NURSING NUR 305 ATI Medical/Surgical Neurosensory AH1 Exam Questions And Answers Graded A+ Assured Success New Update 2022/2023 with rationales

ATI Medical/Surgical Neurosensory AH1 A nurse is collecting data from a client who has a brain tumor. Which of the following indicates cranial nerve involvement? A. Dysphagia B. Positive Babinski sign C. Decreased deep-tendon reflexes D. Ataxia Rationale: Dysphagia, or difficulty swallowing, can occur as a result of damage to cranial nerves IX (glossopharyngeal) or X (vagus). A positive Babinski sign, or the turning up of the toes upon plantar stimulation, is associated with an upper motor neuron lesion. The cranial nerves primarily innervate the face, neck, and a few organs. Decreased deep-tendon reflexes indicate impairment in the electrical conduction of spinal nerves that interfere with reflex arcs. The cranial nerves primarily innervate the face, neck, and a few organs. Ataxia, or uncoordinated movements of the extremities, can indicate damage to the cerebellum or motor pathways. The cranial nerves primarily innervate the face, neck, and a few organs. A nurse in a acute care facility is preparing to admit a client who has myasthenia gravis. Which of the following suppliesshould the nurse place on the client's bedside? A. Metered-dose inhaler B. Continuous passive motion machine C. External defibrillator pads D. Oral-nasalsuction equipment Rationale: The client who has myasthenia gravis is at risk for aspiration because of progressiveweakness of the oropharyngeal muscles. Myasthenia gravis causes muscle weakness due to anautoimmune disease that affects the acetylcholine receptors. The nurse should place oxygen and oral-nasal suction equipment at the bedside in the event of aspiration or respiratory distress. External defibrillator pads are used for a client who has a cardiac dysrhythmia; however, they are not indicated for aclient who has myasthenia gravis. A continuous passive motion machine is used to provide continuous motion of a joint for a client who is postoperative following joint surgery; however, it is not indicated for a client who has NURSING NUR 305 ATI Medical/Surgical Neurosensory AH1 Exam Questions And Answers Graded A+ Assured Success New Update 2022/2023 with rationales myasthenia gravis. A metered-dose inhaler is used to administer medications for a client who has asthma; however, it is not indicated for a client who has myasthenia gravis. NURSING NUR 305 ATI Medical/Surgical Neurosensory AH1 Exam Questions And Answers Graded A+ Assured Success New Update 2022/2023 with rationales A nurse is collecting data from a client who has Guillain-Barre syndrome. Which of the following findings should the nurseexpect? A. Tonic-Clonic seizures B. Report of a severe headache C. Weakness of the lower extremities D. Decreased level of consciousness Rationale: Guillain-Barré syndrome, also called acute inflammatory demyelinating polyneuropathy, is an inflammatory disorder of the peripheral nerves. It is characterized by the rapid onset of ascending weakness and paralysis, starting at the lower extremities, and can advance to the upper extremities. Guillain-Barré syndrome is an inflammatory disorder of the peripheral nerves. Decreased level of consciousness is not a manifestation of Guillain-Barré syndrome. Guillain-Barré syndrome is an inflammatory disorder of the peripheral nerves. Severe headaches are not a manifestation of Guillain-Barré syndrome. Guillain-Barré syndrome is an inflammatory disorder of the peripheral nerves. Tonic-clonic seizures are not a manifestation of Guillain-Barré syndrome. A nurse is collecting data from a client who has a high-thoracic spinal cord injury. Thenurse should identify which of thefollowing findings as a manifestation of autonomic dysreflexia? A. Flushing of the lower extremities B. Hypotension C. Tachycardia D. Report of a headache Rationale: Autonomic dysreflexia is a neurologic emergency that can occur in clients who have a cervical or thoracic spinal cord injury above the level of T6. Autonomic dysreflexia can be triggered by a full bladder or distended rectum. Manifestations include a severe, throbbing headache; flushing of the face and neck; bradycardia; and extreme hypertension. Autonomic dysreflexia is a neurologic emergency that occurs in clients who have a cervical or thoracic spinal cord injury above the level of T6. Manifestations include bradycardia but not tachycardia.Autonomic dysreflexia is a neurologic emergency that