Neuro I
A patient is admitted with uncontrolled atrial fibrillation. The patient’s medication history includes vitamin D supplements and calcium. What type of stroke is this patient at MOST risk for?
A. Ischemic thrombosis
B. Ischemic embolism
C. Hemorrhagic
D. Ischemic stenosis
B. If a patient is in uncontrolled a-fib they are at risk for clot formation within the heart chambers. This clot can leave the heart and travel to the brain. Hence, an ischemic embolism type stroke can occur. An ischemic thrombosis type stroke is where a clot forms within the artery wall of the neck or brain
A patient with multiple sclerosis has issues with completely emptying the bladder. The physician orders the patient to take ___________, which will help with bladder emptying.
A. Bethanechol
B. Oxybutynin
C. Avonex
D. Amantadine
A. Bethanechol is a cholinergic medication that will help with bladder emptying.
A patient is prescribed Alendronate (Fosamax) at 0800 for the treatment of osteoporosis. As the nurse you know you must administer this medication:
A. on an empty stomach with a full glass of water and keep the patient upright for 30 minutes.
B. right after breakfast and to lay the patient flat (as tolerated) for 30 minutes.
C. with food but to avoid giving this medication with dairy products.
D. on an empty stomach with a full glass of juice or milk.
A. Alendronate (Fosamax) is a bisphosphonate which is known for causing GI upset, especially inflammation of the esophagus. These medications should be taken with a full glass of water in morning on empty stomach with NO other medication. The patient should sit up for 30 minutes (60 minutes with Boniva) after taking the medication, and not eat anything for 1 hour after taking (helps the body absorb more of the medicine.)
A client is diagnosed with multiple myeloma. The client asks the nurse about the diagnosis. The nurse bases the response on which of the following descriptions of this disorder?
A. Altered red blood cell production
B. Malignant proliferation of plasma cells and tumors within the bone
C. Altered production of lymph
D. Malignant exacerbation in the number of leukocytes
B. Multiple myeloma is a B cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow.
The nurse is caring for a patient with a new onset left sided facial droop and slurred speech. Which test should the nurse anticipate being ordered stat for this patient?
A) MRI of the Brain with IV contrast
B) PT/INR
C) CT Scan of the Brain without IV contrast
D) Chest Xray
C
Patients presenting with new onset stroke s/s must immediately have a CT brain without contrast to rule out the presence of a hemorrhagic stroke. Contrast is not used in order to expedite the imaging and to be inclusive of those with an allergy to IV contrast or iodine.
The nurse is caring for a patient that has just returned from having a lumbar puncture. Select all the correct nursing interventions for this patient: (Select all that apply)
A. Place the patient in lateral recumbent position.
B. Keep the patient flat.
C. Remind the patient to refrain from eating or drinking for 4 hours.
D. Encourage the patient to consume liquids regularly.
B and D.
The patient will need to stay flat after the procedure for a prescribed amount of time to prevent a headache, and the nurse will need to encourage the patient to drink fluids regularly to help replace the fluid lost during the lumbar puncture.
Which of the following statements about Parkinson’s related tremors is incorrect?
A. The tremors are most likely to occur with purposeful movements.
B. A common term used to describe the tremors in the hands and fingers is called “pill-rolling”.
C. Tremors are one of the most common signs and symptoms in Parkinson’s Disease.
D. Tremors in this disease can occur in the hands, fingers, arms, legs and even the lips and tongue.
A. This option is the only one that is INCORRECT. Tremors in Parkinson’s disease tend to occurs at rest and will actually improve with movement.
Which statement by a patient, who just received a cast on the right arm for a fracture, requires you to notify the physician immediately?
A. “It is really itchy inside my cast!”
B. “My pain is so severe that it hurts to stretch or elevate my arm.”
C. “I can feel my fingers and move them.”
D. “I’ve been using ice packs to reduce swelling.”
B. This statement is very concerning and may represent a condition called compartment syndrome. Compartment syndrome is where the nerves and blood vessels are becoming compromised due to increasing pressure in the compartments within the fascia (remember fascia doesn’t expand, so if there is building pressure within the compartments of muscle from bleeding etc. it will compromise circulation and nerve function). Remember to monitor the 6 P’s. (pain, pallor, paralysis, paresthesia, pulselessness (late sign), poikilothermia)
A client with leukemia has neutropenia. Which of the following functions must be frequently assessed?
A. Heart sounds
B. Bowel sounds
C. Breath sounds
D. Blood pressure
C. Breath sounds
Pneumonia, both viral and fungal, is a common cause of death in clients with neutropenia, so frequent assessment of respiratory rate and breath sounds is required.
Options A, B, and D: Although assessing blood pressure, bowel sounds, and heart sounds is important, it won’t help detect pneumonia.
