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MEDICAL NEUROLOGICAL DISORDERS (NCLEX) QUESTIONS AND ANSWERS ACCURATE AND VERIFIED.
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MEDICAL NEUROLOGICAL DISORDERS (NCLEX) QUESTIONS AND ANSWERS ACCURATE AND VERIFIED.
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MEDICAL NEUROLOGICAL DISORDERS(NCLEX) QUESTIONS AND ANSWERS
ACCURATE AND VERIFIED.
A client admitted to the hospital with a subarachnoid hemorrhage has
complaints of severe headache, nuchal rigidity, and projectile vomiting. The
nurse knows lumbar puncture (LP) would be contraindicated in this client in
which of the following circumstances?
A. Vomiting continues.
B. Intracranial pressure (ICP) is increased.
C. The client needs mechanical ventilation.
D. Blood is anticipated in the cerebrospinal fluid (CSF).
B.
Sudden removal of CSF results in pressures lower in the lumbar area than the
brain and favours herniation of the brain; therefore, LP is contraindicated with
increased ICP.
A client with a subdural hematoma becomes restless and confused, with
dilation of the ipsilateral pupil. The physician orders mannitol for which of
the following reasons?
A. To reduce intraocular pressure.
B. To prevent acute tubular necrosis.
C. To promote osmotic diuresis to decrease ICP.
D. To draw water into the vascular system to increase blood pressure.
C.
Mannitol promotes osmotic diuresis by increasing the pressure gradient,
drawing fluid from intracellular to intravascular spaces. Although mannitol is
used for all the reasons described, the reduction of ICP in this client is a
,concern. The mannitol causes the cells in the brain to dehydrate mildly. The
water inside the brain cells (intracellular water) leaves the cells and enters the
bloodstream as the mannitol draws it out of the cells and into the bloodstream.
Once in the bloodstream, the extra water is whisked out of the skull. When the
mannitol gets to the kidneys, the kidneys filter the mannitol into the urine.
A client with subdural hematoma was given mannitol to decrease
intracranial pressure (ICP). Which of the following results would best show
the mannitol was effective?
A. Urine output increases.
B. Pupils are 8 mm and nonreactive.
C. Systolic blood pressure remains at 150 mm Hg.
D. BUN and creatinine levels return to normal.
A.
Mannitol promotes osmotic diuresis by increasing the pressure gradient in the
renal tubes. The mannitol causes the cells in the brain to dehydrate mildly. The
water inside the brain cells (intracellular water) leaves the cells and enters the
bloodstream as the mannitol draws it out of the cells and into the bloodstream.
Once in the bloodstream, the extra water is whisked out of the skull. When the
mannitol gets to the kidneys, the kidneys filter the mannitol into the urine.
Which of the following values is considered normal for ICP?
A. 0 to 15 mm Hg
B. 25 mm Hg
C. 35 to 45 mm Hg
D. 120/80 mm Hg
A.
Normal ICP is 0-15 mm Hg. Intracranial hypertension (IH) is a clinical condition
that is associated with an elevation of the pressures within the cranium. The
pressure in the cranial vault is measured in millimeters of mercury (mm Hg)
and is normally less than 20 mm Hg.
,Which of the following symptoms may occur with a phenytoin level of 32
mg/dl?
A. Ataxia and confusion
B. Sodium depletion
C. Tonic-clonic seizure
D. Urinary incontinence
A.
A therapeutic phenytoin level is 10 to 20 mg/dl. A level of 32 mg/dl indicates
toxicity. Symptoms of toxicity include confusion and ataxia. The neurotoxic
effects are concentration dependent and can range from mild nystagmus to
ataxia, slurred speech, vomiting, lethargy and eventually coma and death.
Paradoxically, at very high concentrations, phenytoin can lead to seizures.
Which of the following signs and symptoms of increased ICP after head
trauma would appear first?
A. Bradycardia
B. Large amounts of very dilute urine
C. Restlessness and confusion
D. Widened pulse pressure
C.
The earliest symptom of elevated ICP is a change in mental status. Following
the neurological exam closely is very important. Usually, there is an altered
mental status and development of a fixed and dilated pupil. Patients presenting
with findings suggestive of cerebral insult should undergo computed
tomography (CT) scan of the brain; this can show the edema, which is visible as
areas of low density and loss of gray/white matter differentiation, on an
unenhanced image.
Problems with memory and learning would relate to which of the following
lobes?
, A. Frontal
B. Occipital
C. Parietal
D. Temporal
D.
The temporal lobe functions to regulate memory and learning problems
because of the integration of the hippocampus. The hippocampus is
responsible for creating declarative memories-those that can be consciously
thought of and verbalized. Declarative memory can be episodic and semantic.
Episodic memory is the ability to remember a specific occasion in the past in
its specific time and place. Meanwhile, semantic memory is the ability to recall
general facts about the world.
Regular oral hygiene is an essential intervention for a client who has had a
stroke. Which of the following nursing measures is inappropriate when
providing oral hygiene?
A. Placing the client on the back with a small pillow under the head.
B. Keeping portable suctioning equipment at the bedside.
C. Opening the client's mouth with a padded tongue blade.
D. Cleaning the client's mouth and teeth with a toothbrush.
A.
client should be positioned on the side, not on the back. This lateral position
helps secretions escape from the throat and mouth, minimizing the risk of
aspiration.
A 78-year-old client is admitted to the emergency department with
numbness and weakness of the left arm and slurred speech. Which nursing
intervention is a priority?
A. Prepare to administer recombinant tissue plasminogen activator (rt-PA).
B. Discuss the precipitating factors that caused the symptoms.
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