occurs in clients who have a cervical or thoracic spinal cord injury above the level of T6. Manifestations include hypertension but not NURSING NUR 305 ATI Medical/Surgical Neurosensory AH1 Exam Questions And Answers Graded A+ Assured Success New Update 2022/2023 with rationales hypotension. Autonomic dysreflexia is a neurologic emergency that can occur in clients who have a cervical or thoracic spinal cord injury above the level of T6. Manifestations include flushing above the level of injury and pallor below the level of injury. A nurse is reinforcing teaching with a group of client's about transient ischemic attacks (TIAs). Which of the followinginformation should the nurse include in the teaching? A. A TIA can cause irreversible hemiparesis. B. A TIA can be the result of cerebral bleeding. C. A TIA can cause cerebral edema. D. A TIA can precede an ischemic stroke. Rationale: TIAs are considered a manifestation of advanced atherosclerotic disease and often precede an ischemic stroke. Manifestations of a TIA include loss of vision in one eye, inability to speak, transient hemiparesis, vertigo, diplopia, numbness, and weakness. TIAs do not produce edema of the cerebrum. Cerebral edema can be the result of a stroke. A hemorrhagic stroke can be the result of cerebral bleeding. TIAs are caused by a temporary reduction of oxygen supply to the brain, such as from a thromboembolism or cerebral vasospasm. TIAs are brief episodes of a neurologic deficit that last less than 24 hr after onset without any permanentdisabilities. A nurse is reinforcing teaching with a client who has a new diagnosis of Meineres disease. Which of the followinginstructions should the nurse include in the teaching? A. Avoid bearing down B. Increase caffeine intake C. Avoid sudden movements D. Increase sodium intake Rationale: Meniere’s disease is a disorder of the inner ear affecting balance and hearing, characterized by vertigo, hearing loss, and tinnitus. The nurse should instruct the client to avoidsudden movements that can increase manifestations. The nurse should instruct the client to reduce sodium intake and drink an evenly distributed amount of fluids throughout the day to stabilize fluid levels in the body. The nurse should instruct the client to avoid caffeine and drink an evenly distributed amount of fluids throughout the day to stabilize fluid levels in the body. Bearing down, or using the Valsalva maneuver, does not increase the manifestations ofMeniere’s disease. A nurse is caring for a client who has a traumatic brain injury and assumes a decerebrate NURSING NUR 305 ATI Medical/Surgical Neurosensory AH1 Exam Questions And Answers Graded A+ Assured Success New Update 2022/2023 with rationales posture in response to noxiousstimuli. Which of the following reactions should the nurse anticipate when drawing a blood sample? A. The client rigidly extends his arms. B. The client internally flexes his wrists. C. The client curls into a fetal position. D. The client internally rotates his legs. Rationale: A client who exhibits a decerebrate posture rigidly extends and pronates his four extremities and externally rotates his wrists. Decerebrate posturing indicates severe brain stem injury and late neurologic decline. A client who exhibits decorticate posturing internally flexes his wrists and arms and extends and plantar flexes his legs. A fetal position is not a manifestation NURSING NUR 305 ATI Medical/Surgical Neurosensory AH1 Exam Questions And Answers Graded A+ Assured Success New Update 2022/2023 with rationales of a decerebrate posture. A client who exhibits decorticate posturing flexes his arms with internal rotation of the forearms and extends and plantar flexes his legs. A nurse is collecting data from a client who has a new diagnosis of mastoiditis. Which of the following manifestationsshould the nurse expect? A. Swelling behind the affected ear B. Facial drooping on the affected side C. Nystagmus on the affected side D. Pearly gray color of the affected eardrum Rationale: Mastoiditis refers to an inflammation of the temporal bone behind the ear. Manifestations of mastoiditis include swelling and pain behind the ear. Facial drooping can be a manifestation of a tympanoplasty, but it is not a manifestation of mastoiditis. Bilateral nystagmus can be a manifestation of labyrinthitis, but it is not a manifestation of mastoiditis. A pearly gray eardrum is an expected finding of a healthy eardrum. A red, thick eardrum is a manifestation of mastoiditis