a chest radiograph. 5. Ask the patient about a history or symptoms of GI bleeding. 6. Ask the patient whether he or she is sexually active.  7. Which neurotransmitter is thought to be deficient in Alzheimer's disease? 1. Acetylcholine 2. Dopamine 3. Serotonin 4. Norepinephrine  8. A patient with Alzheimer's disease has been prescribed rivastigmine (Exelon). Which expected side effect is most often associated with this drug? 1. Erectile dysfunction 2. Headaches 3. Hallucinations 4. Flulike symptoms  9. Which cardiac side effects could be expected if a patient is taking a cholinesterase inhibitor (hint: cholinergic agonist) such as donepezil (Aricept)? Select all that apply. 1. Bradycardia 2. Increased saliva 3. Hypertension 4. Hypotension 5. Heart block 6. Constipation  10. Which expected side effects are associated with memantine (Namenda)? Select all that apply. 1. Headache 2. Dizziness 3. Diarrhea 4. Constipation 5. Hallucinations 6. Weight gain  11. Which traditional antiepileptic drug is recommended for use during pregnancy? 1. carbamazepine 2. ethosuximide 3. phenytoin 4. valproic acid  12. A patient who is taking lamotrigine reports the appearance of a new rash. What is your best action? 1. Report the rash to the healthcare provider immediately. 2. Add the reaction to the patient's list of allergies in his or her record. 3. Instruct the patient to take the drug with a substantial meal or snack. 4. Suggest that the patient apply a cortisone- containing cream to the area.  13. Which patient taking lamotrigine is more likely to develop symptoms of overdose with recommended dosages? 1. 15-year-old Asian male with asthma 2. 22-year-old white female who is pregnant 3. 48-year-old Mediterranean female who is hypertensive 4. 52-year-old African American male who has type 2 diabetes mellitus  14. Which antiepileptic drugs have an increased risk of psychological dependency? Select all that apply. 1. carbamazepine 2. ethosuximide 3. lacosamide 4. phenytoin 5. phenobarbital 6. valproic acid  15. Which drugs for multiple sclerosis may lead to an increased risk for infection? Select all that apply. 1. dalfampridine 2. alemtuzumab 3. daclizumab 4. natalizumab 5. ocrelizumab 6. beta-inferon Case Study Steven Moor is a 60-year-old male mechanical engineer who was referred to the neurology clinic for an intermittent resting tremor of the left hand that has progressed to the right hand. He has a history of type 2 diabetes for which he takes metformin (Glucophage). On assessment, the patient is found to have normal cognition, and an intermittent mild resting tremor is observed in both hands. Some stop-and-go movements (cogwheel rigidity) and slow movements (bradykinesia) are observed when he was asked to reach for a pencil and transfer it from the right hand to the left hand. Gait, balance, and reflexes are normal. The diagnosis of Parkinson's disease is considered by the healthcare provider.  1. Which drugs would the nurse expect the healthcare provider to prescribe initially for Mr. Moor? Select all that apply. 1. carbidopa/levodopa 2. entacapone 3. rasagiline 4. ropinirole 5. encatone 6. pramipexole 7. rotigotine 8. tolcapone  2. As Mr. Moor's disease worsens, which symptoms pose the greatest risk for safety? Select all that apply. 1. Shuffling gait 2. Tremors 3. Difficulty swallowing 4. Anxiety 5. Difficulty focusing 6. Freezing in place 7. Unstable when standing 8. Difficulty chewing 9. Diminished sense of smell  3. Mr. Moor asks the nurse why he needs to check his blood sugars so often lately. What is the best response by the nurse? 1. “All diabetics should check their blood sugar levels before each meal.” 2. “The drugs you are taking make your liver produce more insulin, causing your blood sugar to become low.” 3. “The drugs you are taking make your liver produce more glucose, causing your blood sugar to become too high.” 4. “The healthcare provider is concerned that your diabetes might worsen with the onset of Parkinson's disease.”  4. Which adverse effects would you discuss with Mr. and Mrs. Moor as the dosing of dopamine agonists increases? Select all that apply. 