Chapter 69: Management of Clients with Cerebral Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 69: Management of Clients with Cerebral Disorders

MULTIPLE CHOICE

1. When doing an ophthalmologic examination the nurse practitioner assesses papilledema, which the practitioner recognizes as an indication of

a.

compression of the second cranial nerve.

b.

increased intraocular pressure.

c.

migraine headache.

d.

impending stroke.

ANS: A

Papilledema, the swelling of the optic disc, occurs when there is increased intracranial pressure. The optic nerve, cranial nerve II, is compressed as well as intracerebral vessels. The most probable cause of the pressure is brain tumor.

DIF: Analysis/Analyzing REF: p. 1823 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. A week after a client experienced a ruptured cerebral aneurysm, he becomes extremely indecisive and has frequent episodes of incontinence. The nurse reports these events as probable

a.

vasospasm.

b.

automatisms.

c.

focal seizures.

d.

early-stage dementia.

ANS: A

Vasospasm, a complication of ruptured aneurysm, occurs 4 to 15 days following the rupture. The manifestations of vasospasm are dependent on the area of the brain involved.

DIF: Analysis/Analyzing REF: p. 1831 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

3. The intraoperative nurse caring for a client having brain surgery to remove a tumor would be particularly careful about

a.

inserting the IVs in the nondominant hand.

b.

padding and assessing the skin under the head frame.

c.

placing the client in straight alignment.

d.

using a catheter bag with a urimeter.

ANS: B

The frames to help immobilize a client during intracranial surgery can cause pressure on the skin, edema of the face, and postoperative muscle soreness, especially in the neck. The nurse needs to take special precautions so as not to injure the clients face.

DIF: Application/Applying REF: p. 1824 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

4. The nurse institutes seizure precautions for a client with a history of epilepsy. Which action is inconsistent with seizure precautions?

a.

Keeping oxygen and suction equipment nearby

b.

Keeping the side rails up while the client is in bed

c.

Padding the side rails of the bed

d.

Taking an oral temperature when doing vital signs

ANS: D

Clients with a history of seizures or epilepsy should have axillary or rectal temperatures taken.

DIF: Application/Applying REF: p. 1817 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

5. Three days following intracranial surgery a client develops fever, nuchal rigidity, and headache. The nurse would suspect

a.

cerebral emboli.

b.

extradural hematoma.

c.

increased ICP.

d.

meningitis.

ANS: D

The classic manifestations of meningitis are nuchal rigidity (rigidity of the neck), Brudzinskis sign and Kernigs sign, and photophobia. Intracranial surgery places the client at high risk of developing meningitis.

DIF: Analysis/Analyzing REF: pp. 1835-1836

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

6. When the client experiences convulsive movement beginning in the hand and progressing to the arm and face, the nurse recognizes this as being consistent with

a.

clonic seizure.

b.

complex partial seizure.

c.

partial seizure with motor signs.

d.

temporal lobe seizure.

ANS: C

The observation of the jacksonian march identifies this seizure activity as a partial seizure with motor signs.

DIF: Analysis/Analyzing REF: pp. 1812-1813

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

7. A client with epilepsy has the nursing diagnosis Risk for Impaired Adjustment. Which statement by the client would indicate movement towards positive resolution of this diagnosis?

a.

Before activities, I should ask myself What would happen if I had a seizure?

b.

Do you know how to apply for food stamps since I cant work?

c.

I feel so sad that so many activities are off-limits for me now.

d.

I have decided to sell my car since I will never be able to drive again.

ANS: A

Activity restrictions will vary among clients, but the key question the client should ask of him/herself is What would happen if I had a seizure while doing this activity? Clients with epilepsy can and do work. There are five major types of activity restrictions to discuss with clients, and only a few things will truly be off-limits for clients with well-controlled seizures. State regulations regarding driving vary; generally no driving is allowed for 6-12 months after a seizure, but many clients are able to drive again.

DIF: Evaluation/Evaluating REF: p. 1817 OBJ: Evaluation

MSC: Psychosocial Integrity Coping and Adaptation-Situational Role Changes

8. The nurse clarifies that a generalized seizure, unlike a partial seizure, involves

a.

areas of special senses.

b.

both hemispheres.

c.

only one hemisphere.

d.

the autonomic system.

ANS: B

A generalized seizure involves both hemispheres.

