Title: Quiz: Neurological, Disease/Disorder
Course: PRN 0092 Practical Nursing II > Section: Nursing Care of Clients with Nervous, Skin and Sensory Disorders

Q: The name of this area of the brain means “bridge.” It is the origin of cranial nerves V through VIII and is responsible for sending impulses to the structures inferior and superior to it. It also contains a respiratory center that complements the part of the brain stem located inferior to it. It is called the
- medulla oblongata.
- diencephalon.
- cerebellum.
- pons.
A: pons.
If right: The pons connects the midbrain to the medulla oblongata. The word pons means “bridge.” It is the origin of cranial nerves V and VIII.
If wrong: The pons connects the midbrain to the medulla oblongata. The word pons means “bridge.” It is the origin of cranial nerves V and VIII.

Q: A patient has a head injury and is presenting with signs and symptoms of increased intracranial pressure. Which nursing intervention would be helpful in reducing this pressure?
- Place the neck in a neutral position to promote venous drainage.
- Suction hourly to stimulate the cough reflex.
- Add extra blankets to keep the patient warm.
- Turn the patient frequently to prevent skin impairment.
A: Place the neck in a neutral position to promote venous drainage.
If right: Place the neck in a neutral position (not flexed or extended) to promote venous drainage.
If wrong: Place the neck in a neutral position (not flexed or extended) to promote venous drainage.

Q: When obtaining a health history from a patient with a neurological problem, the nurse is likely to elicit the most valid response from the patient with which question?
- “Do you have any sensations of pins and needles in your feet?”
- “Does the pain radiate from your back into your legs?”
- “Can you describe the sensations you are having in your head?”
- “Do you ever have any nausea or dizziness?”
A: “Can you describe the sensations you are having in your head?”
If right: For patients with suspected neurological conditions, the presence of many symptoms or subjective data may be significant.
If wrong: For patients with suspected neurological conditions, the presence of many symptoms or subjective data may be significant.

Q: A patient has been injured in a motorcycle accident and is presenting with signs and symptoms of increased intracranial pressure. What is the most significant sign or symptom of increased intracranial pressure?
- Pupil changes
- Ipsilateral paralysis
- Vomiting
- Decrease in the level of consciousness
A: Decrease in the level of consciousness
If right: Collection of objective data includes a change in level of consciousness. A change in the level of consciousness is the earliest sign of increased intracranial pressure.
If wrong: Collection of objective data includes a change in level of consciousness. A change in the level of consciousness is the earliest sign of increased intracranial pressure.

Q: The patient, injured in an automobile accident, is being evaluated in the emergency department for possible head injury. Which test should not be done if there is an indication of increased intracranial pressure?
- CT scan
- MRI scan
- Lumbar puncture
- Electroencephalogram
A: Lumbar puncture
If right: A lumbar puncture is contraindicated in patients who might have increased intracranial pressure, because the withdrawal of fluid may cause the medulla oblongata to herniate downward into the foramen magnum.
If wrong: A lumbar puncture is contraindicated in patients who might have increased intracranial pressure, because the withdrawal of fluid may cause the medulla oblongata to herniate downward into the foramen magnum.

Q: A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned for her with respect to this diagnostic test?
- Obtain an allergy history before the test.
- Ambulate the patient when she is returned to her room after the test.
- Warn her that paralysis could result from injection of the contrast medium.
- Keep her NPO for 6 to 8 hours after the test.
A: Obtain an allergy history before the test.
If right: Before the dye is injected, patients must be asked whether they have any allergies, specifically whether they have had any anaphylactic or hypotensive episodes from other dyes.
If wrong: Before the dye is injected, patients must be asked whether they have any allergies, specifically whether they have had any anaphylactic or hypotensive episodes from other dyes.

Q: A patient has recently suffered a stroke with left-sided weakness. She has problems with choking, especially when she drinks thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely?
- Having her avoid all liquids
- Instructing her to tuck her chin when swallowing
- Giving her sips of water with each bite
- Having her turn her head to the left
A: Instructing her to tuck her chin when swallowing
If right: The patient should sit at a 90-degree angle with the head up and chin slightly tucked.
If wrong: The patient should sit at a 90-degree angle with the head up and chin slightly tucked.

Q: A patient’s neurological status deteriorates over hours, and a craniotomy is performed to evacuate the hematoma. Which nursing intervention is indicated to help decrease the threat of increased intracranial pressure?
- Elevate the head of the bed 30 degrees.
- Cluster nursing interventions to provide uninterrupted periods of rest.
- Teach him to cough and deep breathe to prevent the necessity for suctioning.
- Teach him to hold his breath and bear down while repositioning in bed.
A: Elevate the head of the bed 30 degrees.
If right: Elevate the head of the bed to 30 to 45 degrees to promote venous return.
If wrong: Elevate the head of the bed to 30 to 45 degrees to promote venous return.