1. Psychosis 2. Delirium 3. Hallucinations 4. Depression 5. Involuntary muscle movements (dyskinesia) 6. Neuroleptic malignant syndrome 7. Discoloration of urine to orange-brown 8. Stevens-Johnson syndrom  5. The nurse is planning care for Mr. Moor. Which strategies should receive priority in the patient's plan of care? 1. Install grab bars in the shower. 2. Increase fluids and fiber to relieve constipation. 3. Take deep breaths before speaking. 4. Remove scatter and throw rugs. 5. Give the patient time to talk when asking a question. 6. Make sure halls, stairways, and entrances are well lit. 7. Dress the patient in clothes that are easy to put on. 8. Have the patient wear shoes without rubber soles. 9. Suggest relaxing activities to reduce stress.  1. A patient is to have a laser treatment to cauterize hemorrhaging vessels caused by diabetic retinopathy. The patient asks the nurse what this procedure is called. Which response by the nurse is correct? 1. Enucleation 2. Scleral buckle 3. Photocoagulation 4. Trabeculoplasty  2. The parents want to know more about their child’s conductive hearing loss. Which is the best explanation by the nurse? 1. “Sound is delivered through the external and middle ear, but a defect in the inner ear results in distortion of sound.” 2. “Sound is inadequately delivered through the external or middle ear to the inner ear.” 3. “There is no organic cause, but a functional problem exists.” 4. “The brain’s auditory pathways are damaged.”  3. A patient has impaired hearing. Which action by the nurse would best facilitate communication? 1. Face the patient when speaking. 2. Overaccentuate words to make the communication more effective. 3. Shout to allow the patient to hear. 4. Use one-word phrases when speaking.  4. A patient tells the nurse he has dizziness. He states that the health care provider used another term. What term did the health care provider most likely use? 1. Tinnitus 2. Labyrinthitis 3. Sensorineural 4. Vertigo  5. A patient is diagnosed with an inner ear problem. For what symptom should the nurse monitor the patient closely? 1. Echoing 2. Intense pain 3. Vertigo 4. Loss of hearing  6. The nurse is evaluating a patient’s eye as it adjusts to seeing objects at various distances. When documenting, how should the nurse identify this test? 1. PERRLA 2. Refraction 3. Focusing 4. Accommodation  7. A patient is suspected of having a retinal detachment. What signs/symptoms will provide support to this diagnosis? (Select all that apply.) 1. “I have tunnel vision.” 2. “I am having a lot of pain in my eye.” 3. “It feels like I’m looking through cobwebs.” 4. “I see specks floating around the edges of my vision 5. “I feel like someone pulled a curtain over my eye.”  8. Which of the following would be most hazardous in the home of a patient who is visually impaired? 1. Area rugs 2. Room carpeting 3. Tile floor 4. Concrete flooring  9. A patient arrives in the emergency room after an accident that resulted in a piece of metal penetrating the eye. What nursing action should be taken initially on the patient’s arrival at the hospital? 1. Apply a cool compress immediately. 2. Lightly cover both eyes with an eye shield. 3. Attempt to gently remove the object. 4. Irrigate the eye with tap water.  10. A patient has just had cataract surgery. What information should the nurse include in the discharge instructions? (Select all that apply.) 1. Wear an eye shield at night on the operative eye. 2. Avoid bending, stooping, coughing, or lifting. 3. Instill prescribed eyedrops into the conjunctival sac. 4. Take an analgesic every 4 hours. 5. Avoid lying on the affected eye for 2 weeks after surgery.  11. Which assessment finding would indicate a need for possible glaucoma testing? (Select all that apply.) 1. Presence of “floaters” 2. Halos around lights 3. Progressive loss of peripheral vision 4. Pruritus and erythema of the conjunctiva 5. Lack of ability to adapt to darkness  12. While communicating with a patient, you notice a possible hearing deficit in one ear. Which nursing intervention would be appropriate? 