CVA
1. A patient’s facial droop and aphasia resolve before arrival. Which interpretation best guides care?
A. The absence of symptoms excludes vascular disease
B. A TIA is a warning of increased stroke risk and requires evaluation
C. Neurologic imaging is unnecessary after symptom resolution
D. Preventive therapy is useful only after a completed stroke
B. A TIA is a warning of increased stroke risk and requires evaluation
Which of the following interventions describes an appropriate bladder program for a client in rehabilitation for spinal cord injury?
B. Schedule intermittent catheterization every 2 to 4 hours.
A patient has episodic visual symptoms, ataxia, fatigue, and periods of improvement. MRI shows plaques in CNS white matter. Which diagnosis best fits?
A. Multiple sclerosis
B. Bacterial meningitis
C. Embolic stroke
D. Lumbar strain
A. Multiple sclerosis
MS causes CNS demyelination with characteristic plaques and varied neurologic symptoms.
Which neurotransmitter is responsible for many of the functions of the frontal lobe?
A. Dopamine
The frontal lobe primarily functions to regulate thinking, planning, and affect. Dopamine is known to circulate widely throughout this lobe, which is why it’s such an important neurotransmitter in schizophrenia. Dopamine receptors play an essential role in daily life functions. This hormone and its receptors affect movement, emotions and the reward system in the brain.
A 30-year-old was admitted to the progressive care unit with a C5 fracture from a motorcycle accident. Which of the following assessments would take priority?
C. Pulse ox readings
Your patient has entered the post ictus stage for seizures. The patient’s seizure presented with an aura followed by body stiffening and then recurrent jerking. The patient had incontinence and bleeding in the mouth from injury to the tongue. What is an expected finding in this stage based on the type of seizure this patient experienced?
C. Sleepy, headache, and soreness
Based on the findings during the seizure the patient experienced a tonic-clonic seizure. In the post ictus stage (after the seizure) the patient is expected to be sleepy (very tired), have soreness, and a headache. The nurse should let the patient sleep.
The nurse provides care for a client who is diagnosed with epilepsy and prescribed multiple anticonvulsant medications, including valproic acid, levetiracetam, and topamax. Which is the priority action by the nurse when assessing the client based on the prescribed levetiracetam?
A. Skin turgor due to risk for dehydration
B. Dietary intake due to the risk for malnutrition
C. Mobility due to the risk for loss of coordination
D. Bowel elimination due to the risk for watery stools
C. Mobility due to the risk for loss of coordination
Levetiracetam can cause loss of coordination, including difficulty walking and controlling muscles; therefore, the priority assessment for this medication is to assess mobility.
A thrombotic stroke is most closely linked with:
A. Atherosclerosis
B. Meningitis
C. Spinal shock
D. Myelin loss
A. Atherosclerosis
A client is admitted with a spinal cord injury at the level of T12. He has limited movement of his upper extremities. Which of the following medications would be used to control edema of the spinal cord?
C. methylprednisolone (Solu-Medrol)
A patient with MS experiences attacks followed by partial or complete recovery. Which course is described?
A. Primary progressive
B. Relapsing-remitting
C. Secondary progressive from onset
D. Isolated peripheral neuropathy
B. Relapsing-remitting
The nurse is discussing the purpose of an electroencephalogram (EEG) with the family of a client with massive cerebral hemorrhage and loss of consciousness. It would be most accurate for the nurse to tell family members that the test measures which of the following conditions?
C. Activity of the brain.
An EEG measures the electrical activity of the brain. An electroencephalogram (EEG) is an essential tool that studies the brain’s electrical activity. It is primarily used to assess seizures and conditions that may mimic seizures. It is also useful to classify seizure types, assess comatose patients in the intensive care unit, and evaluate encephalopathies, among other indications.
A client comes into the ER after hitting his head in an MVA. He’s alert and oriented. Which of the following nursing interventions should be done first?
C. Immobilize the client’s head and neck.
You’re educating a 25-year-old female about possible triggers for seizures. Which statement requires you to re-educate the patient about the triggers?*
B. “I will limit my alcohol intake to 2 glasses of wine per day.”
The patient should avoid all alcohol because it can lead to a seizure. Hormone shifts (menstrual cycle, ovulation, pregnancy) sleep deprivation, and dehydration can lead to a seizure.
