NEURO WORKBOOK factors is too difficult for persons who have already experienced A.

ns who have already experienced A. A normal temperature will decrease the score on the
a stroke.III. the resultant deficit will cause the client to deny or Glasgow coma scale.
1. A client has undergone a lumbar laminectomy with spinal minimize that there is a problem. IV. the time period of greatest B. A normal temperature will strengthen the client’s immune
fusion 12 hours earlier. Which findings would indicate that risk for a second stroke is the first 30 days after ischemic system against infection.
there is leakage of the cerebrospinal fluid (CSF)? * symptoms occur. V. most stroke victims develop depression and C. Hyperthermia lowers the incidence of mortality.
1 point less interest in learning preventive measures as the recovery D. Hyperthermia increases the likelihood of a larger area of
process lengthens. VI. the potential for recovery continues for at brain infarct.
A.Clear fluid drainage noted on the surgical dressing least 6 months after the initial stroke event.
B. Backache not relieved by analgesics A. II, III, IV, V 9. What is the earliest sign of increased ICP? *
C. 100 mL of serosanguineous fluid measured from the B. I, III, V, VI A. altered sensation.
Jackson-Pratt® drain since surgery C. I, IV, V B. drop in the blood pressure.
D. Temperature of 38.5°C D. All of the above C. pupillary changes.
D. changes in the level of consciousness.
2. A patient with left-sided weakness and slurred speech is 6. A patient with history of stroke stares at a nurse but does not
brought to the emergency room. He is diagnosed with an attempt to verbally respond to the nurse’s questions; however, 10. An ICU nurse is orienting a new nurse to a unit. The
ischemic stroke and is evaluated for treatment with he follows instructions without any problems. These symptoms experienced ICU nurse evaluates that the new nurse has correct
thrombolytic therapy. A definite contraindication for are consistent with: * understanding of the concepts of a stroke resulting from a
thrombolytic therapy is: * A. receptive aphasia. subarachnoid hemorrhage when which points are addressed by
A. a normal computed tomography (CT) scan of the brain. B. expressive aphasia. the new nurse? SELECT ALL THAT APPLY.I. Subarachnoid
B. the onset of neurological deficits 2 hours earlier. C. global aphasia. hemorrhage often results in bloody cerebrospinal fluid (CSF).II.
C. a history of diabetes mellitus. D. both receptive and expressive aphasia. Subarachnoid hemorrhage is often associated with a rupture of a
D. a serious head injury 4 weeks earlier. cerebral aneurysm.III. Subarachnoid hemorrhage may be treated
7. A client is admitted to the intensive care unit after a severe with thrombolytic therapy if no contraindications exist.IV.
3. What is the primary goal during the first 24 hours after stroke. The client is receiving a continuous intravenous insulin Subarachnoid hemorrhage usually occurs while the client is
thrombolytic treatment for a client with ischemic stroke? It is to infusion titrated according to hourly blood glucose results to sleeping and is noticed when the client awakens.V.
control the client's: * control hyperglycemia. The client’s spouse asks the nurse why Subarachnoid hemorrhage is accompanied by complaints of an
A.Pulse the client is receiving insulin when the client is not diabetic. extremely severe headache.VI Subarachnoid hemorrhage causes
B.Respirations The nurse correctly explains by including which of the nuchal rigidity. *
C.Blood pressure following statements? SELECT ALL THAT APPLY.I. “The A. I, II, IV, V
D. Temperature body reacts to stress by producing various hormones, which B. I, II, III, V
results in elevated glucose levels.”II. “Use of insulin will C. I, II, V, VI
4. The nurse understands that frequent assessments are used to decrease the likelihood of the client becoming diabetic in the D. I, II, III, VI
determine if a client is developing increased intracranial future.”III. “The stroke affected the part of the brain that
pressure (ICP). Which among the following is the outcome if controls the release of insulin.”IV. “The body has less effective 11. A post-craniotomy client is receiving mannitol to decrease
ICP is untreated and progresses? * utilization of glucose during serious illness.”V. “A side effect of his ICP. Which diagnostic laboratory value should be monitored
A. Improved brain tissue oxygenation the medications administered is the development of type 1 while the client is receiving this medication? *
B. Increase in cerebral circulation and perfusion diabetes mellitus.”VI. “Insulin lessens the likelihood of brain A.Serum cholesterol
