Chapter 27: Neurologic Disorders Nursing School Test Banks

Chapter 27: Neurologic Disorders
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. To what does the neural synapse refer?
a. Length of time it takes for afferent neurons to carry impulses to the central nervous system (CNS)
b. Length of time it takes for efferent neurons to carry impulses to the motor neurons
c. Space between the axons and the dendrites of a neuron
d. Space between the axons of one neuron and the dendrites of the next
ANS: D
Smooth, coordinated transmission must travel from one neuron to another across the neural synapse.

DIF: Cognitive Level: Knowledge REF: p. 436 OBJ: N/A
TOP: Anatomy and Physiology of the Central Nervous System (CNS)
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. An older adult patient is experiencing extreme stress related to an admission to the hospital. What should the nurse expect the patient to demonstrate?
a. Decreased heart rate
b. Decreased blood pressure (BP)
c. Irregular respiration
d. Dilation of the pupils
ANS: D
Stress stimulates the fight-or-flight reaction with the release of epinephrine and norepinephrine, which causes increased heart rate and BP, reduced peristalsis, and pupil dilation.

DIF: Cognitive Level: Comprehension REF: p. 438-440 OBJ: 1
TOP: Effects of Sympathetic Nervous System
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. Which neurologic finding would be considered abnormal in an 88-year-old patient?
a. Slow papillary response to light
b. Jerky eye movements
c. Dizziness and problems with balance
d. Absence of the Achilles tendon jerk
ANS: C
Dizziness and vertigo, although common, are considered abnormal.

DIF: Cognitive Level: Comprehension REF: p. 439 OBJ: 1
TOP: Age-Related Neurologic Changes KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. What is the most reliable indicator of neurologic status?
a. Blood pressure
b. Pulse rate
c. Temperature
d. Level of consciousness
ANS: D
The ability to respond readily and correctly to person, place, and time is good evidence of intact sensorium.

DIF: Cognitive Level: Knowledge REF: p. 443 OBJ: 3
TOP: Neurologic Assessment KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. A patient is stuporous but reacts by withdrawing from painful stimuli. What term is most appropriate for this patient?
a. Comatose
b. Lethargic
c. Semicomatose
d. Somnolent
ANS: C
A stuporous patient who reacts to pain is semicomatose. The patient with no reaction to pain is comatose.

DIF: Cognitive Level: Knowledge REF: p. 443 OBJ: 3
TOP: Neurologic Assessment KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. Which describes the Babinski reflex?
a. Downward curl of the toes
b. Big toe bending upward
c. Spreading out of the toes
d. Pain in the big toe
ANS: A
Normal cortical function causes the toes to curl downward. Abnormal findings would be the toes turning up and spreading.

DIF: Cognitive Level: Knowledge REF: p. 447-448 OBJ: 3
TOP: Neurologic Assessment KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. What should the nurse assess for the when a patient is scheduled for an angiogram?
a. Dizziness
b. Allergy to shrimp
c. Increased BP
d. Irregular heartbeat
ANS: B
Allergy to shrimp and other shellfish also indicates a probable allergy to contrast medium.

DIF: Cognitive Level: Application REF: p. 442 | p. 449
OBJ: 3 TOP: Angiogram Preassessment
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

8. What diagnostic test might be contraindicate for a patient who has a pacemaker?
a. Computed tomography (CT)
b. Electromyography (EMG)
c. Magnetic resonance imaging (MRI)
d. Electroencephalography (EEG)
ANS: C
Metal appliances may be affected by the magnetic field during MRI.

DIF: Cognitive Level: Knowledge REF: p. 442 | p. 449
OBJ: 3 TOP: Neurologic Assessment
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

9. A patient with a severe head injury begins to assume a posture of flexed upper extremities, with plantarflexed lower extremities. What do these assessments indicate?
a. Increasing intracranial pressure (ICP) with decorticate posturing
b. Decreasing ICP with decerebrate posturing
c. Decreasing ICP with decorticate posturing
d. Increasing ICP with decerebrate posturing
ANS: A
Increasing pressure on the tissue above the midbrain results in abnormal flexion (decorticate posturing).