The nurse is caring for a patient in the emergency room that has just been diagnosed with a hemorrhagic stroke. The nurse knows that the patient is not a candidate for which of the following medications?
A) Metoprolol (Lopressor)
B) tPA
C) Levitacirem (Keppra)
D) Enalapril (Vasotec
B – tPA
The medication t-PA is a “clot-busting” medication that is used to treat patients with ischemic stroke who meet stringent criteria. It is absolutely contraindicated in the presence of a hemorrhagic stroke as it will worsen the bleed and lead to a devastating outcome for the patient. Lopressor and Vasotec are prescribed to reduce blood pressure to prevent long-term damage from excessive shear stress and reduce the chance for complications of hypertension, such as intracerebral hemorrhage or secondary stroke. Keppra is prescribed for the patient experiencing or at high risk for post stroke seizures.
During nursing report you learn that the patient you will be caring for has Guillain-Barré Syndrome. As the nurse you know that this disease tends to present with:
A. signs and symptoms that are unilateral and descending that start in the lower extremities
B. signs and symptoms that are symmetrical and ascending that start in the upper extremities
C. signs and symptoms that are asymmetrical and ascending that start in the upper extremities
D. signs and symptoms that are symmetrical and ascending that start in the lower extremities
D. GBS signs and symptoms will most likely start in the lower extremities (ex: feet), be symmetrical, and will gradually spread upward (ascending) to the head. There are various forms of Guillain-Barré Syndrome. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is the most common type in the U.S. and this is how this syndrome tends to present.
Which clinical manifestations are included in a diagnosis of Parkinson’s disease? (Select all that apply)
A. Shuffling gait
B. Flaccidity
C. Tremor
D. Bradykinesia
E. Rigidity
A, C, D, E
A patient sustained a fracture to the femur. The patient has suddenly become confused, restless, and has a respiratory rate of 30 breaths per minute. Based on the location of fracture and the presenting symptoms, this patient may be experiencing what type of complication?
A. Compartment Syndrome
B. Osteomyelitis
C. Fat embolism
D. Hypovolemia
C. Patients who experience a fracture of the long bones (such as the femur) are at risk for a fat embolism. The patient will become confused and restless along with an abnormal respiratory status.
The nurse is caring for a client with suspected acute osteomyelitis. Which of the following are key features of this condition? (Select all that apply)
A. Temperature of 101.0 degrees or higher
B. Increased drainage from the affected area
C. Constant bone pain that increases with movement
D. Skin ulceration around the affected area
E. Increased swelling around the affected area
A, C, E
Options B and D are seen with chronic osteomyelitis rather than acute osteomyelitis
The nurse is performing a head-to-toe assessment on a patient with a spinal cord injury at T6. The patient is restless, diaphoretic, and extremely flushed. The nurse notes that the BP is 140/98 and HR is 52. The nurse notes this is a change from patient’s baseline BP of 106/76 and heart rate of 72. What action should the nurse take FIRST?
A. Reassess the patient’s blood pressure.
B. Check the patient’s blood glucose.
C. Position the patient at 90 degrees and lower the legs.
D. Provide cooling blankets for the patient
C. Based on the patient findings and how the patient has a spinal cord injury at T6, they are experiencing autonomic dysreflexia. Patients with this condition may have a blood pressure that is 20-40 mmHg higher than their baseline and may experience bradycardia (heart rate less than 60). The FIRST action the nurse should take when AD is suspected is to position the patient at 90 degree (high Fowler’s) and lower the legs. This will allow gravity to cause the blood to pool in the lower extremities and help decrease the blood pressure. Then the nurse should try to find the cause of the autonomic dysreflexia, which could be a full bladder, impacted bowel, or skin break down.
The nurse is caring for a patient with right side brain damage from a stroke. The nurse can expect the patient may exhibit which of the following symptoms (Select all that apply):
A. Right side hemiplegia
B. Confusion on date, time, and place
C. Aphasia
D. Unilateral neglect
E. Aware of limitations
F. Impulsive
G. Short attention span
H. Agraphia
B, D, F, and G.
Patients who have right side brain damage will have LEFT side hemiplegia (opposite side), confused on date, time, and place, unilateral neglect (left side neglect), DENIAL about limitations, be impulsive, and have a short attention span. Agraphia, right side hemiplegia, aware of limitations, and aphasia occur in a LEFT SIDE brain injury.
Mrs. Mendoza is a 75-year-old client who has dementia of the Alzheimer’s type and confabulates. The nurse understands that this client:
A. Denies confusion by being jovial
B. Pretends to be someone else
C. Rationalizes various behaviors
D. Fills in memory gaps with fantasy
D. Fills in memory gaps with fantasy.
Confabulation is a communication device used by patients with dementia to compensate for memory gaps. Confabulation is a type of memory error in which gaps in a person’s memory are unconsciously filled with fabricated, misinterpreted, or distorted information. When someone confabulates, they are confusing things they have imagined with real memories. A person who is confabulating is not lying. They are not making a conscious or intentional attempt to deceive. Rather, they are confident in the truth of their memories even when confronted with contradictory evidence.