C. Increase in serum pH tissue becoming swollen. * B. Serum osmolarity
D. Displacement of brain tissue A. I, II, III C. White blood cell (WBC) count
B. I, III, IV D. Erythrocyte sedimentation rate (ESR)
5. A client who receives a diagnosis of right-sided stroke should
be assessed for risk factors of stroke during the initial C. I, IV, VI
12. The nurse provides oral hygiene for a client who has had a
hospitalization, and measures should be instituted to lessen the D. II, IV, VI
stroke by doing the following, except? *
client’s risk. A nurse should address these risk factors as a 8. A client with a deteriorating mental status after suffering a A. Place the client on the back with a small pillow under the
priority and institute measures because of which reasons? stroke has a rectal temperature of 39.1°C. What is the purpose head.
SELECT ALL THAT APPLY.I. one of every four strokes of maintaining the client in a normal temperature? * B. Keep portable suctioning equipment at the bedside
occurs as a recurrent stroke.II. controlling modifiable risk C. Open the client's mouth with a padded tongue blade
D. Clean the client's mouth and teeth with a toothbrush. A. The medication should not be taken with food. A. “Although it’s not unusual to experience some lapses of
B. The client should stop taking multiple vitamins. memory, let’s discuss your concerns.”
13. In changing the position of client with hemiparalysis, which C. The medication has very few adverse effects. B. “Oh, what you are describing isn’t Alzheimer’s disease. It’s
of the following techniques should the nurse not perform? * D. The client is at increased risk for falls due to dizziness and much more complicated than that.”
A. Rolling the client onto his side orthostatic hypotension. C. “Now, I don’t think we really need to discuss this. I’m sure
B.Having the client help lift off the bed using trapeze it is just normal aging.”
C.Sliding the client to move up in bed 19. Which of the following is an initial sign of Parkinson's D. “I’m forgetful, too. I have to make lists to remember
D. Lifting the client when moving the client up in bed disease? * everything.”
A. Tremor
14. A nurse is teaching a client who had a stroke about ways to B.Rigidity 25. A home health nurse caring for a client diagnosed with
adapt to a visual disability. Which does the nurse identify as the C. Bradykinesia Alzheimer’s disease is attempting to determine whether the
primary safety precaution to use? * D. Akinesia client’s daughter understands the client’s prognosis. Which of
A.Turn the head from side to side when waling the daughter’s questions to the nurse will most accurately assess
B.Wear a patch over one eye 20. The nurse is developing a teaching plan for a client newly the daughter’s understanding of Alzheimer’s disease and its
C.Place personal items on the sighted side diagnosed with Parkinson's disease. Which of the following prognosis? *
D.Lie in bed with the unaffected side toward the door topics that the nurse plans to include in his teaching is the most A. “Which local hospital has the best treatment program?”
important? * B. “What can we do to improve our father’s memory?”
15. A client seeks medical attention from a primary care A. Engaging in diversional activity C. “What types of support services are available?”
provider after experiencing muscle weakness. The client asks a B. Maintaining a balanced nutritional diet. D. “How long does it take for his medication to help?”
nurse during the initial assessment if the symptoms suggest C. Enhancing the immune system.
“Lou Gehrig’s” disease. The nurse correctly responds by stating D. Maintaining a safe environment. 26. An older client diagnosed with Alzheimer’s disease
which of the following? * becomes agitated and insists that he must “go and clean out the
A.“You may have been working too much and that is why you 21. What is the most realistic goal is for a client with barn.” Which nursing response is most therapeutic? *
are tired. Let’s not think the worst.” Parkinson's disease? * A. “It’s awfully hot today; maybe you should wait until
B. “Have you been having trouble remembering things along A.To cure the disease tomorrow.”
with this weakness?” B. To stop the progression of the disease B. “What makes you think that the barn needs to be cleaned?”
C. “Well, you are in the right place to figure out what is going C. To begin preparations for terminal care C. “So you’ve cleaned a barn. Tell me, did you live on a
on.” D. To maintain optimal body function farm?”
D. “Tell me what has you thinking that you might have Lou D. “There are no barns around here. Would you like something
Gehrig’s disease.” 22. Which of the following goals is collaboratively established
to eat?”
