1. A client has undergone a lumbar laminectomy with spinal fusion 12 hours earlier.

Which findings would indicate that there is leakage of the (CSF)?

A.Clear fluid drainage noted on the surgical dressing
B. Backache not relieved by analgesics
C. 100 mL of serosanguineous fluid measured from the Jackson-Pratt® drain since surgery
D. Temperature of 38.5°C
2. A patient with left-sided weakness and slurred speech is brought to the emergency room. He is diagnosed with an ischemic stroke and is evaluated for
treatment with thrombolytic therapy. A definite contraindication for thrombolytic therapy is:
A. a normal computed tomography (CT) scan of the brain.
B. the onset of neurological deficits 2 hours earlier.
C. a history of diabetes mellitus.
D. a serious head injury 4 weeks earlier.
3. What is the primary goal during the first 24 hours after thrombolytic treatment for a client with ischemic stroke? It is to control the client's:
A.Pulse
B.Respirations
C.Blood pressure
D. Temperature
4. The nurse understands that frequent assessments are used to determine if a client is developing increased intracranial pressure (ICP). Which among the
following is the outcome if ICP is untreated and progresses?
A. Improved brain tissue oxygenation
B. Increase in cerebral circulation and perfusion
C. Increase in serum pH
D. Displacement of brain tissue
5. A client who receives a diagnosis of right-sided stroke should be assessed for risk factors of stroke during the initial hospitalization, and measures should be
instituted to lessen the client’s risk. A nurse should address these risk factors as a priority and institute measures because of which reasons?
I. one of every four strokes occurs as a recurrent stroke. A. II, III, IV, V
II. controlling modifiable risk factors is too difficult for persons who have already experienced a stroke. B. I, III, V, VI
III. the resultant deficit will cause the client to deny or minimize that there is a problem. C. I, IV, V
IV. the time period of greatest risk for a second stroke is the first 30 days after ischemic symptoms occur. D. All of the above
V. most stroke victims develop depression and less interest in learning preventive measures as the recovery process lengthens.
VI. the potential for recovery continues for at least 6 months after the initial stroke event.
6. A patient with history of stroke stares at a nurse but does not attempt to verbally respond to the nurse’s questions; however, he follows instructions without
any problems. These symptoms are consistent with:
A. receptive aphasia.
B. expressive aphasia.
C. global aphasia.
D. both receptive and expressive aphasia.
7. A client is admitted to the intensive care unit after a severe stroke. The client is receiving a continuous intravenous insulin infusion titrated according to hourly
blood glucose results to control hyperglycemia. The client’s spouse asks the nurse why the client is receiving insulin when the client is not diabetic. The nurse
correctly explains by including which of the following statements? SELECT ALL THAT APPLY.
I. “The body reacts to stress by producing various hormones, which results in elevated glucose levels.” A. I, II, III
II. “Use of insulin will decrease the likelihood of the client becoming diabetic in the future.” B. I, III, IV
III. “The stroke affected the part of the brain that controls the release of insulin.” C. I, IV, VI
IV. “The body has less effective utilization of glucose during serious illness.” D. II, IV, VI
V. “A side effect of the medications administered is the development of type 1 diabetes mellitus.”
VI. “Insulin lessens the likelihood of brain tissue becoming swollen.
8. A client with a deteriorating mental status after suffering a stroke has a rectal temperature of 39.1°C. What is the purpose of maintaining the client in a normal
temperature?
A. A normal temperature will decrease the score on the Glasgow coma scale.
B. A normal temperature will strengthen the client’s immune system against infection.
C. Hyperthermia lowers the incidence of mortality.
D. Hyperthermia increases the likelihood of a larger area of brain infarct.
9. What is the earliest sign of increased ICP?
A. altered sensation.
B. drop in the blood pressure.
C. pupillary changes.
D. changes in the level of consciousness.
10. An ICU nurse is orienting a new nurse to a unit. The experienced ICU nurse evaluates that the new nurse has correct understanding of the concepts of a
stroke resulting from a subarachnoid hemorrhage when which points are addressed by the new nurse? SELECT ALL THAT APPLY.