Option A is denial. Option B is reaction formation. Option C is rationalization. All three of these are defense mechanisms that can be commonly seen in patients with Alzheimer’s disease.
A 5 year old has a fracture of the right upper arm. The x-ray showed that one side of the bone is bent while the other is broken. This known as a __________ fracture?
A. Spiral
B. Greenstick
C. Oblique
D. Transverse
B. This is a greenstick fracture. These types of fractures are more common in the pediatric population because their bones tend to be more flexible and the periosteum is stronger than an adult.
The nurse is admitting a client with a diagnosis of rule-out Hodgkin's lymphoma. Which assessment data support this diagnosis?
A. Night sweats and fever without chills.
B. Edematous lymph nodes in the groin.
C. Malaise and complaints of an upset stomach.
D. Pain in the neck area after a fatty meal
A Clients with Hodgkin's disease experience drenching diaphoresis, especially at night; fever without chills; and unintentional weight loss. Early-stage disease is indicated by a painless enlargement of a lymph node on one side of the neck (cervical area). Pruritus is also a common symptom.
The nurse is providing an in-service to a group of new nurse graduates on the causes of autonomic dysreflexia. Select all the most common causes the nurse will discuss during the in-service:
A. Hypoglycemia
B. Distended bladder
C. Sacral pressure injury
D. Fecal impaction
E. Urinary tract infection
B, C, D, and E.
Anything that can cause an irritating stimulus below the site of the spinal injury (T6 or higher) can lead to autonomic dysreflexia, which causes an exaggerated sympathetic reflex response and the parasympathetic system is unable to oppose it. This will lead to severe hypertension. The most common cause of AD is a bladder issue (full/distended bladder, urinary tract infection etc). Other common causes are due to a bowel issue like fecal impaction or skin break down (pressure injury/ulcer, cut, infection etc.).
Which of the below findings represents a positive Romberg Sign in a patient with multiple sclerosis?
A. The patient report dark spots in the visual fields during the confrontation visual field test.
B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth.
C. The patient’s sign and symptoms increase when expose to hot temperatures.
D. The patient reports an electric shock feeling when the head and neck are moved downward.
B. This is an example of a positive Romberg’s Sign.
Which of the following patients is at MOST risk for increased intracranial pressure?
A. A patient who is experiencing severe hypotension.
B. A patient who is admitted with a traumatic brain injury.
C. A patient who recently experienced a myocardial infarction.
D. A patient post-op from eye surgery.
B. Remember head trauma, cerebral hemorrhage, hematoma, hydrocephalus, tumor, encephalitis etc. can all increase ICP.
The nurse is caring for a patient with a right hip fracture. The patient is prescribed 5lb Buck's traction. Which of the following findings requires immediate intervention?
A. The 5lb weight is touching the floor.
B. The foam boot is completely strapped across the foot and shin of the affected extremity .
C. Patient uses the overhead trapeze bar to move around in the bed.
D. Patient’s extremities have a capillary refill of less than 2 seconds
A. Weights used for traction should freely hang WITHOUT TOUCHING THE FLOOR. All the other options are expected findings.
A patient’s complete blood count (CBC) results are back. Which result demonstrates polycythemia?
A. RBC 10 million
B. WBC 15,000
C. Platelets 600,000
D. RBC 2.5 million
A: Polycythemia is an increase in RBCs. Normal range for RBC 4.5-5.5 million.
A 25 year-old presents to the ER with unexplained paralysis from the hips downward. The patient explains that a few days ago her feet were feeling weird and she had trouble walking and now she is unable to move her lower extremities. The patient reports suffering an illness about 2 weeks ago, but has no other health history. The physician suspects Guillain-Barré Syndrome and orders some diagnostic tests. Which finding below during your assessment requires immediate nursing action?
A. The patient reports a headache.
B. The patient has a weak cough.
C. The patient has absent reflexes in the lower extremities.
D. The patient reports paresthesia in the upper extremities.
B. The patient’s signs and symptoms in this scenario are typical with Guillain-Barré Syndrome. The syndrome tends to start in the lower extremities (with paresthesia that will progress to paralysis) and migrate upward. The respiratory system can be affected leading to respiratory failure. Therefore, the nurse should assess for any signs and symptoms that the respiratory system may be compromised (ex: weak cough, shortness of breath, dyspnea…patient says it is hard to breath etc.). The nurse should immediately report this to the MD because the patient may need mechanical ventilation. Absent reflexes is common in GBS and paresthesia can extend to the upper extremities as the syndrome progresses. A headache is not common.