by the client with Parkinson's disease, nurse, and physical
16. Due to upper and lower motor neuron affectations, patients therapist? * 27. While taking the history of a client diagnosed with Guillain-
with amyotrophic lateral sclerosis or ALS experience the A.To build muscle strength Barre syndrome (GBS), the nurse should ask the family if the
following early manifestations, except: * B. To maintain joint flexibility client has recently experienced which physical problem? *
A. Fasciculations of the face C. To improve muscle endurance A Meningitis
B. Dysphagia D. To reduce ataxia B. Seizures or head trauma
C. Weakness of the hands and arms C. A respiratory or gastrointestinal infection
D. Muscle hypertrophy of the arms 23. A client with Parkinson’s disease has begun taking his
D. A back injury or spinal cord trauma
levodopa. The client knows that the effects of this drug may not
17. What is the common cause of death of patients with ALS? * be apparent for what period of time? * 28. What is the purpose of plasmapheresis in clients with
A. Malnutrition A. 2-3 weeks GBS? *
B. Hypovolemia B. 5-7 days A. infuse lipoproteins to restore the myelin sheath.
C. Respiratory failure C. 24 hours B. remove excess fluid from the bloodstream.
D. Metabolic acidosis D. 1 week C. remove circulating antibodies from the bloodstream.
D. restore protein levels in the blood.
18. An elderly client with Parkinson’s disease is prescribed with 24. A nurse is caring for a client who states, “Lately I’m getting
levodopa and carbidopa (Sinemet). Which point should a nurse forgetful about things. I’m so afraid I’m getting Alzheimer’s
include in the teaching plan for the client and spouse? * disease.” Which response by the nurse is most therapeutic? *
29. What severe complication is associated with Guillain-Barré A. Weakness of extremities C. She will live longer, but ultimately the disease will lead to
syndrome? * B. Double vision death
A.Respiratory failure C. Sudden bursts of energy D. Her fatigue will be relieved but occasional periods of
B. Autonomic dysreflexia D. Muscle tremors muscle weakness are expected
C. Septic emboli
D. Increased intracranial pressure (ICP) 35. A client spills her coffee twice at lunch and cannot get her 39. A client with refractory myasthenia gravis (MG) undergoes
dress fastened securely because of the tremors she experiences plasmapheresis therapy. The therapy effectiveness would be
30. The patient brought to the Emergency Room has a chief with her right hand during voluntary actions. Which is the best evident in the improvement of which parameter? *
complaint of an ascending paralysis that has reached the level of legal documentation in nurses' notes of the chart for this client A.Diplopia
the waist. He was diagnosed to have GBS. Which items should assessment? * B. Ptosis
the nurse plan to have available for emergency use? * A. “Slight shaking of right hand increases to severe tremor C. Vital capacity
A. Nebulizer and pulse oximeter when client tries to button her clothes or drink from a cup.” D. Leg strength
B. Cardiac monitor and intubation tray B. “Has an intention tremor of the right hand.”
C. Blood pressure cuff and flashlight C. “Right-hand tremor worsens with purposeful acts.” 40. What is a safe practice in administering pyridostigmine to a
D. Flashlight and incentive spirometer D. “Needs assistance with dressing and eating due to severe client with MG? *
trembling and clumsiness.” A.Asking the client to look up at the ceiling for 30 seconds
31. A client with GBS is intubated and receiving mechanical B.Asking the client to lie down on her right side
ventilation. Which strategy should the nurse incorporate in the 36. What should a nurse include in his discharge teaching for a C.Asking the client to take sips of water
plan of care to help the client cope with this illness? * client with multiple sclerosis? * D.Instructing the client to void before taking the medication
A. Giving client full control over care decisions and restricting A. “Practice using the mechanical aids that you will need when
visitors future disabilities arise.” 41. Patients with myasthenia gravis usually experiences fatigue
B. Providing positive feedback and encouraging active range of B. “Keep active, use stress reduction strategies, and avoid during which time? *
motion fatigue.” A. Early in the morning and late in the day
C. Providing information, giving positive feedback, and C. “You will need to accept the necessity for a quiet and B. Early in the morning and before lunch
encouraging relaxation inactive lifestyle.” C. Following exertion and at the end of the day
D. Providing intravenously administered sedatives, reducing D. “Follow good health habits to change the course of the D. Before meals and at the end of the day