DIF: Comprehension/Understanding REF: p. 1813 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

9. A nurse is teaching a newly diagnosed epileptic client about anticonvulsant medications. The nurse should include information to

a.

help the client learn to control stress in his/her life.

b.

limit heavy exercise and aerobic activities.

c.

stop medications if seizures are controlled for several months.

d.

take an extra dose of medication if a seizure is beginning.

ANS: A

Seizure activity is closely related to increasing stress. Clients should not alter their medication dosages without instruction and supervision of their prescriber. Exercise and aerobic activities are part of a healthy lifestyle and should be encouraged.

DIF: Application/Applying REF: p. 1817 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Stress Management

10. The nurse caring for a client receiving phenytoin (Dilantin) should assess for

a.

anorexia, numbness, and tingling of extremities.

b.

ataxia, nausea, and bleeding tendency.

c.

headache, myalgias, and arthralgias.

d.

unsteady gait, slurred speech, and blurred vision.

ANS: D

Serious adverse outcomes of antiseizure medications are unsteady gait, slurred speech, extreme fatigue, blurred vision, or feelings of suicide.

DIF: Application REF: p. 1816 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

11. An important age-related consideration the nurse should include in the care plan for an elderly client with a seizure disorder is

a.

a decreased serum albumin level can increase the free plasma level of medications.

b.

fortunately, seizure medications have very few drug-drug interactions.

c.

older adults have very few choices when it comes to seizure medications.

d.

the elderly rarely have seizure disorders, so community support for them is poor.

ANS: A

Protein-calorie malnutrition is common among elders and the subsequent decreased serum albumin level can lead to increased plasma levels of the drug, making them prone to drug toxicities. Many seizure medications do have multiple drug-drug interactions, but all are available for use in this population. The frequency of seizures being diagnosed in the elderly population is increasing.

DIF: Application/Applying REF: p. 1818 OBJ: Intervention

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Age Related Changes

12. The cerebrospinal (CSF) fluid laboratory finding the nurse would expect in a client with bacterial meningitis is

a.

clear color.

b.

decreased glucose level.

c.

decreased protein level.

d.

negative nitrates.

ANS: B

Clients with bacterial meningitis show the following: elevated CSF pressures, elevated CSF protein, decreased CSF glucose, and usually increased cell count with predominantly polymorphonuclear leukocytes.

DIF: Knowledge/Remembering REF: p. 1836 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

13. The nurse should observe a client with bacterial meningitis for

a.

changes in sensorium.

b.

high blood pressure.

c.

hypothermia.

d.

muscle spasms.

ANS: A

Other general manifestations related to infection are also present, such as fever, tachycardia, headache, prostration, chills, fever, nausea, and vomiting. The client may be irritable at first, but as the infection progresses, the sensorium often becomes clouded, and coma may develop.

DIF: Application/Applying REF: p. 1836 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

14. The nurse assesses for the most common manifestations of a post-traumatic brain abscess, which are

a.

headache and lethargy.

b.

photophobia and dizziness.

c.

muscle spasms and tingling.

d.

sluggish pupillary reactions.

ANS: A

Headache and lethargy are the most common manifestations. Manifestations of infection are present about half the time.

DIF: Application/Applying REF: p. 1837 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

15. A client has been diagnosed with epilepsy and is going home. The client has received extensive teaching on the disease, medications, and lifestyle changes that are required. What else should the nurse include in the discharge plan?

a.

A referral to a support group

b.

Easy-to-prepare menu guide

c.

Psychiatry clinic information

d.

The citys bus schedule

ANS: A

Clients with epilepsy often have poor self-image, feelings of inferiority, self-consciousness, guilt, anger, depression, and other emotional problems. While any of the above options might be needed by a particular client, a referral to a self-help group or support group can best help the client learn to adapt to the new diagnosis and incorporate it into a healthy self-image.

DIF: Knowledge/Remembering REF: p. 1820 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

16. The client with epilepsy asks the nurse if he will have to take antispasmodic medication for the rest of his life. The nurses most helpful response would be

a.

Maybe. You might be able to stop medication if you are seizure free for 2 years.

b.

No. After a stable pattern is recognized, you can take it sporadically.

c.

Yes. Epilepsy requires compliance to a regimen of lifelong medication.

d.

Yes. Stopping a med after you take it a while makes seizure activity worse.