The client who is diagnosed with Parkinson disease (PD) is on multiple medications, including benztropine. When providing education to the client regarding the management of PD, which information should the nurse provide to address the anticholinergic side effects of the benztropine? Select all that apply.
A. “Chewing sugar free gum helps to moisten your mouth.”
B. “Increasing foods that are rich in fiber is important to decrease constipation.”
C. “Be sure to monitor your intake and output as urinary retention may occur due to your prescribed medication.”
D. “You should decrease your intake of fluids due to the risk for urinary retention.”
E. “Taking a walk everyday is a strategy to address constipation.”
A, B, C, E
8. The nurse receives an order for fibrinolytic treatment of an acute stroke. Which action is most important before administration?
A. Assume all stroke types are eligible
B. Confirm evaluation has excluded intracranial hemorrhage and assess eligibility
C. Delay neurologic assessment until infusion ends
D. Give aspirin immediately regardless of treatment plan
B. Confirm evaluation has excluded intracranial hemorrhage and assess eligibility
Fibrinolytic therapy is intended for eligible ischemic stroke patients, not intracranial hemorrhage.
A client with a C6 spinal injury would most likely have which of the following symptoms?
D. Tetraplegia
A client with a C6 injury will typically retain the ability to move their shoulders, bend their elbows, and extend their wrists, but they will lack functional control over their fingers, hands, torso, and lower body
A patient has gradually increasing MS-related disability without discrete attacks from onset. Which course is most consistent?
A. Primary progressive
B. Relapsing-remitting
C. Secondary progressive
D. Acute traumatic SCI
A. Primary progressive
A client is at risk for increased ICP. Which of the following would be a priority for the nurse to monitor?
A. Unequal pupil size
Increasing ICP causes unequal pupils as a result of pressure on the third cranial nerve. Clinical suspicion for intracranial hypertension should be raised if a patient presents with the following signs and symptoms: headaches, vomiting, and altered mental status varying from drowsiness to coma.
A client with head trauma develops a urine output of 300 ml/hr, dry skin, and dry mucous membranes. Which of the following nursing interventions is the most appropriate to perform initially?
A. Evaluate urine specific gravity.
B. Anticipate treatment for renal failure.
C. Provide emollients to the skin to prevent breakdown.
D. Slow down the IV fluids and notify the physician.
A. Evaluate urine specific gravity.
You’re assessing a patient who recently experienced a focal type seizure (partial seizure). As the nurse, you know that which statement by the patient indicates the patient may have experienced a focal impaired awareness (complex partial) seizure?*
A. “My friend reported that during the seizure I was staring off and rubbing my hands together, but I don’t remember doing this.”
B. “I remember having vision changes, but it didn’t last long.”
C. “I woke up on the floor with my mouth bleeding.”
D. “After the seizure I was very sleepy, and I had a headache for several hours.”
A. “My friend reported that during the seizure I was staring off and rubbing my hands together, but I don’t remember doing this.”
The patient will experience an alternation in consciousness (hence the name focal IMPAIRED awareness) AND will perform an action without knowing they are doing it called automatism like lip-smacking, rubbing the hands together etc. With a focal onset AWARE seizure (also called partial simple seizure) the patient is aware and will remember what happens (like vision changes etc.).
The home health nurse reviews the serum laboratory test results for a client with seizures. The phenytoin level is 27 mcg/mL. The client makes which statement that may indicate the presence of dose-related drug toxicity and prompt the nurse to notify the health care provider?
A. I am feeling unsteady when I walk.
B. I am getting up to urinate about 4 times during the night
C. I have a metallic taste in my mouth when I eat
D. My gums are getting so puffy and red.
A. I am feeling unsteady when I walk
- Phenytoin is an anticonvulsant drug used to treat generalized tonic-clonic seizures. Common symptoms of phenytoin drug-induced toxicity involve the central nervous system and include ataxia, nystagmus, slurred speech, and decreased alertness.
A patient receiving thrombolytic therapy develops abrupt headache and worsening neurologic findings. What is the priority?