1. Shout in the affected ear. 2. Speak clearly and in a slightly louder voice toward the patient’s face. 3. Plug the affected ear and shout in the unaffected ear. 4. Speak more softly than usual in the affected ear.  13. The nurse is admitting an adult patient to a walk-in clinic. The patient complains of recent hearing loss. What does the nurse anticipate as the most probable cause of this patient’s hearing loss? 1. Cerumen buildup 2. Ossification of the pinna 3. Low batteries in the hearing aid 4. Fluid in the ear  14. A 71-year-old patient complains of being severely dizzy. What instruction should the nurse give the patient? 1. Avoid sudden movements. 2. Avoid noises. 3. Increase fluid intake. 4. Lie on the affected side.  15. A patient who has been blind for the past 10 years is hospitalized with heart failure. What intervention should the nurse include in the plan of care? 1. Keep all personal care items at a distance so that he won’t bump into them. 2. Schedule a consultation with an occupational therapist to teach activities of daily living. 3. All personnel announce themselves when entering and leaving the room. 4. Initiate a referral to the Department of Health and Human Services.  16. A patient has a family history of cataracts. He asks what early symptoms he should watch for that would alert him to the development of cataracts. What is the nurse’s best response? 1. Pain in the eyes 2. Blurred vision 3. Loss of peripheral vision 4. Dry eyes  17. A patient is scheduled for a stapedectomy. What postoperative instructions should the nurse include in patient teaching? (Select all that apply.) 1. Change cotton in external ear canal hourly. 2. Gently blow through both nares simultaneously. 3. Teach the patient to open the mouth when sneezing or coughing. 4. Limit exercise or active sports for 3 weeks. 5. Avoid exposure to people with upper respiratory tract infections.  18. A 15-year-old hearing-impaired patient is having problems communicating with the staff. Which behavior would improve communication? (Select all that apply.) 1. Overaccentuating words 2. Facing the patient when speaking 3. Speaking in conversational tones 4. Asking permission to turn off the television or radio 5. Using written communication for most interactions  19. The nurse is caring for a patient with vertigo. What is the nurse’s priority concern when caring for this patient? 1. Safety 2. Comfort 3. Hygiene 4. Quiet  20. While cleaning the garage, a patient splashed a chemical in his eyes. What is the initial action after the chemical burn? 1. Transport to an emergency facility immediately. 2. Cover the eyes with sterile gauze. 3. Lubricate eye with petroleum-based jelly. 4. Irrigate the eye with water for 20 minutes.  21. A patient visits the health care provider to have her vision tested using the Snellen eye chart. What instruction should the nurse provide to the patient? 1. Use both eyes to read the chart. 2. Read the chart from right to left. 3. Cover one eye while testing the other. 4. Use either eye because they will be the same.  22. A 78-year-old patient comes into the clinic complaining of progressive loss of vision in the center of the visual field. The nurse is aware that the patient is most likely experiencing symptoms of which disorder? 1. Macular degeneration 2. Primary open-angle glaucoma 3. Color blindness 4. Retinal degeneration  23. After cataract surgery a patient complains of sudden sharp pain in the operative eye. What is the most appropriate nursing action? 1. Remove the metal eye shield to relieve pressure. 2. Call the surgeon. 3. Administer an analgesic. 4. Document complaint of pain on chart.  24. A patient is asked to sign a surgical consent for treatment of otosclerosis. Which statement indicates correct understanding of the procedure? 1. “It involves surgical repair of the external ear.” 2. “It means cutting the nerve in my ear.” 3. “It cleans the ear canal of wax.” 4. “It will help me hear sounds again.” The patient tells the nurse that he is legally blind. How would this information impact the nurse’s plan of care for this patient? A. The nurse would need to determine how this patient’s visual impairment affects normal functioning. B. This patient has some usable vision, which enables function at an acceptable level. C. This patient probably has some light perception, but no usable vision. D. The patient would be considered totally blind.  