DIF: Cognitive Level: Analysis REF: p. 451 OBJ: 5
TOP: Symptoms of Intracranial Pressure KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. What should be immediately reported by the nurse caring for a 90-year-old patient with a closed head injury?
a. Blood pressure change from 147/72 to 176/70 mm Hg
b. Respiration rate increase from 14 to 18 breaths/min
c. Slow pupillary reaction bilaterally
d. Temperature decrease from 100.2 F to 97.6 F
ANS: A
The widening pulse pressure is an indicator of increased ICP. Respirations and temperature are returning to more normal levels. Older adults have a slowed pupillary response as they age.

DIF: Cognitive Level: Analysis REF: p. 451-452 OBJ: 5
TOP: Nursing Care of Patient with Closed Head Injury
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

11. A patient with generalized convulsive disorder has a nursing diagnosis of Deficient knowledge, related to lack of information about the side effects of phenytoin (Dilantin). Which goal and outcome criteria would be most appropriate?
a. Absence of gastrointestinal (GI) complaint; takes medication with food
b. Stimulation of gingiva; brushes teeth vigorously to encourage gingival growth
c. Maintenance of normal pattern of elimination; limits fluids and eats foods that reduce diarrhea
d. Maintenance of normal sleep pattern; reduces stimuli and takes warm baths to induce drowsiness
ANS: A
Dilantin is irritating to GI tissues. Dilantin causes gingival hyperplasia, constipation, and drowsiness.

DIF: Cognitive Level: Application REF: p. 456 OBJ: 7
TOP: Dilantin KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. A nurse is caring for a patient with meningitis who has a positive Brudzinski sign. Which assessment led to this conclusion?
a. Flexed hips when the neck is flexed by the nurse
b. Inability to extend the flexed leg fully because of hamstring pain
c. Resisting efforts of the nurse to flex his or her neck
d. Flexing the big toe upward and fan out the other toes
ANS: A
Inflamed meninges will stimulate hip flexion to reduce meningeal discomfort.

DIF: Cognitive Level: Comprehension REF: p. 463 OBJ: 6
TOP: Symptoms of Meningitis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. Which assessment on a patient on mannitol therapy for cerebral edema indicates the medication is effective in decreasing ICP?
a. Increased BP
b. Increased urinary output
c. Decreased pulse
d. Widening pulse pressure
ANS: B
Mannitol is a hyperosmolar diuretic that draws fluid from brain tissue into the bloodstream, which is then excreted by the kidneys. Decreasing pulse and widening pulse pressure indicate increased ICP.

DIF: Cognitive Level: Comprehension REF: p. 452-453 OBJ: 6
TOP: Mannitol Therapy in Increased Intracranial Pressure (ICP)
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

14. What should a nurse instruct a patient after a lumbar puncture to prevent a headache?
a. Lie flat.
b. Lie on left side.
c. Stay in semi-Fowler position.
d. Ambulate in the room with assistance.
ANS: A
Lying flat for a prescribed period will allow the loss of cerebrospinal fluid during the procedure to replenish.

DIF: Cognitive Level: Application REF: p. 441 OBJ: 3
TOP: Lumbar Puncture Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

15. Which three symptoms are characteristic of Cushing triad associated with increased ICP?
a. Hypotension, tachycardia, and narrowing pulse pressure
b. Hypertension, tachycardia, and headache
c. Widening pulse pressure, headache, and seizure
d. Bradycardia, hypertension, and widening pulse pressure
ANS: D
Bradycardia, increasing BP, and widening pulse pressure are all signs of increased ICP.

DIF: Cognitive Level: Knowledge REF: p. 452 OBJ: 6
TOP: Increased ICP: Cushing Triad KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. A nurse is evaluating the goal of teaching for the nursing diagnosis of Knowledge deficit, related to conservation of energy in a patient with multiple sclerosis (MS). Which statement by the patient indicates a positive outcome?
a. Now that I am taking steroids, I will be able to work like I used to.
b. Im making a list of things that are important and things I will simply have to let go.
c. I will make a plan to allow for long rest periods at least four times a day.
d. I am working on balancing time among rest, work, and family time.
ANS: D
Balancing time between various activities indicates that the patient with MS understands the need to conserve energy, not just to give up things or attempt to perform at a preillness level.

DIF: Cognitive Level: Application REF: p. 470-472 OBJ: 7
TOP: Altered Energy in Patients with Multiple Sclerosis (MS)
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. A patient in the emergency department states that she fell and hit her head and blacked out for a while but became alert again. The nurse suspects an epidural hematoma. For what should the nurse be diligent to assess?
a. Headache
b. Drowsiness
c. Increasing respiration rate
d. Vomiting
ANS: B
Increasing BP, drowsiness, and a widening pulse pressure are indicators of increased ICP.