I. Subarachnoid hemorrhage often results in bloody cerebrospinal fluid (CSF).
II. Subarachnoid hemorrhage is often associated with a rupture of a cerebral aneurysm. A. I, II, IV, V
III. Subarachnoid hemorrhage may be treated with thrombolytic therapy if no contraindications exist. B. I, II, III, V
IV. Subarachnoid hemorrhage usually occurs while the client is sleeping and is noticed when the client awakens. C. I, II, V, VI
V. Subarachnoid hemorrhage is accompanied by complaints of an extremely severe headache. D. I, II, III, VI
VI Subarachnoid hemorrhage causes nuchal rigidity.
11. A post-craniotomy client is receiving mannitol to decrease his ICP. Which dx lab value should be monitored while the client is receiving this medication?
A.Serum cholesterol
B. Serum osmolarity
C. White blood cell (WBC) count
D. Erythrocyte sedimentation rate (ESR)
12. The nurse provides oral hygiene for a client who has had a stroke by doing the following, except?
A. Place the client on the back with a small pillow under the head.
B. Keep portable suctioning equipment at the bedside
C. Open the client's mouth with a padded tongue blade
D. Clean the client's mouth and teeth with a toothbrush.
13. In changing the position of client with hemiparalysis, which of the following techniques should the nurse not perform?
A. Rolling the client onto his side
B.Having the client help lift off the bed using trapeze
C.Sliding the client to move up in bed
D. Lifting the client when moving the client up in bed
14. A nurse is teaching a client who had a stroke about ways to adapt to a visual disability. Which does the nurse identify as the primary safety precaution
A.Turn the head from side to side when waling
B.Wear a patch over one eye
C.Place personal items on the sighted side
D.Lie in bed with the unaffected side toward the door
15. A client seeks medical attention from a primary care provider after experiencing muscle weakness. The client asks a nurse during the initial assessment if the
symptoms suggest “Lou Gehrig’s” disease. The nurse correctly responds by stating which of the following?
A.“You may have been working too much and that is why you are tired. Let’s not think the worst.”
B. “Have you been having trouble remembering things along with this weakness?”
C. “Well, you are in the right place to figure out what is going on.”
D. “Tell me what has you thinking that you might have Lou Gehrig’s disease.”
16. Due to upper and lower motor neuron affectations, patients with amyotrophic lateral sclerosis or ALS experience the following early manifestations, except:
A. Fasciculations of the face
B. Dysphagia
C. Weakness of the hands and arms
D. Muscle hypertrophy of the arms
17. What is the common cause of death of patients with ALS?
A. Malnutrition
B. Hypovolemia
C. Respiratory failure
D. Metabolic acidosis
18. An elderly client with Parkinson’s disease is prescribed with levodopa and carbidopa (Sinemet). Which point should a nurse include in the teaching plan for
the client and spouse?
A. The medication should not be taken with food.
B. The client should stop taking multiple vitamins.
C. The medication has very few adverse effects.
D. The client is at increased risk for falls due to dizziness and orthostatic hypotension.
19. Which of the following is an initial sign of Parkinson's disease?
A. Tremor
B. Rigidity
C. Bradykinesia
D. Akinesia
20. The nurse is developing a teaching plan for a client newly diagnosed with Parkinson's disease. Which of the following topics that the nurse plans to include in
his teaching is the most important?
A. Engaging in diversional activity
B. Maintaining a balanced nutritional diet.
C. Enhancing the immune system.
D. Maintaining a safe environment.
21. What is the most realistic goal is for a client with Parkinson's disease?
A.To cure the disease
B. To stop the progression of the disease
C. To begin preparations for terminal care
D. To maintain optimal body function
22. Which of the following goals is collaboratively established by the client with Parkinson's disease, nurse, and physical therapist?