The 62-year-old home health patient who is recovering from eye surgery complains of a feeling of “grittiness” in the eye and is having blurred vision. The eyes are reddened and have stringy mucus. What do these complaints indicate? A. Sjögren syndrome B. Early cataracts C. Macular degeneration D. Retinal detachment  When the newly blind male home health patient asks the nurse how he might get assistance, who might the nurse suggest he contact? A. American Foundation for the Blind for a list of agencies B. The public health department C. American Red Cross D. Local hospital social worker  What should a patient who has had a cataract repair avoid? A. The lifting of heavy objects B. The use of sunglasses C. The use of eye patches D. Reading for long periods of time  What should the nurse advise the 20 year old to do who has been put on cefaclor (Ceclor) for a resistant otitis media? A. Avoid alcoholic beverages. B. Store suspension at room temperature. C. Take with meals only. D. Discontinue drug when symptoms abate.  How should the nurse advise a patient who has severe vertigo from labyrinthitis? A. Lie immobile and hold the head in one position until the vertigo lessens. B. Drink an iced drink slowly. C. Lean against a wall and not head forward until vertigo lessens. D. Bend at the waist and take several deep breaths.  How would the nurse explain the purpose of photocoagulation to a diabetic patient with diabetic retinopathy? A. The procedure will destroy new blood vessels, seal leaking vessels, and help prevent retinal edema. B. The procedure will destroy the retina, which is not getting enough blood supply. C. The procedure will reduce edema in the macula of the eye. D. The procedure will vaporize fatty deposits that appear in the retina.  What is the first indication of macular degeneration? A. The loss of central vision B. The loss of peripheral vision C. Eye fatigue D. The loss of color discrimination  Why is otitis media found more frequently in children 6 to 36 months? A. Eustachian tubes in children are shorter and straighter. B. Otitis media is seen equally in both children and adults. C. Children’s eustachian tubes are more vertical and longer. D. Infection descends via the eustachian tube to the throat.  The home health patient complains of tearing and a feeling of dryness in the right eye. The nurse assesses that the eyelid is turned inward and the sclera is red. The nurse documents the presence of a(n)__.  The nurse explains that a pneumatic retinopexy is a repair of a retinal detachment using a bubble of__ to put pressure on the damaged retina.  The total removal of an eye is a(n) __.  The surgical incision into the eardrum with either a knife or a heated wire loop to relieve pressure in the middle ear is a(n) __.  Progressive deafness caused by the ankylosis of the stapes is the condition of__.  The nurse is aware that the patient has 20/40 vision. This means that the patient can see at 20 ft what the normal eye can see at _______ ft.  One of the housekeepers splashes a chemical in the eyes. What should be the first priority? A. Irrigate with H2O for 5 minutes. B. Cover the eyes with a sterile gauze. C. Transport to a health care provider immediately. D. Irrigate with normal saline solution for 20 minutes.  What does a tympanoplasty correct? A. Sensorineural hearing loss B. Functional hearing loss C. Conductive hearing loss D. Congenital hearing loss Four hours after a stapedectomy, the patient complains that hearing has not improved at all. What knowledge would the nurse use to shape a response? A. A large percentage of stapedectomies are not successful. B. It will take at least 10 days for the graft to heal. C. Hearing will not return until edema subsides. D. Hearing will improve after irrigation of the ear. What is a common mistake that hinders communication when communicating with the hearing impaired? A. Speaking in conversational tones B. Overaccentuating words C. Facing the patient when speaking D. Speaking into the ear with the hearing aid What is the process when the lens of the eye changes its curvature to focus on the retina? A. Convergence B. Constriction C. Refraction