Chapter 27: Neurologic Disorders
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. To what does the neural synapse refer?
a.
Length of time it takes for afferent neurons to carry impulses to the central nervous
system (CNS)
b.
Length of time it takes for efferent neurons to carry impulses to the motor neurons
c.
Space between the axons and the dendrites of a neuron
d.
Space between the axons of one neuron and the dendrites of the next
2. An older adult patient is experiencing extreme stress related to an admission to the hospital.
What should the nurse expect the patient to demonstrate?
a.
Decreased heart rate
b.
Decreased blood pressure (BP)
c.
Irregular respiration
d.
Dilation of the pupils
3. Which neurologic finding would be considered abnormal in an 88-year-old patient?
a.
Slow papillary response to light
b.
Jerky eye movements
c.
Dizziness and problems with balance
d.
Absence of the Achilles tendon jerk
4. What is the most reliable indicator of neurologic status?
a.
Blood pressure
b.
Pulse rate
c.
Temperature
d.
Level of consciousness
5. A patient is stuporous but reacts by withdrawing from painful stimuli. What term is most
appropriate for this patient?
a.
Comatose
b.
Lethargic
c.
Semicomatose
d.
Somnolent
6. Which describes the Babinski reflex?
a.
Downward curl of the toes
b.
Big toe bending upward
c.
Spreading out of the toes
d.
Pain in the big toe
7. What should the nurse assess for the when a patient is scheduled for an angiogram?
a.
Dizziness
b.
Allergy to shrimp
c.
Increased BP
d.
Irregular heartbeat
8. What diagnostic test might be contraindicate for a patient who has a pacemaker?
a.
Computed tomography (CT)
b.
Electromyography (EMG)
c.
Magnetic resonance imaging (MRI)
d.
Electroencephalography (EEG)
9. A patient with a severe head injury begins to assume a posture of flexed upper extremities,
with plantarflexed lower extremities. What do these assessments indicate?
a.
Increasing intracranial pressure (ICP) with decorticate posturing
b.
Decreasing ICP with decerebrate posturing
c.
Decreasing ICP with decorticate posturing
d.
Increasing ICP with decerebrate posturing
10. What should be immediately reported by the nurse caring for a 90-year-old patient with a
closed head injury?
a.
Blood pressure change from 147/72 to 176/70 mm Hg
b.
Respiration rate increase from 14 to 18 breaths/min
c.
Slow pupillary reaction bilaterally
d.
Temperature decrease from 100.2° F to 97.6° F
11. A patient with generalized convulsive disorder has a nursing diagnosis of “Deficient
knowledge, related to lack of information about the side effects of phenytoin (Dilantin).”
Which goal and outcome criteria would be most appropriate?
a.
Absence of gastrointestinal (GI) complaint; takes medication with food
b.
Stimulation of gingiva; brushes teeth vigorously to encourage gingival growth
c.
Maintenance of normal pattern of elimination; limits fluids and eats foods that
reduce diarrhea
d.
Maintenance of normal sleep pattern; reduces stimuli and takes warm baths to
induce drowsiness
12. A nurse is caring for a patient with meningitis who has a positive Brudzinski sign. Which
assessment led to this conclusion?
a.
Flexed hips when the neck is flexed by the nurse
b.
Inability to extend the flexed leg fully because of hamstring pain
c.
Resisting efforts of the nurse to flex his or her neck
d.
Flexing the big toe upward and fan out the other toes
13. Which assessment on a patient on mannitol therapy for cerebral edema indicates the
medication is effective in decreasing ICP?
a.
Increased BP
b.
Increased urinary output
c.
Decreased pulse
d.
Widening pulse pressure
14. What should a nurse instruct a patient after a lumbar puncture to prevent a headache?
a.
Lie flat.
b.
Lie on left side.
c.
Stay in semi-Fowler position.
d.
Ambulate in the room with assistance.
15. Which three symptoms are characteristic of Cushing triad associated with increased ICP?
a.
Hypotension, tachycardia, and narrowing pulse pressure
b.
Hypertension, tachycardia, and headache
c.
Widening pulse pressure, headache, and seizure
d.
Bradycardia, hypertension, and widening pulse pressure
16. A nurse is evaluating the goal of teaching for the nursing diagnosis of “Knowledge deficit,
related to conservation of energy in a patient with multiple sclerosis” (MS). Which statement
by the patient indicates a positive outcome?
a.
“Now that I am taking steroids, I will be able to work like I used to.”
b.
“I’m making a list of things that are important and things I will simply have to let
go.”
c.
“I will make a plan to allow for long rest periods at least four times a day.”
d.
“I am working on balancing time among rest, work, and family time.”
17. A patient in the emergency department states that she fell and hit her head and blacked out for
a while but became alert again. The nurse suspects an epidural hematoma. For what should the
nurse be diligent to assess?
a.
Headache
b.
Drowsiness
c.