distractions, and limiting visitors disease.”
42. Which CSF finding from a lumbar tap would most likely
32. A nurse reviews the medication, baclofen, taken by the 37. When caring for a client with myasthenia gravis (MG), confirm diagnosis of bacterial meningitis? *
client who has multiple sclerosis. What should the nurse ask the which of the following signs and symptoms indicate a A. Cloudy CSF with low protein and low glucose
client to determine the drug effectiveness? * cholinergic crisis? Select all that apply.I. Decreased secretions B. Cloudy CSF with high protein and low glucose
A. “Are you having trouble with spasms?” and salivaII.PtosisIII.RR of 6 breaths/min with irregular C. Clear CSF with low protein and low glucose
B. “Does your urine look clear and not infected?” rhythmIV.FasciculationV. Abdominal crampsVI. Increased D. Decreased pressure and cloudy CSF with high protein
C. “How has your appetite been?” HR *
43. A nurse is admitting a client with a diagnosis of meningitis.
D. “Are you having any difficulty with having regular bowel A.I, II, III
The nurse expects to assess which of the following
movements?” B.II, IV, VI
manifestations? SELECT ALL THAT APPLY.I.Severe
C. II, III, IV
33. The nurse administering methocarbamol IV to a client with headacheII.Nuchal
D. II, III, V
multiple sclerosis knows that the side/ adverse effect he should rigidityIII.PhotophobiaIV.MicrographiaV.FeverVI.Pill-rolling
monitor for is? * 38. After teaching a client about MG, the nurse would know tremor *
A. Tachycardia that the client has formed a realistic concept of her health A. I, II, III, VI
B. Rapid pulse problem when she says that by taking her medication and B. II, III, IV
C. Bradycardia pacing her activities,: * C. I, II, III, V
D. Hypertension A. She can control her symptoms and eventually cure the D. I, II, IV, V
disease
34. Which of the following is not a typical clinical 44. Which finding would indicate the presence of Kernig’s
B. She should be able to control the disease and enjoy a healthy
manifestation of multiple sclerosis? * sign? *
lifestyle
A. The inability of the child to extend the legs fully when lying apply.I. Administer oxygen and prepare for endotracheal
supine intubation.II.Administer dexamethasone
B. The flexion of the hips when the neck is flexed from a lying intravenously.III.Prepare for immediate
position defibrillation.IV.Continue to protect the patient from
C. Calf pain when the foot is dorsiflexed injury.V.Administer lorazepam IV.VI.Transfer to a facility with
D. Pain when the chin is pulled down to the chest expertise in treating status epilepticus. *
A. II, III, IV, V
45. The nurse is evaluating the status of a client who had a B. I, II, IV V, VI
craniotomy 3 days ago. Which assessment finding would C. II, III, V, VI
indicate that the client is developing meningitis as a D. I, IV, V
complication of surgery? *
A. Positive Brudzinski sign 50. A client with epilepsy is prescribed with phenytoin sodium
B. Negative Kernig’s sign 100 mg 3 times per day orally as part of his anticonvulsant
C. GCS score of 15 therapy. The most precise method for a nurse to determine if
D. A & B this is the proper dose for the client is: *
A. monitoring serum phenytoin levels.
46. A client who has meningococcal meningitis is at risk for the B. observation of the client for seizures.
complication of septic emboli. Which intervention by a nurse C. observation of the client for adverse effects.
will directly address this risk? * D. determining whether the client is able to participate in usual
A. Assessing neurological function with the Glasgow coma activities.
scale every 2 hours
B. Completing a vascular assessment of all extremities every 2
hours
C. Monitoring vital signs on an hourly basis
D. Administering meningitis polysaccharide vaccine.

47. A client is admitted to an emergency department (ED). A

nurse in the ED documents that the client is “postictal upon
transfer” as evidenced by which observation? *
A. Recently experienced a seizure and is in a drowsy or
confused state
B. Severe itching of the eyes
C. Abnormal sensations including tingling of the skin
D. Yellowing of the skin

48. Which notation is a nurse most likely to document in the

client’s medical record about the postictal period? *
A. Whether the client experienced an “aura”
B. What the client was doing immediately preceding the
seizure
C. What the condition of the client was immediately following
the seizure
D. Where the tonic-clonic activity started and how long the
client was unresponsive

49. Which interventions should be included in the immediate

treatment of a patient with status epilepticus?Select all that