Q: A patient has a history of tonic-clonic seizures. She was admitted to the neurological unit after having had three tonic-clonic seizures in the past 2 days. Her husband reported that she had been sleeping for long periods after each seizure. The nurse explains to him that this rest period after a tonic-clonic seizure is called a
- convalescent period.
- post–status epilepticus period.
- post–tonic-clonic period.
- postictal period.
A: postictal period.
If right: Seizures are followed by a rest period of variable length, called a postictal period.
If wrong: Seizures are followed by a rest period of variable length, called a postictal period.

Q: Before the patient undergoes computed tomographic (CT) scanning with a contrast medium, the nurse should
- verify that the patient is not allergic to seafood or iodine.
- explain that the patient will have to change position frequently during the procedure.
- maintain a safe distance from the patient to reduce the exposure to radiation.
- verify that the patient has no metal objects such as an implant or a pacemaker.
A: verify that the patient is not allergic to seafood or iodine.
If right: It is important for the nurse to document and report to the physician any history of allergy to iodine and seafood because iodine is present in the contrast medium.
If wrong: It is important for the nurse to document and report to the physician any history of allergy to iodine and seafood because iodine is present in the contrast medium.

Q: The Glasgow coma scale is a screening tool used to assess level of consciousness in three major areas. They are
- verbal, sensation, motor.
- eye, motor, verbal.
- verbal, pain, reflexes.
- eye, pain, verbal.
A: eye, motor, verbal.
If right: The Glasgow coma scale was developed in 1974 and consists of three parts of the neurological assessment: eye opening, best motor response, and best verbal response.
If wrong: The Glasgow coma scale was developed in 1974 and consists of three parts of the neurological assessment: eye opening, best motor response, and best verbal response.

Q: When the seriousness of craniocerebral trauma is assessed, it is important to remember that
- heavy scalp bleeding indicates serious trauma.
- open injuries are always more serious than closed injuries.
- signs and symptoms may not occur until several days after the trauma.
- trauma to the frontal lobe is more significant than to any other area.
A: signs and symptoms may not occur until several days after the trauma.
If right: If a patient who has been conscious for several days after head injury loses consciousness or develops neurological signs and symptoms, a subdural hematoma should be suspected.
If wrong: If a patient who has been conscious for several days after head injury loses consciousness or develops neurological signs and symptoms, a subdural hematoma should be suspected.

Q: A patient, age 23, has a comminuted fracture of T6-T7. She has a spinal cord injury resulting in paraplegia. She manifests signs and symptoms of autonomic dysreflexia, which is frequently triggered by
- bladder distention.
- nausea.
- food allergies.
- electrolyte imbalance.
A: bladder distention.
If right: Autonomic dysreflexia occurs as a result of abnormal cardiovascular response to stimulation of the sympathetic division of the autonomic nervous system as a result of stimulation of the bladder, large intestine, or other visceral organs. The most common cause of this condition includes a distended bladder or fecal impaction.
If wrong: Autonomic dysreflexia occurs as a result of abnormal cardiovascular response to stimulation of the sympathetic division of the autonomic nervous system as a result of stimulation of the bladder, large intestine, or other visceral organs. The most common cause of this condition includes a distended bladder or fecal impaction.

Q: A patient, age 52, is brought to the emergency department by ambulance after she hit her head on her bathroom sink and fell unconscious to the floor. Which assessment should the nurse perform first?
- History of health problems
- Patency of airway
- Neurological status
- Status of bodily functions
A: Patency of airway
If right: Nursing diagnosis and interventions for the patient with a severe head injury may include Ineffective breathing pattern related to neuromuscular impairment. Nursing interventions will be to maintain a patent airway.
If wrong: Nursing diagnosis and interventions for the patient with a severe head injury may include Ineffective breathing pattern related to neuromuscular impairment. Nursing interventions will be to maintain a patent airway.

Q: A 39-year-old mother of four has a 6-year history of multiple sclerosis. During planning, the nurse remembers this is a degenerative neurological disease that
- occurs most often in tropical climates.
- occurs most often in the older adult.
- has classic signs and symptoms that are readily recognized.
- results from demyelination of the nerve sheath.
A: results from demyelination of the nerve sheath.
If right: In patients with multiple sclerosis, multiple foci of demyelination are distributed randomly in the white matter of the brain stem, spinal cord, optic nerves, and cerebrum.
If wrong: In patients with multiple sclerosis, multiple foci of demyelination are distributed randomly in the white matter of the brain stem, spinal cord, optic nerves, and cerebrum.

Q: A patient, age 69, is being evaluated by a neurologist for signs of muscle rigidity, masklike face (area from forehead to chin), and propulsive gait. These signs are often characteristic of
- multiple sclerosis.
- Parkinsonism.
- Alzheimer’s disease.
- epilepsy.
A: Parkinsonism.
If right: Parkinsonism is a syndrome that consists of a slowing down in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor, and impaired postural reflexes.
If wrong: Parkinsonism is a syndrome that consists of a slowing down in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor, and impaired postural reflexes.