D. Accommodation  What does the cataract treatment of phacoemulsification involve? A. Removing the lens through the anterior capsule B. “Drying” the cataract with hypertonic saline C. The insertion of a new lens D. Breaking the cataract with ultrasound  Which complaint made by a 64-year-old patient during a health interview would alert the nurse to the possibility of cataracts? A. Pain in the eyes B. Difficulty driving at night C. Loss of peripheral vision D. Dry eyes  What does diabetes retinopathy result from? A. Long-term overdosing of insulin B. Aging C. Retinal detachment D. Capillaries in retina hemorrhage  When the patient in the emergency room complains of seeing flashing lights and a curtain down over his right eye, the nurse recognizes this as a symptom of which condition? A. Early sign of cataract B. Macular degeneration C. Detached retina D. Diabetic retinopathy  The nurse will assess for _____________ when the older adult home health patient complains that the entire right side of his head hurts and he cannot chew without pain. A. otitis media B. mumps C. external otitis D. labyrinthitis  The nurse takes into consideration that the Weber test indicated a conductive hearing loss in a patient because the patient reported hearing the tone: A. as a shrill noise. B. very faintly. C. louder in his affected ear. D. equally in both ears.  What should the nurse remind the hearing aid wearer to do when the nurse hears a whistling hearing aid? A. Wash the ear mold with warm water. B. Reinsert the ear mold. C. Change the battery. D. Recharge the hearing aid.  What do miotic eye drops do for a patient with glaucoma? A. Lubricate and moisten the dry eye. B. Dilate the pupil and sharpen vision. C. Constrict the pupil and open the canal of Schlemm. D. Irrigate the surface of the eye.  What should the nurse include in the plan of care following a tympanoplasty? A. Continuous irrigation of the ear canal with antibiotic solutions B. Frequent turning, coughing, and deep breathing C. Enforcing bed rest for 72 hours D. Elevating head of bed with operative side facing upward  When the patient stares at the black dot on an Amsler grid, what should the nurse ask him to report? A. Movement of the black dot B. Any color visible on the grid C. Fading of the edges of the grid D. Any distortion of the grid  A patient who had an enucleation of the right eye has been admitted PACU. What should the nurse include in the plan of care? 1. Document dressing assessment every 2 hours. 2. Turn, cough, and deep breathe every 3 hours. 3. Turn on the affected side. 4. Apply a pressure dressing over the right eye socket.  What must a patient do following a left vitrectomy? 1. Keep head upright and cushioned with pillows for 24 hours. 2. Assume a side-lying position with the left side down for 3 days. 3. Remain flat in bed for 48 hours. 4. Position self in a face-down position for 4 to 5 days.  Which is a sign of acute angle closure glaucoma (AACG)? 1. Drooping eyelid 2. Bluish color in sclera 3. Large fixed pupil 4. Nystagmus  Why would the nurse encourage a group of teenagers to protect their eyes with dark sunglasses while using a UV lamp? 1. The lamp can cause presbycusis. 2. The lamp can cause keratitis. 3. The lamp can cause ectropion. 4. The lamp can cause cataracts.  The nurse counsels the 16-year-old boy that playing his music at high volume can result in impairment in hearing related to: 1. damaged tympanic membrane. 2. damage of the fine hair cells in the organ of Corti. 3. protective buildup of cerumen. 4. rupture of the oval window.  What is the most interior part of the eye? 1. Aqueous humor 2. Cornea 3. Choroid 4. Lens 5. Retina 6. Iris What is the first nursing intervention step for the immediate care of a patient with a penetrating wound of the eye? 1. Check for the irregularity of the pupil. 2. Cover both eyes with an eye shield or cup. 3. Obtain medical attention immediately. 4. Assess eye, do not remove object. 5. Lay the patient down flat. Select all the conditions that may cause conductive hearing loss. (Select all that apply.) 1. Buildup of cerumen 2. Otitis media with effusion 3. Otosclerosis of external auditory canal 4. Foreign bodies Which may contribute to otitis media? (Select all that apply.) 