A. Continue therapy and reassess in an hour
B. Treat this as possible intracranial bleeding and escalate immediately
C. Encourage ambulation
D. Administer oral fluids
B. Treat this as possible intracranial bleeding and escalate immediately
Acute neurologic deterioration during thrombolysis requires urgent evaluation for hemorrhage.
While in the ER, a client with C8 tetraplegia develops a blood pressure of 80/40, pulse 48, and RR of 18. The nurse suspects which of the following conditions?
C. Neurogenic shock
You’re assessing your patient load for the patients who are at MOST risk for seizures. Select all the patients below that are at risk:*
The answers are A, B, D, and E. All the patients are at risk except option C. Remember all the risk factors: illness (especially CNS types like bacterial meningitis), fever, electrolyte/metabolic issues (low blood sugar, acidosis etc), ETOH (alcohol) withdraw, brain injury, STROKE, congenital brain defects, tumors etc.
Which of the following describes decerebrate posturing?
D. Back arched; rigid extension of all four extremities.
Decerebrate posturing occurs in patients with damage to the upper brain stem, midbrain, or pons and is demonstrated clinically by the arching of the back, rigid extension of the extremities, pronation of the arms, and plantar flexion of the feet.
An 18-year-old client is admitted with a closed head injury sustained in a MVA. His intracranial pressure (ICP) shows an upward trend. Which intervention should the nurse perform first?
A. Reposition the client to avoid neck flexion.
B. Administer 1 g Mannitol IV as ordered.
C. Increase the ventilator’s respiratory rate to 20 breaths/minute.
D. Administer 100 mg of pentobarbital IV as ordered.
A. Reposition the client to avoid neck flexion.
The nurse should first attempt nursing interventions, such as repositioning the client to avoid neck flexion, which increases venous return and lowers ICP. Elevate the head of the bed to greater than 30 degrees. Keep the neck midline to facilitate venous drainage from the head.
You have a patient who has a brain tumor and is at risk for seizures. In the patient’s plan of care you incorporate seizure precautions. Select below all the proper steps to take in initiating seizure precautions:
A, E, F, and G.
The clinic nurse prepares to administer a newly prescribed dose of sumatriptan to a client with a migraine headache. Which item in the client's history would cause the nurse to question the medication?
A. BUN of 12 mg/dL
B. BMI of 34 kg/m recorded during todays exam
C. Past medical history of uncontrolled hypertension
D. Takes alprazolam as prescribed for anxiety
C. Past medical history of uncontrolled hypertension
triptan drugs work by constricting cranial blood vessels and client should be instructed to take a dose at the first sign of a migraine to help prevent and relieve symptoms
A client with a subarachnoid hemorrhage is prescribed a 1,000-mg loading dose of Dilantin IV. Which consideration is most important when administering this dose?
B. Rapid Dilantin administration can cause cardiac arrhythmias.
A 22-year-old client with quadriplegia is apprehensive and flushed, with a blood pressure of 210/100 and a heart rate of 50 bpm. Which of the following nursing interventions should be done first?
B. Assess patency of the indwelling urinary catheter.
A patient with a history of epilepsy is taking Phenytoin. The patient’s morning labs are back, and the patient’s Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will?
B. Initiate seizure precautions
A therapeutic phenytoin level is generally considered to be 10-20 mg/L
A 23-year-old patient with a recent history of encephalitis is admitted to the medical unit with new onset generalized tonic-clonic seizures. Which nursing activities included in the patient’s care will be best to delegate to an LPN/LVN whom you are supervising?
B. Administer phenytoin (Dilantin) 200 mg PO daily.
Administration of medications is included in LPN education and scope of practice. Collection of data about the seizure activity may be accomplished by an LPN/LVN who observes initial seizure activity. An LPN/LVN would know to call the supervising RN immediately if a patient started to seize.
A client who is admitted to the ER for head trauma is diagnosed with an epidural hematoma. The underlying cause of epidural hematoma is usually related to which of the following conditions?
Correct Answer: A. Laceration of the middle meningeal artery.
Epidural hematoma or extradural hematoma is usually caused by laceration of the middle meningeal artery. Most epidural hematomas result from arterial bleeding from a branch of the middle meningeal artery. The anterior meningeal artery or dural arteriovenous (AV) fistula at the vertex may be involved.