Q: When planning care for a patient with aphasia, the nurse should
- talk loudly so he or she can hear.
- refrain from giving explanations about procedures because the patient cannot understand them anyway.
- provide as much environmental stimuli as possible to prevent feelings of isolation.
- consider the type of aphasia that the patient has and adapt communication methods accordingly.
A: consider the type of aphasia that the patient has and adapt communication methods accordingly.
If right: Many stroke patients have communication problems, including dysarthria and aphasia. The nurse should wait for the patient to communicate, rather than prompting or finishing the sentence before the patient has a chance to find the appropriate word.
If wrong: Many stroke patients have communication problems, including dysarthria and aphasia. The nurse should wait for the patient to communicate, rather than prompting or finishing the sentence before the patient has a chance to find the appropriate word.

Q: A patient, age 27, has been admitted to the neurological department because of seizures of unknown cause. The nurse should take precautions by
- placing the patient in protective restraints.
- being certain padded side rails are present.
- suggesting that the family monitor the patient.
- placing the patient with one-on-one nursing service.
A: being certain padded side rails are present.
If right: Padded side rails may be used, especially if seizures often occur during sleep.
If wrong: Padded side rails may be used, especially if seizures often occur during sleep.

Q: If a patient with a head injury has drainage from the nose or ears, which nursing intervention would be appropriate?
- Cleanse ear or nose with a soft cotton-tipped swab.
- Gently suction the nasal cavity.
- Allow the patient to wipe the nose or ears, but not blow the nose or place anything in the external ear.
- Place a pressure dressing over the ear.
A: Allow the patient to wipe the nose or ears, but not blow the nose or place anything in the external ear.
If right: The patient’s ear and nose are checked carefully for signs of blood and serous drainage, which indicate that the meninges are torn and spinal fluid is escaping. No attempt should be made to clean out the orifice.
If wrong: The patient’s ear and nose are checked carefully for signs of blood and serous drainage, which indicate that the meninges are torn and spinal fluid is escaping. No attempt should be made to clean out the orifice.

Q: Which body system would the nurse choose to closely monitor in a patient diagnosed with Guillain-Barré syndrome?
- CNS
- GI
- Respiratory
- Cardiovascular
A: Respiratory
If right: The patient’s condition can rapidly deteriorate into paralysis that affects the respiratory muscles. Close monitoring of respiratory function is important and necessary.
If wrong: The patient’s condition can rapidly deteriorate into paralysis that affects the respiratory muscles. Close monitoring of respiratory function is important and necessary.

Q: A method of reducing a person’s risk of becoming infected with the West Nile virus would be to
- wear shorts and short-sleeve shirts.
- apply baby lotion to all extremities.
- apply insect repellent that contains DEET.
- apply flea and tick repellent.
A: apply insect repellent that contains DEET.
If right: One can reduce the risk of becoming infected with West Nile virus by applying insect repellent to exposed skin. Choose an insect repellant that contains diethyltoluamide (DEET) and one that provides protection for the amount of time you will be outdoors.
If wrong: One can reduce the risk of becoming infected with West Nile virus by applying insect repellent to exposed skin. Choose an insect repellant that contains diethyltoluamide (DEET) and one that provides protection for the amount of time you will be outdoors.

Q: A lumbar puncture is performed to obtain which specimen?
- Serum
- Cerebral spinal fluid (CSF)
- Urine
- Arterial blood gases
A: Cerebral spinal fluid (CSF)
If right: A lumbar puncture is done to obtain CSF for examination, to relieve pressure, or to introduce dye or medication.
If wrong: A lumbar puncture is done to obtain CSF for examination, to relieve pressure, or to introduce dye or medication.

Q: In the aging process, older adults are able to
- react to events immediately.
- master new material quickly.
- remember information from the immediate present (short-term memory).
- learn new skills.
A: learn new skills.
If right: Most older people possess the ability to learn, but the speed of learning is slowed. Short-term memory is more affected by aging than is long-term memory.
If wrong: Most older people possess the ability to learn, but the speed of learning is slowed. Short-term memory is more affected by aging than is long-term memory.

Q: The earliest sign of increased intracranial pressure is
- headache.
- dilated pupil.
- decreasing level of consciousness.
- diplopia (double vision).
A: decreasing level of consciousness.
If right: A decreasing level of consciousness is the earliest sign of increased intracranial pressure.
If wrong: A decreasing level of consciousness is the earliest sign of increased intracranial pressure.

Q: A therapeutic measure to reduce increased intracranial pressure is
- suction the patient every 2 hours.
- place in a semiprone position.
- reduce fluid intake.
- keep the patient flat in bed.
A: reduce fluid intake.
If right: Restrict fluid intake. Elevate the head of the bed 30 to 45 degrees to promote venous return. Prevent hip flexion to prevent an increase in intra-abdominal and intrathoracic pressure. Perform suctioning only as necessary.
If wrong: Restrict fluid intake. Elevate the head of the bed 30 to 45 degrees to promote venous return. Prevent hip flexion to prevent an increase in intra-abdominal and intrathoracic pressure. Perform suctioning only as necessary.