NUR 211 Neuro Practice Questions with Correct Answers Latest Updates

NUR 211 Neuro Practice Questions with Correct Answers Latest Updates Michael is a 24 year old man who presents with a 6 hour history of sudden onset of inability to raise his eyebrow or smile on the right side. He also reports decreased lacrimation in the right eye and difficulty closing the right eyelid. The rest of his health history and physical exam is otherwise unremarkable. This likely represents paralysis of cranial nerve (CN): III, VII, IV, VII - Answer: d (KNOW HOW TO ASSESS ALL CRANIAL NERVES) The nurse is evaluates the client who is being treated for DKA. Which finding indicates that the client is responding to the treatment plan? Eyes sunken and skin flushed, Skin moist with rapid elastic recoil, Serum potassium level is 3.3 mEq/L, ABG results are pH 7.25, Paco2 30, HCO3 17 - Answer: b - these are signs that the patient is well hydrated A - incorrect - s/sx of dehydration C - incorrect - hypokalemia D - incorrect - you might see these ABG results in the DKA patient when they first present to the hospital The nurse is assess the client who has Type II Diabetes. Which findings indicate to the nurse that the client is experiencing HHNS? Select all that apply Serum osmolality 364 mOsm/kg Blood glucose level 160 mg/dL Very dry mucous membranes Blood pressure of 90/42 mm Hg Urine output 500 mL past 8 hours - Answer: a, c & d Serum osmolality of 364 is elevated. The extremely high blood glucose levels in HHNS increase serum osmolality. Blood glucose levels for HHNS are usually over 600 mg/dL Persistent hyperglycemia in HHNS causes osmotic diuresis, a loss of water and electrolytes and extreme dehydration. Very dry mucous membranes are a sign of dehydration. Hypotension from the loss of water and electrolytes in HHNS Urine output of 500 mL in 8 hours is normal. Clients with HHNS experience polyuria. The client develops SIADH secondary to a pituitary tumor. The client's assessment findings include thirst, weight gain, fatigue, and a serum sodium of 127 mEq/L. Which intervention, if prescribed should the nurse implement to treat SIADH? Elevate the head of the bed 55 degrees Administer vasopressin IV Restrict fluids to 800-1000 mL per day Give 0.3% sodium chloride per IV infusion - Answer: c Incorrect - position client to promote venous return to the heart Incorrect - Vasopressin is an ADH and will aggravate the client's problem If symptoms are mild and hyponatremia is not severe, treatment includes fluid restriction to 800-1000 ml/day. Incorrect - Hypertonic saline should be reserved for treatment of severe hyponatremia The nurse is assessing the client with a tentative diagnosis of meningitis. Which findings should the nurse associate with meningitis? Select all that apply Nuchal rigidity Severe headache Pill rolling tremor Photophobia - Answer: a, b, d All answers are correct except pill-rolling tremors which are associated with Parkinson's disease. The nurse is caring for the client with a spinal cord injury at the C6 vertebrae. Which findings support the nurse's conclusion that the client may be experiencing autonomic dysreflexia? Select all that apply Blurred vision BP 198/102 Heart rate 150 bpm Extreme headache Sweaty face and arms - Answer: a, b, d, & e Blurred vision results from the HTN occurring with autonomic dysreflexia HTN is a symptom of autonomic dysreflexia from overstimulation of the SNS Bradycardia (not tachycardia) is a symptom of autonomic dysreflexia HA results from the HTN Sweating results from the sympathetic stimulation above the level of injury