DIF: Cognitive Level: Application REF: p. 458 OBJ: 5
TOP: Epidural Hematoma Assessment KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

18. Which intervention should be added to the nursing care plan for supporting nutritional intake in a patient with Parkinson disease?
a. Offer large meals with a variety of finger foods.
b. Thicken liquids to make them easier to swallow.
c. Puree all foods and drink through a straw.
d. Offer a diet high in carbohydrates and fat and low in protein.
ANS: B
Thickened feedings are easier to swallow. Several small, protein-rich meals are preferable to large ones. A pureed diet is unappealing.

DIF: Cognitive Level: Application REF: p. 469 OBJ: 7
TOP: Nutrition in Parkinson Disease KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

19. A patient with Parkinson disease is depressed because his drug protocol of L-dopa and Sinemet is no longer controlling his symptoms. What is the best response by the nurse?
a. Other drugs can be combined with L-dopa to increase its effectiveness.
b. The effect of these drugs has an uneven course; symptoms will begin to subside again soon.
c. The two drugs can be given in higher doses to control the symptoms.
d. Surgical interventions have been very effective in the control of parkinsonian symptoms.
ANS: A
The addition of other drugs to L-dopa may improve the conversion of L-dopa to dopamine. Palliative surgical implementations all have had little effect on controlling the symptoms.

DIF: Cognitive Level: Comprehension REF: p. 468 OBJ: 6
TOP: Treatment of Parkinson Disease KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

20. A patient with Parkinson disease is considering taking St. Johns wort, an herbal remedy for depression, in addition to Sinemet and L-dopa. What is the most appropriate nursing response?
a. Depression is reduced by the use of herbal remedies such as St. Johns wort.
b. Doses of St. Johns wort and parkinsonian drugs should be taken on alternate days.
c. St. Johns wort must be taken in large doses to reduce depression.
d. Herbal remedies can interfere with the effectiveness of the parkinsonian drugs.
ANS: D
Herbal remedies interfere with effectiveness of prescribed parkinsonian drugs.

DIF: Cognitive Level: Application REF: p. 469 OBJ: 7
TOP: Treatment of Parkinson Disease KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

21. Which nursing assessment would indicate a need for suctioning a patient with Guillain-Barr who is experiencing impaired breathing patterns because of neuromuscular failure?
a. Decreased pulse rate and respiration of 20 breaths/min
b. Increased pulse rate and adventitious breath sounds
c. Increased pulse rate and respiration of 16 breaths/min
d. Decreased pulse and abdominal breathing
ANS: B
Increased pulse rate, adventitious breath sounds, and abdominal breathing indicate an impaired breathing pattern.

DIF: Cognitive Level: Application REF: p. 466 OBJ: 6
TOP: Nursing Care of the Patient with Guillain-Barr Syndrome
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

22. A family member asks the nurse what would be an appropriate gift for a patient with Parkinson disease. What is the most useful suggestion?
a. Soft-soled house shoes
b. Jigsaw puzzle
c. Set of card games
d. Satin sheets
ANS: D
Satin sheets make moving in bed easier. Card games and jigsaw puzzles are frustrating because of the palsy. Hard-soled shoes provide better support than soft-soled shoes.

DIF: Cognitive Level: Comprehension REF: p. 469 OBJ: 7
TOP: Care of the Patient with Parkinson Disease
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. What action should the nurse implement when a patient falls to the floor in a generalized seizure?
a. Cradle the head to prevent injury.
b. Insert an object between the teeth to prevent the patient from biting the tongue.
c. Manually restrain the limbs.
d. Keep the patient on his or her back to prevent aspiration.
ANS: A
Cradling the head and turning it to the side prevents injury and aspiration; restraint of limbs and insertion of an object into a patients mouth often result in injury.

DIF: Cognitive Level: Application REF: p. 455 OBJ: 7
TOP: Seizure Implementations KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

24. How can the nurse help reduce ICP in caring for the patient after a craniotomy?
a. Keeping the patient flat in bed
b. Elevating the head of the bed 30 degrees
c. Closely monitoring the IV rate
d. Turning the patient to the right side
ANS: B
Elevating the head of the bed at least 30 degrees helps reduce ICP.

