Nervous System | Neurological Disorders NCLEX Quiz 52
All questions are shown, but the results will only be given after you’ve finished the quiz. You are given 1 minute per question, a total of 10 minutes in this quiz.
- 1.
A nurse is reviewing the record of a child with increased ICP and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child. the nurse would expect to note which of the following if this type of posturing was present?
- A.
Abnormal flexion of the upper extremities and extension of the lower extremities
- B.
Rigid extension and pronation of the arms and legs
- C.
Rigid pronation of all extremities
- D.
Flaccid paralysis of all extremities
Correct Answer
B. Rigid extension and pronation of the arms and legsExplanation
Decerebrate posturing is characterized by the rigid extension and pronation of the arms and legs.Rate this question:
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- 2.
Which of the following assessment data indicated nuchal rigidity?
- A.
Positive Kernig’s sign
- B.
Negative Brudzinski’s sign
- C.
Positive homan’s sign
- D.
Negative Kernig’s sign
Correct Answer
A. Positive Kernig’s signExplanation
A positive Kernig’s sign indicated nuchal rigidity. caused by an irritative lesion of the subarachnoid space. Brudzinski’s sign is also indicative of the condition.Rate this question:
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- 3.
Meningitis occurs as an extension of a variety of bacterial infections due to which of the following conditions?
- A.
Congenital anatomic abnormality of the meninges
- B.
Lack of acquired resistance to the various etiologic organisms
- C.
Occlusion or narrowing of the CSF pathway
- D.
Natural affinity of the CNS to certain pathogens
Correct Answer
B. Lack of acquired resistance to the various etiologic organismsExplanation
Extension of a variety of bacterial infections is a major causative factor of meningitis and occurs as a result of a lack of acquired resistance to the etiologic organisms. Preexisting CNS anomalies are factors that contribute to susceptibility.Rate this question:
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- 4.
Which of the following pathologic processes is often associated with aseptic meningitis?
- A.
Ischemic infarction of cerebral tissue
- B.
Childhood diseases of viral causation such as mumps
- C.
Brain abscesses caused by a variety of pyogenic organisms
- D.
Cerebral ventricular irritation from a traumatic brain injury
Correct Answer
A. Ischemic infarction of cerebral tissueExplanation
Aseptic meningitis is caused principally by viruses and is often associated with other diseases such as measles. mumps. herpes. and leukemia.Options A and C: Incidences of brain abscess are high in bacterial meningitis. and ischemic infarction of cerebral tissue can occur with tubercular meningitis.Option D: Traumatic brain injury could lead to bacterial (not viral) meningitis.Rate this question:
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- 5.
You are preparing to admit a patient with a seizure disorder. Which of the following actions can you delegate to LPN/LVN?
- A.
Complete admission assessment.
- B.
Set up oxygen and suction equipment.
- C.
Place a padded tongue blade at bedside.
- D.
Pad the side rails before patient arrives.
Correct Answer
B. Set up oxygen and suction equipment.Explanation
The LPN/LVN can set up the equipment for oxygen and suctioning. Focus: Delegation/supervision.Option A: The RN should perform the complete initial assessment.Option C: Tongue blades should not be at the bedside and should never be inserted into the patient’s mouth after a seizure begins.Option D: Padded side rails are controversial in terms of whether they actually provide safety and ay embarrass the patient and family.Rate this question:
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- 6.
If a male client experienced a cerebrovascular accident (CVA) that damaged the hypothalamus. the nurse would anticipate that the client has problems with:
- A.
Body temperature control.
- B.
Balance and equilibrium.
- C.
Visual acuity.
- D.
Thinking and reasoning.
Correct Answer
A. Body temperature control.Explanation
The body’s thermostat is located in the hypothalamus; therefore. injury to that area can cause problems of body temperature control.Option B: Balance and equilibrium problems are related to cerebellar damage.Option C: Visual acuity problems would occur following occipital or optic nerve injury.Option D: Thinking and reasoning problems are the result of injury to the cerebrum.Rate this question:
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- 7.
A female client admitted to an acute care facility after a car accident develops signs and symptoms of increased intracranial pressure (ICP). The client is intubated and placed on mechanical ventilation to help reduce ICP. To prevent a further rise in ICP caused by suctioning. the nurse anticipates administering which drug endotracheally before suctioning?
- A.
Phenytoin (Dilantin)
- B.
Mannitol (Osmitrol)
- C.
Lidocaine (Xylocaine)
- D.
Furosemide (Lasix)
Correct Answer
C. Lidocaine (Xylocaine)Explanation
Administering lidocaine via an endotracheal tube may minimize elevations in ICP caused by suctioning.Option A: Phenytoin doesn’t reduce ICP directly but may be used to abolish seizures. which can increase ICP. However. phenytoin isn’t administered endotracheally.Option B and D: Although mannitol and furosemide may be given to reduce ICP. they’re administered parenterally. not endotracheally.Rate this question:
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- 8.
After striking his head on a tree while falling from a ladder. a young man age 18 is admitted to the emergency department. He’s unconscious and his pupils are nonreactive. Which intervention would be the most dangerous for the client?
- A.
Give him a barbiturate.
- B.
Place him on mechanical ventilation.
- C.
Perform a lumbar puncture.
- D.
Elevate the head of his bed.
Correct Answer
C. Perform a lumbar puncture.Explanation
The client’s history and assessment suggest that he may have increased intracranial pressure (ICP). If this is the case. lumbar puncture shouldn’t be done because it can quickly decompress the central nervous system and. thereby. cause additional damage.Option A: After a head injury. barbiturates may be given to prevent seizures.Option B: Mechanical ventilation may be required if breathing deteriorates.Option D: Elevating the head of the bed may be used to reduce ICP.Rate this question:
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- 9.
When obtaining the health history from a male client with retinal detachment. the nurse expects the client to report:
- A.
Light flashes and floaters in front of the eye.
- B.
A recent driving accident while changing lanes.
- C.
Headaches. nausea. and redness of the eyes.
- D.
Frequent episodes of double vision.
Correct Answer
A. Light flashes and floaters in front of the eye.Explanation
The sudden appearance of light flashes and floaters in front of the affected eye is characteristic of retinal detachment.Option B: Difficulty seeing cars in another driving lane suggests a gradual loss of peripheral vision. which may indicate glaucoma.Option C: Headache. nausea. and redness of the eyes are signs of acute (angle-closure) glaucoma.Option D: Double vision is common in clients with cataracts.Rate this question:
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- 10.
Which nursing diagnosis takes highest priority for a client with Parkinson’s crisis?
- A.
Imbalanced nutrition: Less than body requirements
- B.
Ineffective airway clearance
- C.
Impaired urinary elimination
- D.
Risk for injury
Correct Answer
B. Ineffective airway clearanceExplanation
In Parkinson’s crisis. dopamine-related symptoms are severely exacerbated. virtually immobilizing the client. A client confined to bed during such a crisis is at risk for aspiration and pneumonia. Also. excessive drooling increases the risk of airway obstruction. Because of these concerns. the nursing diagnosis of Ineffective airway clearance takes highest priority. Although the other options also are appropriate. they aren’t immediately life-threatening.Rate this question:
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Mar 22, 2023Quiz Edited by
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Sep 29, 2017Quiz Created by
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