Neuro Practice Questions (GEE)

A nurse is caring for a patient who has had hip replacement. The nurse should be most concerned about which of the following findings? A. Complaints of pain during repositioning. B. Scant bloody discharge on the surgical dressing. C. Complaints of pain following physical therapy. D. Temperature of 101.8⁰ F (38.7⁰ C). Answer: D Rationale: Post-surgical nursing assessment after hip replacement should be principally concerned with the risk of neurovascular complications and the development of infection. A temperature of 101.8⁰ F (38.7⁰ C) postoperatively is higher than the low grade that is to be expected and should raise concern. Some pain during repositioning and following physical therapy is to be expected and can be managed with analgesics. A small amount of bloody drainage on the surgical dressing is a result of normal healing. Which patient should NOT be prescribed alendronate (Fosamax) for osteoporosis? A. A female patient being treated for high blood pressure with an ACE inhibitor. B. A patient who is allergic to iodine/shellfish. C. A patient on a calorie restricted diet. D. A patient on bed rest who must maintain a supine position Answer: D Rationale: Alendronate can cause significant gastrointestinal side effects, such as esophageal irritation, so it should not be taken if a patient must stay in supine position. It should be taken upon rising in the morning with 8 ounces of water on an empty stomach to increase absorption. The patient should not eat or drink for 30 minutes after administration and should not lie down. ACE inhibitors are not contraindicated with alendronate and there is no iodine allergy relationship An older patient with osteoarthritis is preparing for discharge. Which of the following information is correct? A. Increased physical activity and daily exercise will help decrease discomfort associated with the condition. B. Joint pain will diminish after a full night of rest. C. Nonsteroidal anti-inflammatory medications should be taken on an empty stomach. D. Acetaminophen (Tylenol) is a more effective anti-inflammatory than ibuprofen (Motrin). Answer: A Rationale: Physical activity and daily exercise can help to improve movement and decrease pain in osteoarthritis. Joint pain and stiffness are often at their worst during the early morning after several hours of decreased movement. Acetaminophen is a pain reliever, but does not have anti-inflammatory activity. Ibuprofen is a strong antiinflammatory, but should always be taken with food to avoid GI distress. A patient returns to the emergency department less than 24 hours after having a fiberglass cast applied for a fractured right radius. Which of the following patient complaints would cause the nurse to be concerned about impaired perfusion to the limb? A. Severe itching under the cast. B. Severe pain in the right shoulder. C. Severe pain in the right lower arm. D. Increased warmth in the fingers. Answer: C Rationale: Impaired perfusion to the right lower arm as a result of a closed cast may cause neurovascular compromise and severe pain, requiring immediate cast removal. Itching under the cast is common and fairly benign. Neurovascular compromise in the arm would not cause pain in the shoulder, as perfusion there would not be affected. Impaired perfusion would cause the fingers to be cool and pale. Increased warmth would indicate increased blood flow or infection. A nurse in the emergency department is observing a 24-year-old for signs of increased intracranial pressure after a fall from a bicycle, resulting in head trauma. Which of the following signs or symptoms would be cause for concern? A. Bruising under one eye. B. Repeated vomiting. C. Signs of sleepiness at 11 PM. D. Inability to read short words from a distance of 18 inches. Answer: B Rationale: Increased pressure caused by bleeding or swelling within the skull can damage delicate brain tissue and may become life threatening. Repeated vomiting can be an early sign of pressure as the vomit center within the medulla is stimulated. Bruising is expected after a fall. Blurred vision resulting from the head injury may take time to resolve. Sleepiness at 11 PM is not out of the ordinary. Thrombolytic therapy is frequently used in the treatment of suspected stroke. Which of the following is a significant complication associated with thrombolytic therapy? A. Air embolus B. Hemorrhage C. Hypotension D. Seizures Answer: B Rationale: Hemorrhage is a significant risk when treating a stroke victim with thrombolytic therapy intended to dissolve a suspected clot. Success of the treatment demands that it be instituted as soon as possible, often before the cause of stroke has been determined. Air embolus is not a concern. Thrombolytic therapy does not lead to hypotension or seizures. A patient is about to undergo a lumbar puncture and expresses fear and anxiety about the procedure. Which of the following is the most effective nursing response? A. Warn the patient to stay very still because the smallest movement will increase her pain. B. Encourage the family to stay in the room for the procedure. C. Stay with the patient