ANS: A

Many physicians allow their patients to stop antispasmodic medication if they have been seizure-free for 2 years. Other physicians prefer a seizure-free period of 5 years.

DIF: Comprehension/Understanding REF: p. 1816 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

17. A nurse is reviewing leisure time activities with a client who has epilepsy. An important self-care measure the nurse teaches the client is to avoid

a.

alcoholic beverages.

b.

driving a motor vehicle.

c.

hiking and camping.

d.

light sports.

ANS: A

Alcoholic beverages are contraindicated for two reasons. First, alcohol lowers the seizure threshold, and second, alcohol is detoxified by the liver. Most anticonvulsant medications are also detoxified by the liver. Although certain dangerous activities should be avoided or performed with special safeguards (e.g., swimming or horseback riding), a wide range of activities can still be enjoyed. Driving motor vehicles depends on state laws and the clients medical control of seizures, with driving restrictions ranging from 3 months to 2 years.

DIF: Application/Applying REF: p. 1819 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

18. The nurse gives diazepam to a client in status epilepticus to stop the seizure because prolonged seizure activity can cause

a.

brain injury.

b.

cardiac dysrhythmias.

c.

muscle and tendon damage.

d.

respiratory arrest.

ANS: A

Prolonged seizure activity exhausts the bodys supply of oxygen and glucose and can result in brain injury.

DIF: Knowledge/Remembering REF: p. 1820 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

19. A client is being worked up for a possible brain tumor. An important intervention the nurse would include in the nursing care plan specific to this client is

a.

documenting manifestations.

b.

preparing the client for tests.

c.

seizure precautions.

d.

supporting the client and family.

ANS: C

Options a, b, and d are always important interventions for the client who is being worked up for a medical condition. But the specific care this client needs is seizure precautions, because seizures are a common manifestation in clients with brain tumors.

DIF: Application/Applying REF: p. 1823 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

20. For a client who had a transsphenoidal resection of a pituitary tumor, the nurse plans to

a.

assess the mustache dressing for drainage.

b.

do minimal mouth care for the first 2 days.

c.

encourage the use of straws when drinking.

d.

provide heated mist and humidified oxygen.

ANS: A

Postoperative care after pituitary surgery using a transsphenoidal approach includes prohibition of the use of straws for drinking any fluid, to prevent trauma to the oral/gingival incision site. Frequent oral hygiene is provided, and a cool mist vaporizer may be used to keep oral mucous membranes moist. The nasal drip pad (mustache dressing pad) is assessed frequently for bloody and/or clear CSF.

DIF: Application/Applying REF: p. 1829 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

21. A client who has had intracranial surgery develops urine output in excess of 200 ml per hour. The nurse reports the findings, suspecting

a.

diabetes insipidus.

b.

fluid volume excess.

c.

hyponatremia.

d.

hyperkalemia.

ANS: A

A fairly common effect of pituitary surgery is the development of transient diabetes insipidus (DI) as a result of decreased secretion of antidiuretic hormone. The main clinical manifestations of DI are polyuria and polydipsia, with 2 to 5 L per day of dilute urine that has a specific gravity of 1.005 or less.

DIF: Analysis/Analyzing REF: p. 1829 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

22. When a client is admitted to the hospital in an unconscious state following subarachnoid hemorrhage resulting from a ruptured intracranial aneurysm, the nurse anticipates that the manifestations that preceded the loss of consciousness were

a.

generalized weakness and fatigue accompanied by anorexia.

b.

gradual loss of speech or vision.

c.

sudden severe headache accompanied by vomiting.

d.

weakness, fever, nausea, and vomiting.

ANS: C

The onset of a subarachnoid hemorrhage is sudden. The client experiences a sudden, severe headache, often accompanied by vomiting, often describing the headache as the worst headache I have ever had.

DIF: Knowledge/Remembering REF: p. 1831 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

23. The nurse explains that an epidural blood patch may be used to treat a headache that has resulted from a

a.

brain tumor.

b.

concussion.

c.

lumbar puncture.

d.

migraine.

ANS: C

For a post-lumbar puncture headache, an epidural blood patch accomplished by injection of 15 ml of autologous whole blood rarely fails for those who do not respond to caffeine.