DIF: Cognitive Level: Application REF: p. 452 OBJ: 6
TOP: Intervening for Increased ICP KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

25. Why is a patient with amyotrophic lateral sclerosis (ALS) uniquely prone to depression?
a. Nutritional intake is poor.
b. Intellectual capacity is not affected.
c. Mobility is limited.
d. Communication is altered.
ANS: B
Because of their unimpaired intellect, patients with ALS are able to assess their deterioration, which increases their risk for depression. Altered mobility, nutrition, and communication are common to many disorders.

DIF: Cognitive Level: Comprehension REF: p. 472 OBJ: 6
TOP: Symptoms of Amyotrophic Lateral Sclerosis (ALS)
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

26. A nurse is careful about limb position in caring for an unconscious patient who sustained a head injury 10 days ago. What is the nurse trying to prevent?
a. Flexion deformities
b. Atrophy
c. Paralysis
d. Pathologic fracture
ANS: A
An unconscious patient should be positioned in anatomic alignment to prevent flexion deformities. Passive range of motion and frequent position changes are essential to maintain the limbs in a functional position.

DIF: Cognitive Level: Comprehension REF: p. 461 OBJ: 7
TOP: Flexion Deformities KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

27. What should the nurse implement before giving an enteral feeding to a patient?
a. Palpate the abdomen to check for residual feeding.
b. Warm the feeding.
c. Elevate the head of the bed 30 degrees.
d. Ask the patient to tip his head forward.
ANS: C
The head of the bed should be elevated 30 degrees to prevent aspiration.

DIF: Cognitive Level: Application REF: p. 466 OBJ: 7
TOP: Enteral Feedings KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE

28. Which neurotransmitters support smooth neural transmission? (Select all that apply.)
a. Acetylcholine
b. CSF
c. Dopamine
d. Dendrite
e. Epinephrine
ANS: A, C, E
Acetylcholine, dopamine, and epinephrine are neurotransmitters. CSF bathes the brain and spinal cord but has no transmission activity; the dendrite is the locus of the synapse.

DIF: Cognitive Level: Knowledge REF: p. 436 OBJ: N/A
TOP: Neurotransmitters KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

29. A nurse caring for an immobilized patient with a brain tumor stimulates the patient several times a day with range-of-motion exercises and changes his position every 2 hours to try to prevent a disuse syndrome. What signs and symptoms does disuse syndrome include? (Select all that apply.)
a. Pooling of pulmonary secretions
b. Paralysis
c. Muscle tremor
d. Pressure ulcers
e. Altered visual perceptions
ANS: A, D
A disuse syndrome includes pooling of pulmonary secretions, pressure ulcers, weakness, and stiff joints.

DIF: Cognitive Level: Knowledge REF: p. 462-463 OBJ: 6
TOP: Disuse Syndrome KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

30. Which are normal brain alterations associated with age? (Select all that apply.)
a. Decrease in brain weight
b. Pigmentation of brain with lipofuscin
c. Present of amyloid
d. Tiny clot formation
e. Tangled nerve fibers
ANS: A, B, C, E
All brain alterations listed are expected changes that affect the older adults neurologic function except for tiny clot formations, which are a pathologic change.

DIF: Cognitive Level: Knowledge REF: p. 439 OBJ: 1
TOP: Age-Related Cerebral Changes KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

OTHER

31. The nurse assessing the level of consciousness in a patient will perform the following: (Arrange in order from the simplest to the most complex. Separate letters by a comma and space as follows: A, B, C, D.)
A. Apply pressure to the nail bed.
B. Shake the patient.
C. Touch the patient.
D. Call the patients name.
E. Approach the patient.

ANS:
E, D, C, B, A
The assessment begins with simply approaching the patient and progresses to imposing painful stimuli.

DIF: Cognitive Level: Application REF: p. 443 OBJ: 3
TOP: Assessing Level of Consciousness KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

32. The nurse conducting a Romberg test will ask the patient to do what? (Arrange in the correct sequence. Separate letters by a comma and space as follows: A, B, C, D.)
A. Touch his or her nose with the index finger with the eyes open.
B. Stand with eyes closed.
C. Touch his or her nose with the index finger with the eyes closed.
D. Touch his or her fingertip to nurses fingertip.
E. Pat the knees with the palms and then the back of the hands rapidly.

ANS:
B, E, D, A, C
These simple exercises used to assess balance and perception should be performed in order from least to most difficult.

DIF: Cognitive Level: Application REF: p. 445 OBJ: 3
TOP: Romberg Test for Balance KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

Leave a Reply