A patient is taking Phenytoin for treatment of seizures. Which statement by the patient requires you to re-educate the patient about this medication?*
A. “Every morning I take this medication with a full glass of milk with my breakfast.”
This medication should NOT be taken with milk products or antacids because it affects absorption. All the other options are correct.
The nurse is reinforcing education to a client newly prescribed levetiracetam for seizures. Which statement made by the client indicates a need for further instruction?
A. Drowsiness is a common side effect of this medication and will improve over time
B. I can begin driving again after I have been on this medication for a few weeks
C. I need to immediately report any new or increased anxiety when on this medication
D. I need to immediately report any new rash when on this medication
B. I can begin driving again after I have been on this medication for a few weeks
During the first 24 hours after thrombolytic therapy for ischemic stroke, the primary goal is to control the client’s:
C. Blood pressure
The American Heart Association guidelines require that blood pressure be maintained below 180/105 mm Hg during and for the full 24 hours following the infusion
During an episode of autonomic dysreflexia in which the client becomes hypertensive, the nurse should perform which of the following interventions?
D. Put the client in the high-Fowler’s position.
Putting the client in the high-Fowler’s position will decrease cerebral blood flow, decreasing hypertension. Sitting the patient upright and removing any tight clothing or constrictive devices will orthostatically help lower blood pressure by inducing pooling of blood in the abdominal and lower extremity vessels as well as removing any possible stimuli.
The nurse is assigned to care for a patient scheduled to undergo a lumbar puncture. Which of the following signs or symptoms, if present in the patient’s chart, would prompt the nurse to question the order?
A. Grand mal seizures
B. Brain tumor
C. Midline shift on CT scan
D. Shingles outbreak in the right axilla
C. Midline shift on CT scan
A midline shift on CT scan indicates increased intracranial pressure. The midline shift could be worsened by a lumbar puncture (LP) and cause brain herniation. Grand mal seizures and a brain tumor are indications, not contraindications, for a lumbar puncture. Infected skin at the LP needle insertion site is an absolute contraindication, but infection on distant areas of skin is not.
The nurse is caring for a patient with Alzheimer disease (AD). The patient is able to speak and hear, but is unable to understand what is being said to him. Which term does the nurse use to document this finding?
A. Apraxia
B. Aphasia
C. Anomia
D. Acalculia
B. Aphasia
This patient has aphasia, namely the inability to understand speech, although he is able to hear and speak. This can be a finding in a degenerative brain disease like AD. Specifically, he has a Wernicke’s aphasia. The inability to produce speech is also a form of aphasia called Broca’s aphasia. Apraxia is the inability to use tools appropriately. Anomia is the inability to name objects properly. Acalculia is the inability to perform simple arithmetic calculations.
The nurse is caring for a patient who sustained a C4 spinal cord injury one year ago. This patient is most likely at risk for which of the following pulmonary complications?
1. Pneumonia
2. Dry, hacking cough
3. Bronchoconstriction
4. Kussmaul Respirations
1. Pneumonia
Individuals with a spinal cord injury from C3-C6 have a weak, ineffective cough reflex, which puts them at risk for aspiration pneumonia. They do not have a dry, hacking cough due to suppression of their cough reflex. Bronchoconstriction is associated with asthma; there is no indication this patient has asthma. Kussmaul respirations are deep, rapid respirations associated with acidosis, which is much less likely than aspiration pneumonia.
The nurse is ordered to administer Lorazepam to a patient experiencing status epilepticus. As a precautionary measure, the nurse will also have what reversal agent on standby?
A. Narcan
B. Flumazenil
C. Calcium Chloride
D. Idarucizumab
B. Flumazenil
Flumazenil is the reversal agent for Lorazepam, which is a benzodiazepine.
A client is receiving valproic acid for seizure control. Which laboratory parameters should the nurse monitor closely to detect serious adverse effects associated with this drug?
A. Serum creatinine and blood urea nitrogen (BUN).
B. Serum sodium and potassium levels.
C. White blood cell count and differential only.
D. Liver function tests (AST, ALT) and platelet count.
D. Liver function tests (AST, ALT) and platelet count.
Valproic acid carries risks for fatal hepatotoxicity and thrombocytopenia (low platelets), requiring vigilant monitoring of liver enzymes and coagulation/platelet profiles.