1. Upper respiratory infections 2. Exposure to cigarette smoke 3. Allergies 4. Swimming 5. Prolonged exposure to loud noise What factors must the nurse consider when assessing readiness to learn when teaching health promotion practices for the visually and hearing impaired? (Select all that apply.) 1. Values 2. Habits 3. Cultural beliefs 4. Occupation Which of the following are causes of cataracts? (Select all that apply) 1. Smoking 2. Long-term use of corticosteroids 3. Diabetes mellitus 4. Congenital from exposure to maternal rubella 5. Exposure to sand and dust What would a nurse do when the patient arrives in the PACU after a left stapedectomy? (Select all that apply.) 1. Medicate immediately on the complaint of nausea 2. Leave the bed flat. 3. Turn the patient to his right side. 4. Turn patient every 2 hours. What should the nurse do when assisting a blind person to walk in an unfamiliar hospital environment? (Select all that apply.) 1. Encourage the patient to ask for verbal cues 2. Place patient hand on nurse’s shoulder or elbow. 3. Describe the surroundings. 4. Discourage the use of the cane.  __ is/are responsible for the transmission of impulses between synapses.  The nurse explains that the triad of signs of Parkinson disease is: __, rigidity, and bradykinesia.  Involuntary rhythmic movement of the eyes, with oscillations that may be horizontal, vertical, or mixed movements, is called __.  The waxy substance that covers the neuron fibers and increases the rate of transmission of impulses is the __.  What are the two divisions of the nervous system? 1. Somatic and the autonomic 2. Cerebellum and the brainstem 3. Medulla oblongata and the diencephalon 4. Central and the peripheral  What is the cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and carries motor fibers to glands that produce digestive juices and other secretions? 1. Vagus nerve 2. Visceral sensory nerve 3. Somatic motor nerve 4. Abducens nerve  The nurse is aware that when assessing a patient by the FOUR score coma scale, the patient is assessed in four categories: eye response, brainstem reflexes, motor response, and respiration. How are these results reported? 1. As individual scores in each category 2. As a sum of the scores of the four categories 3. As part of the Glasgow Coma Scale 4. As progressive scores during a 24-hour period  The nurse is aware that the drug t-PA (Activase), a tissue plasminogen activator, must be given in hours of the onset of symptoms to have maximum benefit. 1. 3 hours 2. 6 hours 3. 4 hours 4. 8 hours  What should the nurse do when the child arrives on the floor with the diagnosis of bacterial meningitis? 1. Place the child in respiratory isolation 2. Arrange for humidified oxygen per mask. 3. Hold NPO until orders arrive 4. Inquire about drug allergy  Why is the patient with suspected Guillain- Barre Syndrome (GBS) hospitalized immediately? 1. The disease can rapidly progress into respiratory failure. 2. The brain may swell quickly causing seizures. 3. IV hydration is needed to prevent possible fatal hypotension. 4. The infection needs to be treated with IV antibiotics to prevent paralysis.  __ is/are responsible for the transmission of impulses between synapses  A __ is a diagnostic procedure used to identify lesions by observing the flow of radiopaque dye through the subarachnoid space.  The nurse explains that the triad of signs of Parkinson disease is: __, rigidity, and bradykinesia.  Involuntary rhythmic movement of the eyes, with oscillations that may be horizontal, vertical, or mixed movements, is called __.  The waxy substance that covers the neuron fibers and increases the rate of transmission of impulses is the __. What are the two divisions of the nervous system? 1. Somatic and the autonomic 2. Cerebellum and the brainstem 3. Medulla oblongata and the diencephalon 4. Central and the peripheral The newly admitted patient to the emergency room 30 minutes ago after a fall off a ladder has gradually decreased in consciousness and has slowly reacting pupils, a widening pulse pressure, and verbal responses that are slow and unintelligible. What is the most appropriate position for the patient? 