1
modifiable risk factor for TIA's & CVAS
smoking
A client presents to the emergency department stating numbness and tingling occurring down the left leg into the left foot. When documenting the experience, which medical terminology would the nurse be most correct to report?
parethesia
The nurse is caring for a client with a head injury after a fall from a hayloft. What indicates the presence of/leaking of cerebral spinal fluid (CSF)?
HALO sign
paraplegia
unable to move lower legs
The nurse is providing health education to a client who has a C6 spinal cord injury. The client asks why autonomic dysreflexia is considered an emergency. You respond:
the sudden increase in BP can raise the ICP or rupture a cerebral blood vessel.”
A client presents to the walk-in clinic complaining of a migraine. The client is prescribed an antileptic. What should the nurse suggest to the client?
use caution/driving hazards
The nurse is evaluating the transmission of a report from a paramedic unit to the emergency room. The medic reports that a client is unconscious with edema of the head and face and Battle's sign. What clinical picture would the nurse anticipate?
bruising at mastoid process
A client with MS has developed dysphagia as a result of cranial nerve dysfunction. What nursing action should the nurse consequently perform?
position upright when eating
A client diagnosed with migraine headaches asks the nurse what he can do to help control the headaches and minimize the number of attacks he is having. What instructions should the nurse give this client?
avoid triggers
A client who has experienced an initial transient ischemic attack (TIA) states: “I'm glad it wasn't anything serious.” Which is the best nursing response to this statement?
TIAS are a warning sign to an impending CVA
Which nursing assessment finding is most indicative of a hemorrhagic stroke?
breathing alterations/BP/heart rate .
SUDDEN ONSET
A client has been diagnosed with a frontal lobe brain abscess. Which nursing intervention is appropriate?
seizure precautions
A client is admitted with weakness, expressive aphasia, and right hemianopia. The brain MRI reveals an infarct. The nurse understands these symptoms to be suggestive of which of the following findings?
Left sided CVA
The client with a cerebral aneurysm asks the nurse, “What's the big fuss over a headache?” Which is the best response from the nurse regarding to a cerebral aneurysm?
its all about location/condition of aneurysm.
While the nurse is making initial rounds after coming on shift, a client thrashes about in bed complaining of a severe headache. The client tells the nurse the pain is behind the right eye, which is red and tearing. What type of headache would the nurse suspect this client of having?
cluster headache
The nurse initiates a teaching plan for the family and client with neurological deficits because of Parkinson's disease. What nursing instruction is the highest priority?
The nurse is caring for a client who was discovering unconscious after falling off a ladder. The client is diagnosed with a concussion. All testing is normal, and discharge instructions are compiled. Which instructions have been compiled for the spouse?
monitor behavior changes
The nurse is caring for a client immediately after a spinal cord injury. Which assessment finding is essential when caring for a client in spinal shock with injury in the lower thoracic region?
blood pressure/pulse (respiratory not concern=THORACIC)
What phase of a neurologic deficit begins when the client's condition is stabilized?
Recovery
A client who complains of recurring headaches, accompanied by increased irritability, photophobia, and fatigue is asked to track the headache symptoms and occurrence on a calendar log. Which is the best nursing rationale for this action?
migraines coincide with menstrual cycle