NUR 320: Intracranial Exam Questions And
Answers 100% Pass
A client with a seizure disorder is receiving phenytoin and phenobarbital. What client statement
indicates that the instructions regarding the medications are understood? - ANS "Stopping
the drugs can cause continuous seizures and I may die."
Which information should be included in the teaching plan for the client diagnosed with
epilepsy? - ANS People taking phenytoin must floss regularly.
Rational: Gingival hyperplasia is a common side effect of phenytoin
A client has a tonic-clonic seizure. Which is the priority nursing intervention during the tonic-
clonic stage of the seizure? - ANS Protect the client from injury
A client is admitted to the hospital after having a tonic-clonic seizure and is diagnosed with a
seizure disorder. Which is most important for the nurse to include in a teaching program? -
ANS Explain ways to prevent physical trauma from occurring during a seizure.
A 2-year-old toddler is admitted to the pediatric unit with a diagnosis of bacterial meningitis.
What is the most important safety measure for the nurse to institute immediately after the
child has a seizure? - ANS Placing the child in the side-lying position
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A client has a tonic-clonic seizure at work and is admitted to the emergency department. Which
question is most useful when planning nursing care related to the client's seizure? -
ANS "Were you aware of anything different or unusual just before your seizure began?"
Rationale: Identification of a sensation that occurs before each seizure (aura) is helpful in
identifying the cause of the seizure and planning how to identify and avoid a future seizure.
Warfarin is prescribed for the client who takes phenytoin for a seizure disorder. Why must the
nurse observe the client closely during the initial days of treatment with warfarin? -
ANS Warfarin affects the metabolism of phenytoin.
What action should the nurse take when caring for a client who has a possible skull fracture as a
result of trauma? - ANS Monitor the client for signs of brain injury.
A client is admitted to the hospital with a head injury sustained while playing soccer. For which
early sign of increased intracranial pressure should the nurse monitor this client? -
ANS Lethargy
A nurse should plan to maintain a client who has experienced a subarachnoid hemorrhage in
what position? - ANS In bed with the head of the bed elevated
Rationale: With the head of the bed elevated, the force of gravity helps prevent additional
intracranial pressure, which will intensify the ischemic manifestations of hemorrhage.
A nurse is caring for a client who had a traumatic brain injury with increased intracranial
pressure. Which healthcare provider prescription should the nurse question? - ANS Teach
isometric exercises
Rationale: The prescription for isometric exercises should be questioned; isometric exercises
increase the basal metabolic rate and intracranial pressure.