1. Supine in gravity neutral position. 2. Neck placed in a neutral position. 3. Turn on right side with head elevated 4. Head raised slightly with hips flexed. Which question is likely to elicit the most valid response from the patient who is being interviewed about a neurologic problem? 1. “Does the pain radiate from your back into your legs?” 2. Can you describe the sensations you are having?” 3. “Do you have any sensations of pins and needles in your feet?” 4. “Do you ever have any nausea or dizziness?” What is the cardinal sign of increased intracranial pressure in a brain injured patient? 1. Pupil changes 2. Vomiting 3. Ipsilateral paralysis 4. Decrease in the level of consciousness As the result of a stroke, a patient has difficulty discerning the position of his body without looking at it. In the nurse’s documentation, which would best describe the patient’s inability to assess spatial position of his body? 1. Sensation 2. Apraxia 3. Agnosia 4. Proprioception  A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned with respect to this diagnostic test? 1. Keep NPO for 6 to 8 hours after the test. 2. Obtain an allergy history before the test. 3. Use heated blanket to keep patient warm after procedure. 4. Ambulate the patient when returned to the room after the test. A patient has recently suffered a stroke with left-sided weakness and has problems with choking, especially when drinking thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely? 1. Take a sip of liquid with each bite. 2. Tuck chin when swallowing. 3. Turn head to the left 4. Use a straw. What are surgical navigational systems? 1. A written set of progressive processes for the resection of small brain tumors 2. The use of radioactive materials to pinpoint small tumors of the brain 3. A set of detailed anatomic maps pinpointing specific areas of the brain 4. Computerized devices that guide the surgeon A family member of a patient who has just suffered a tonic-clonic seizure is concerned about the patient’s deep sleep. What is this behavior called? 1. Sombulant period 2. Convalescent period 3. Postictal period 4. Neural recovery period How would a nurse record the behavior when a patient with Alzheimer’s disease attempts to eat using a napkin rather than a fork? 1. Apraxia 2. Dysphagia 3. Agnosia 4. Aphasia  Which symptom is specific to migraine headaches? 1. They involve the entire head 2. Tachycardia 3. They are preceded by an aura 4. They become worse in the evening The nurse assures an anxious family member of a 92-year-old patient who is demonstrating signs of dementia that many causes of dementia are reversible and preventable. What is one example? 1. Diabetes 2. Alzheimer’s disease 3. Hypotension 4. Parkinson disease  What is the nurse assessing when asking the patient, “Who is the president of the United States?” during a level of consciousness assessment? 1. Memory 2. Orientation 3. Calculation 4. Fund of knowledge What Glasgow Coma Scale rating would a patient receive who opens the eyes spontaneously, but has incomprehensible speech and obeys commands for movement? A. 10 B. 8 C. 11 D. 12 What is the nurse aware of when assessing a person with a craniocerebral injury? 1. Open injuries are always more serious than closed injuries. 2. Most injuries of this type are irreversible 3. Signs and symptoms may not occur until several days after the trauma 4. Trauma to the frontal lobe is more significant than to any other area. A frantic family member is distressed about the flaccid paralysis of her son following a spinal cord injury several hours ago. What does the nurse know about this condition? 1. It is an ominous indicator of permanent paralysis. 2. It is possibly a temporary condition and will clear. 3. It will progress up the cord to cause seizures. 4. It degenerates into a spastic paralysis. A patient with a spinal cord injury at T1complains of stuffiness of the nose and a headache.The nurse notes a flushing of the neck and “goose flesh.” What should be the primary nursing intervention based on these assessments? 1. Administer oxygen and check oxygen saturation 2. Place patient in flat position and check temperature. 