MDC 4 EXAM 1 REVIEW A AND B
COMBINED QUESTIONS & CORRECT
PASSED ANSWERS
1. A client has been in a MVC and presents with signs and symptoms of increased
intracranial pressure. What is the most significant sign or symptoms in increased ICP?
a. Pupil changes
b. Ipsilateral paralysis
c. Vomiting
d. Decrease in LOC
D
2. A client has recently suffered a stroke with left-sided weakness. A nurse assesses for
dysphagia, especially with thin liquids. Which nursing intervention is most helpful in
assessing this client to swallow safely?
a. The client should avoid all liquids
b. Instructing to tuck the chin when swallowing
c. Give sips of water with each bite
d. Turn head to the left
B
3. A nurse assesses a 27 y.o. female client who presents with muscle weakness and
decreased muscle coordination over the past few months. What nervous system
disease is she most likely suffering from?
a. Systemic lupus erythematous
b. Multiple sclerosis
c. Guillain-Barre syndrome
d. Myasthenia gravis
B
4. During an assessment of a recent seizure client, the nurse interprets which finding is
congruent with the postictal state?
a. The clients motor function is returning to baseline
b. The client states there is a visible aura
c. The client has brief jerking of the extremities
d. The client O2 saturation is 80%
A
5. The client has a head injury and is presenting with signs and symptoms of increased
ICP. Which nursing intervention would be helpful in reducing this pressure?
a. Place the neck in a neutral position to promote venous drainage
b. Suction hourly to stimulate the cough reflex
c. Add extra blankets to keep the client warm
d. Turn the client frequently to prevent skin impairment
A
, 6. A client injured in an MVA is being evaluated at the emergency department for a
possible head injury. Which test should NOT be done if there is indication of increased
ICP?
a. CT Scan
b. MRI Scan
c. Lumbar Puncture
d. Electroencephalogram
C
7. The nurse is obtaining a health history for a 45-year-old woman with Guillain-Barré
syndrome (GBS). Which statement by the client does the nurse correlate with the
client's diagnosis?
a. "I have a history of a cardiac dysrhythmia.
b. "I just got over the flu a couple of weeks ago, and now this."
c. "My neighbor also has Guillain-Barré syndrome."
d. "I am an artist and work with oil paints."
B
8. A client arrives in the emergency department with an ischemic stroke. Because the
healthcare team is considering administering tissue plasminogen activator (t-PA), what
should the nurse perform first?
a. Ask what medications the client is taking
b. Complete the history and health assessment
c. Identify the time of onset of the stroke
Determine if the client is scheduled for any surgical procedures
C
9. During the first 24 hours after thrombolytic treatment for an ischemic stroke, the
nurse's primary goal is to control which of the following vital signs?
a. Pulse
b. Respirations
c. Blood pressure
d. Temperature
C
10. The nurse is educating a client on the types of anesthesia used in surgery. Which
client statement indicates a correct understanding?
a. "I am having general anesthesia, so I will be given a gas to breathe and medication in
my IV."
b. "I may still be aware of what's happening with general anesthesia.
c. "An epidural is used for general anesthesia
d. "When I had my skin cancer removed on my leg, the doctor used general anesthesia
to numb the area."
A
11. A client with new-onset status epileptics is prescribed phenytoin. After teaching the
client about this treatment regimen, the nurse assesses the client's understanding.
Which statement indicates that the client understands the teaching?
a. "I must drink at least 2 liters of water daily."
b. "This will stop me from getting an aura before a seizure."
COMBINED QUESTIONS & CORRECT
PASSED ANSWERS
1. A client has been in a MVC and presents with signs and symptoms of increased
intracranial pressure. What is the most significant sign or symptoms in increased ICP?
a. Pupil changes
b. Ipsilateral paralysis
c. Vomiting
d. Decrease in LOC
D
2. A client has recently suffered a stroke with left-sided weakness. A nurse assesses for
dysphagia, especially with thin liquids. Which nursing intervention is most helpful in
assessing this client to swallow safely?
a. The client should avoid all liquids
b. Instructing to tuck the chin when swallowing
c. Give sips of water with each bite
d. Turn head to the left
B
3. A nurse assesses a 27 y.o. female client who presents with muscle weakness and
decreased muscle coordination over the past few months. What nervous system
disease is she most likely suffering from?
a. Systemic lupus erythematous
b. Multiple sclerosis
c. Guillain-Barre syndrome
d. Myasthenia gravis
B
4. During an assessment of a recent seizure client, the nurse interprets which finding is
congruent with the postictal state?
a. The clients motor function is returning to baseline
b. The client states there is a visible aura
c. The client has brief jerking of the extremities
d. The client O2 saturation is 80%
A
5. The client has a head injury and is presenting with signs and symptoms of increased
ICP. Which nursing intervention would be helpful in reducing this pressure?
a. Place the neck in a neutral position to promote venous drainage
b. Suction hourly to stimulate the cough reflex
c. Add extra blankets to keep the client warm
d. Turn the client frequently to prevent skin impairment
A
, 6. A client injured in an MVA is being evaluated at the emergency department for a
possible head injury. Which test should NOT be done if there is indication of increased
ICP?
a. CT Scan
b. MRI Scan
c. Lumbar Puncture
d. Electroencephalogram
C
7. The nurse is obtaining a health history for a 45-year-old woman with Guillain-Barré
syndrome (GBS). Which statement by the client does the nurse correlate with the
client's diagnosis?
a. "I have a history of a cardiac dysrhythmia.
b. "I just got over the flu a couple of weeks ago, and now this."
c. "My neighbor also has Guillain-Barré syndrome."
d. "I am an artist and work with oil paints."
B
8. A client arrives in the emergency department with an ischemic stroke. Because the
healthcare team is considering administering tissue plasminogen activator (t-PA), what
should the nurse perform first?
a. Ask what medications the client is taking
b. Complete the history and health assessment
c. Identify the time of onset of the stroke
Determine if the client is scheduled for any surgical procedures
C
9. During the first 24 hours after thrombolytic treatment for an ischemic stroke, the
nurse's primary goal is to control which of the following vital signs?
a. Pulse
b. Respirations
c. Blood pressure
d. Temperature
C
10. The nurse is educating a client on the types of anesthesia used in surgery. Which
client statement indicates a correct understanding?
a. "I am having general anesthesia, so I will be given a gas to breathe and medication in
my IV."
b. "I may still be aware of what's happening with general anesthesia.
c. "An epidural is used for general anesthesia
d. "When I had my skin cancer removed on my leg, the doctor used general anesthesia
to numb the area."
A
11. A client with new-onset status epileptics is prescribed phenytoin. After teaching the
client about this treatment regimen, the nurse assesses the client's understanding.
Which statement indicates that the client understands the teaching?
a. "I must drink at least 2 liters of water daily."
b. "This will stop me from getting an aura before a seizure."