Increasing respiration rate
d.
Vomiting
18. Which intervention should be added to the nursing care plan for supporting nutritional intake
in a patient with Parkinson disease?
a.
Offer large meals with a variety of finger foods.
b.
Thicken liquids to make them easier to swallow.
c.
Puree all foods and drink through a straw.
d.
Offer a diet high in carbohydrates and fat and low in protein.
19. A patient with Parkinson disease is depressed because his drug protocol of L-dopa and
Sinemet is no longer controlling his symptoms. What is the best response by the nurse?
a.
Other drugs can be combined with L-dopa to increase its effectiveness.
b.
The effect of these drugs has an uneven course; symptoms will begin to subside
again soon.
c.
The two drugs can be given in higher doses to control the symptoms.
d.
Surgical interventions have been very effective in the control of parkinsonian
symptoms.
20. A patient with Parkinson disease is considering taking St. John’s wort, an herbal remedy for
depression, in addition to Sinemet and L-dopa. What is the most appropriate nursing
response?
a.
Depression is reduced by the use of herbal remedies such as St. John’s wort.
b.
Doses of St. John’s wort and parkinsonian drugs should be taken on alternate days.
c.
St. John’s wort must be taken in large doses to reduce depression.
d.
Herbal remedies can interfere with the effectiveness of the parkinsonian drugs.
21. Which nursing assessment would indicate a need for suctioning a patient with Guillain-Barré
who is experiencing impaired breathing patterns because of neuromuscular failure?
a.
Decreased pulse rate and respiration of 20 breaths/min
b.
Increased pulse rate and adventitious breath sounds
c.
Increased pulse rate and respiration of 16 breaths/min
d.
Decreased pulse and abdominal breathing
22. A family member asks the nurse what would be an appropriate gift for a patient with
Parkinson disease. What is the most useful suggestion?
a.
Soft-soled house shoes
b.
Jigsaw puzzle
c.
Set of card games
d.
Satin sheets
23. What action should the nurse implement when a patient falls to the floor in a generalized
seizure?
a.
Cradle the head to prevent injury.
b.
Insert an object between the teeth to prevent the patient from biting the tongue.
c.
Manually restrain the limbs.
d.
Keep the patient on his or her back to prevent aspiration.
24. How can the nurse help reduce ICP in caring for the patient after a craniotomy?
a.
Keeping the patient flat in bed
b.
Elevating the head of the bed 30 degrees
c.
Closely monitoring the IV rate
d.
Turning the patient to the right side
25. Why is a patient with amyotrophic lateral sclerosis (ALS) uniquely prone to depression?
a.
Nutritional intake is poor.
b.
Intellectual capacity is not affected.
c.
Mobility is limited.
d.
Communication is altered.
26. A nurse is careful about limb position in caring for an unconscious patient who sustained a
head injury 10 days ago. What is the nurse trying to prevent?
a.
Flexion deformities
b.
Atrophy
c.
Paralysis
d.
Pathologic fracture
27. What should the nurse implement before giving an enteral feeding to a patient?
a.
Palpate the abdomen to check for residual feeding.
b.
Warm the feeding.
c.
Elevate the head of the bed 30 degrees.
d.
Ask the patient to tip his head forward.
MULTIPLE RESPONSE
28. Which neurotransmitters support smooth neural transmission? (Select all that apply.)
a.
Acetylcholine
b.
CSF
c.
Dopamine
d.
Dendrite
e.
Epinephrine
29. A nurse caring for an immobilized patient with a brain tumor stimulates the patient several
times a day with range-of-motion exercises and changes his position every 2 hours to try to
prevent a disuse syndrome. What signs and symptoms does disuse syndrome include? (Select
all that apply.)
a.
Pooling of pulmonary secretions
b.
Paralysis
c.
Muscle tremor
d.
Pressure ulcers
e.
Altered visual perceptions
30. Which are normal brain alterations associated with age? (Select all that apply.)
a.
Decrease in brain weight
b.
Pigmentation of brain with lipofuscin
c.
Present of amyloid
d.
Tiny clot formation
e.
Tangled nerve fibers
OTHER
31. The nurse assessing the level of consciousness in a patient will perform the following:
(Arrange in order from the simplest to the most complex. Separate letters by a comma and
space as follows: A, B, C, D.)
A. Apply pressure to the nail bed.
B. Shake the patient.
C. Touch the patient.
D. Call the patient’s name.
E. Approach the patient.
32. The nurse conducting a Romberg test will ask the patient to do what? (Arrange in the correct
sequence. Separate letters by a comma and space as follows: A, B, C, D.)
A. Touch his or her nose with the index finger with the eyes open.
B. Stand with eyes closed.
C. Touch his or her nose with the index finger with the eyes closed.
D. Touch his or her fingertip to nurse’s fingertip.
E. Pat the knees with the palms and then the back of the hands rapidly.