and focus on slow, deep breathing for relaxation. D. Delay the procedure to allow the patient to deal with her feelings. Answer: C Rationale: Slow, deep breathing is the most effective method of reducing anxiety and stress. It reduces the level of carbon dioxide in the brain to increase calm and relaxation. Warning the patient to remain still will likely increase her anxiety. Encouraging family members to stay with the patient may make her worry about their anxiety as well as her own. Delaying the procedure is unlikely to allay her fears. A fifty-year-old blind and deaf patient has been admitted to your floor. As the charge nurse your primary responsibility for this patient is? A: Let others know about the patient’s deficits B: Communicate with your supervisor your concerns about the patient’s deficits. C: Continuously update the patient on the social environment. D: Provide a secure environment for the patient Answer: D Rationale: This patient’s safety is your primary concern. A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? A. "Do all your chores in the morning, when pain and stiffness are least pronounced." B. "Do all your chores after performing morning exercises to loosen up." C. "Pace yourself and rest frequently, especially after activities." D. "Do all your chores in the evening, when pain and stiffness are least pronounced.” Answer: C: Rationale: A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace herself during daily activities. A client is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease? Select all that apply. A. "It's common in females after menopause." B. "It's a degenerative disease characterized by a decrease in bone density." C. "It's a congenital disease caused by poor dietary intake of milk products. D. "It can cause pain and injury." E. "Passive range-of-motion exercises can promote bone growth." F. "Weight-bearing exercise should be avoided." Answer: A, B, D Rationale: Osteoporosis is a degenerative metabolic bone disorder in which the rate of bone resorption accelerates and the rate of bone formation decelerates, thus decreasing bone density. Postmenopausal women are at increased risk for this disorder because of the loss of estrogen. The decrease in bone density can cause pain and injury. Osteoporosis isn't a congenital disorder; however, low calcium intake does contribute to the disorder. Passive range-of-motion exercises may be performed but they won't promote bone growth. The client should be encouraged to participate in weight-bearing exercise because it promotes bone growth A client is diagnosed with gout. Which foods should the nurse instruct the client to avoid? Select all that apply. A. Green, leafy vegetables B. Liver C. Red wine D. Chocolate E. Sardines F. Eggs Answer: B, C, E Rationale: Clients with gout should avoid foods that are high in purines, such as liver, cod, and sardines. They should also avoid anchovies, kidneys, sweetbreads, lentils, and alcoholic beverages — especially beer and wine. Green, leafy vegetables; chocolate; and eggs aren't high in purines. A client who recently had a stroke requires a cane to ambulate. When teaching about cane use, explain that the reason for holding a cane on the uninvolved side is to: A. prevent leaning. B. distribute weight away from the involved side. C. maintain stride length D. prevent edema Answer: A Rationale: Holding a cane on the uninvolved side distributes weight away from the involved side. Holding the cane close to the body prevents leaning. Use of a cane won't maintain stride length or prevent edema. A client is preparing for discharge from the emergency department after sustaining an ankle sprain. The client is instructed to avoid weight bearing on the affected leg and is given crutches. After instruction, the client demonstrates proper crutch use in the hallway. What additional information is most important to know before discharging the client? A. Whether the client needs to navigate stairs routinely at home B. Whether pets are present in the home C. Whether the client parks his car on the street D. Whether the client drives a car with a stick shift Answer: A Rationale: Knowing whether the client must routinely navigate steps at home is most important. If the client must navigate steps, special crutch-walking techniques must be taught to safely navigate the stairs. The other choices can pose problems for the client; however, they aren't important to know before discharging the client with crutches. The nurse is teaching a client with a left fractured tibia how to walk with crutches. Which instruction is appropriate? A. "Use the axillae to help carry the weight." B. "All weight should be on the hands." C. "Keep feet apart to provide stability and a wide base of support." D. "Take long strides to maintain maximum mobility.” Answer: C Rationale: When using crutches, all weight should be on the hands. Constant pressure on the axillae from weight bearing can damage thebrachial plexus nerve and produce crutch paralysis. Feet should be 6″ to 8″ (15 to 20 cm) apart to provide stability and support. Short strides, not long ones, provide safety and maximum mobility.