DIF: Comprehension/Understanding REF: p. 1840 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Blood and Blood Products

24. The nurse observes for manifestations of typical migraine headaches, which include

a.

aura, visual disturbances, and nausea.

b.

bilateral pain, abrupt onset, and tinnitus.

c.

diarrhea, nasal congestion, and eye redness.

d.

scalp tenderness, sensation of pressure, and nighttime onset.

ANS: A

The client may feel transient neurologic disturbances, including visual phenomena (flashes of light, bright spots, distorted vision, diplopia, transitory impaired vision), vertigo, nausea, diarrhea, abdominal pain, paresthesias (numbness or tingling of lips, face, or extremities), or transient hemiparesis. It gradually increases in severity. The pain is usually unilateral.

DIF: Application/Applying REF: p. 1839 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

25. A client has cyclical headaches accompanied by constricted pupils, unilateral lacrimation, and rhinorrhea. The nurse is exploring ways to prevent these headaches with the client. The nurse could focus questions and interventions on modifying the clients

a.

daily level of stress.

b.

family history of brain tumors.

c.

pattern of caffeine consumption.

d.

usual alcohol intake.

ANS: D

The client is experiencing cluster headaches, which are frequently associated with drinking alcohol.

DIF: Application/Applying REF: pp. 1838-1839

OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

26. Following surgery for a pituitary tumor, when the client develops diabetes insipidus, the nurse explains that the drug that will be helpful to remedy the manifestations is

a.

atropine.

b.

desmopressin.

c.

diazepam (Valium).

d.

NPH insulin.

ANS: B

Clients who have diabetes insipidus after pituitary surgery often require IV vasopressin (Pitressin) or desmopressin (DDAVP).

DIF: Comprehension/Understanding REF: p. 1829 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

27. The nurse explains to a newly diagnosed epileptic client that the basic pathophysiology of epilepsy is related to

a.

a period of hypoxia from sleep apnea.

b.

brain waves losing amplitude.

c.

excitation of neurons discharging in the brain stem.

d.

specific metabolic disturbances.

ANS: C

Epilepsy occurs when neurons fire with greater frequency and amplitude, spreading to adjacent neurons that ultimately discharge in the brain stem, causing muscle contractures and possible unconsciousness.

DIF: Comprehension/Understanding REF: p. 1812 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

28. The clinic nurse recommends to a client with cluster headaches that to abate the manifestations associated with an attack, he should inhale

a.

100% oxygen for 15 minutes.

b.

deeply for 5 minutes.

c.

oil of cloves for 5 minutes.

d.

warm mist for 10 minutes.

ANS: A

Inhalation of 100% oxygen for 15 minutes has been found effective in combating the manifestations of cluster headache attack.

DIF: Comprehension/Understanding REF: p. 1839 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Disease Management

MULTIPLE RESPONSE

1. A nurse is teaching a client preventive strategies for migraine headaches. The nurse would evaluate that teaching goals have been met when the client says (Select all that apply)

a.

Do you know where I can learn relaxation techniques like yoga?

b.

Eating on a regular schedule may help prevent some migraines.

c.

I should keep a headache diary to see if I can identify headache triggers.

d.

Small amounts of alcohol should not cause any headaches.

e.

There may be some foods that trigger my headaches that I should avoid.

ANS: A, B, C, E

Alcohol temporarily increases the diameter of the blood vessels, which may trigger migraines. Some foods, such as chocolate, cheese, citrus fruits, coffee, pork, and dairy products, contain substances that may trigger migraines. Low food intake may lead to a low blood glucose level that can trigger migraines. Eating smaller, more frequent meals will decrease this risk. Getting enough sleep is essential, as is learning a stress management technique like yoga.

DIF: Evaluation/Evaluating REF: p. 1839 OBJ: Intervention

MSC: Health Promotion Prevention and/or Early Detection of Health Problems-Self Care

2. When a client suffers a tonic-clonic seizure, the nurse should (Select all that apply)

a.

insert an oral airway into the clients mouth.

b.

move objects out of the clients way.

c.

observe and document characteristics of the seizure.

d.

place a pillow or some padding under the clients head.

e.

turn the client gently on one side.

ANS: B, C, D, E

A person having a seizure needs protection from the environment. The nurse should move objects out of the way, place some type of padding under the clients head, loosen clothing that is tight around the clients neck, turn the client to one side to facilitate draining saliva, and observe the characteristics of the seizure. Nothing should be forced into the clients mouth.

DIF: Application/Applying REF: p. 1815 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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