3. Place on side and check for leg swelling 4. Sit upright and check blood pressure The nurse is aware that the characteristic gait of the person with Parkinson disease is a propulsive gait,which causes the patient to: 1. take small steps balanced on the toes. 2. stagger and need support of a walker 3. shuffle with arms flexed. 4. fall over to one wide when walking What does the nurse know about the stroke patient who has expressive aphasia? 1. Has total loss and comprehension of language 2. Has difficulty comprehending spoken and written communication. 3. Can understand the spoken word,but cannot speak. 4. Cannot make any vocal sounds. An 83-year-old patient has had a stroke. He is right handed and has a history of hypertension and “little” strokes. He presents with right hemiplegia. To afford him the best visual field, the nurse should approach him: 1. from the right side 2. from the center 3. from either side 4. from the left side. The newly admitted patient to the emergency room after a motorcycle accident has serosanguineous drainage coming from the nose.What is the most appropriate nursing response to this assessment? 1. Cleanse nose with a soft cotton-tipped swab. 2. Ask patient to blow his nose. 3. Gently wipe nose with absorbent gauze. 4. Gently suction the nasal cavity. How would the nurse instruct a patient with Parkinson disease to improve activity level? 1. To use a soft mattress to relax the spine. 2. To walk with hands clasped behind back to help balance. 3. To sit in hard chair with arms for posture control 4. To walk with a shuffling gait to avoid tripping What is the basic problem that prompts most of the early signs of Alzheimer’s disease? 1. Problems with words in speaking 2. Memory loss that disrupts daily life 3. Misplacing things 4. Changes in mood A patient is in which stage of Alzheimer’s disease when she demonstrates “sundowning”? 1. Final stage 2. Early stage 3. Second stage 4. Third stage Why are the drugs neostigmine (Prostigmin) and pyridostigmine (Mestinon) helpful to the person with myasthenia gravis? 1. Improves speech. 2. Reduces pain. 3. Improves visual disturbances 4. Promotes nerve impulse transmission. What is the purpose of a “drug holiday” in the treatment of Parkinson disease? 1. Reduce the extrapyramidal symptoms. 2. Allow the natural dopamine levels to rise 3. Change all drugs 4. Restart drugs at a lower dosage with favorable results What is the first sign of Bell’s palsy? 1. Excessive mucus running from nostril on affected side 2. Sudden pain in nostril on affected side 3. Inability to wrinkle forehead and pucker lips on affected side 4. Excessive salivation on the affected side Following a myelogram the nurse should include in the postprocedure care assessment for: 1. urine retention 2. sensation in lower extremities. 3. elevation of blood pressure. 4. slurred speech. The nurse explains that the two divisions of the autonomic nervous system work to maintain homeostasis. Which is the first autonomic event? 1. Sympathetic nervous system dominates 2. Heart rate and blood pressure rise, secretion of adrenaline 3. Extremely stressful or frightening event 4. Parasympathetic nervous system dominates 5. Blood pressure,heart rate,and adrenaline output decrease Which foods should the person who suffers from migraine headaches avoid? (Select all that apply.) 1. Marinated foods 2. Caffeine 3. Pears 4. yogurt What are the three signs of Cushing response? (Select all that apply.) 1. Increased blood pressure 2. Bradycardia 3. Increased pulse rate 4. Increased systolic blood pressure 5. Widened pulse pressure Which of the following techniques are necessary for safely feeding a hemiplegic patient? (Select all that apply.) 1. Taking the patient’s dentures out to prevent choking 2. Adding a thickening agent to liquids 3. Offering small bites of food 4. Mixing liquids and solid foods together What is the reticular activating system (RAS) essential to? (Select all that apply.) 1. Introspection 2. Memory 3. Concentration 4. Wakefulness 5. Attention What are the effects of normal aging on the nervous system? (Select all that apply.) 1. Loss of neurons 2. Lipofuscin 3. Decrease in oxygen use 4. Reduction of cerebral blood flow