A.To build muscle strength
B. To maintain joint flexibility
C. To improve muscle endurance
D. To reduce ataxia
23. A client with Parkinson’s disease has begun taking his levodopa. The client knows that the effects of this drug may not be apparent for what period of time?
A. 2-3 weeks C. 24 hours
B. 5-7 days D. 1 week
24. A nurse is caring for a client who states, “Lately I’m getting forgetful about things. I’m so afraid I’m getting Alzheimer’s disease.” Which response by the
nurse is most therapeutic?
A. “Although it’s not unusual to experience some lapses of memory, let’s discuss your concerns.”
B. “Oh, what you are describing isn’t Alzheimer’s disease. It’s much more complicated than that.”
C. “Now, I don’t think we really need to discuss this. I’m sure it is just normal aging.”
D. “I’m forgetful, too. I have to make lists to remember everything.”
25. A home health nurse caring for a client diagnosed with Alzheimer’s disease is attempting to determine whether the client’s daughter understands the client’s
prognosis. Which of the daughter’s questions to the nurse will most accurately assess the daughter’s understanding of Alzheimer’s disease and its prognosis?
A. “Which local hospital has the best treatment program?”
B. “What can we do to improve our father’s memory?”
C. “What types of support services are available?”
D. “How long does it take for his medication to help?”
26. An older client diagnosed with Alzheimer’s disease becomes agitated and insists that he must “go and clean out the barn.” Which nursing response is most
therapeutic?
A. “It’s awfully hot today; maybe you should wait until tomorrow.”
B. “What makes you think that the barn needs to be cleaned?”
C. “So you’ve cleaned a barn. Tell me, did you live on a farm?”
D. “There are no barns around here. Would you like something to eat?”
27. While taking the history of a client diagnosed with Guillain-Barre syndrome (GBS), the nurse should ask the family if the client has recently experienced
which physical problem?
A Meningitis C. A respiratory or gastrointestinal infection
B. Seizures or head trauma D. A back injury or spinal cord trauma
28. What is the purpose of plasmapheresis in clients with GBS?
A. infuse lipoproteins to restore the myelin sheath.
B. remove excess fluid from the bloodstream.
C. remove circulating antibodies from the bloodstream.
D. restore protein levels in the blood.

29. What severe complication is associated with Guillain-Barré syndrome?

A.Respiratory failure
B. Autonomic dysreflexia
C. Septic emboli
D. Increased intracranial pressure (ICP)
30. The patient brought to the Emergency Room has a chief complaint of an ascending paralysis that has reached the level of the waist. He was diagnosed to
have GBS. Which items should the nurse plan to have available for emergency use?
A. Nebulizer and pulse oximeter
B. Cardiac monitor and intubation tray
C. Blood pressure cuff and flashlight
D. Flashlight and incentive spirometer
31. A client with GBS is intubated and receiving mechanical ventilation. Which strategy should the nurse incorporate in the plan of care to help the client cope
with this illness?
A. Giving client full control over care decisions and restricting visitors
B. Providing positive feedback and encouraging active range of motion
C. Providing information, giving positive feedback, and encouraging relaxation
D. Providing intravenously administered sedatives, reducing distractions, and limiting visitors
32. A nurse reviews the medication, baclofen, taken by the client who has multiple sclerosis. What should the nurse ask the client to determine the drug
effectiveness?
A. “Are you having trouble with spasms?”
B. “Does your urine look clear and not infected?”
C. “How has your appetite been?”
D. “Are you having any difficulty with having regular bowel movements?”
33. The nurse administering methocarbamol IV to a client with multiple sclerosis knows that the side/ adverse effect he should monitor for is?
A. Tachycardia
B. Rapid pulse
C. Bradycardia
D. Hypertension
34. Which of the following is not a typical clinical manifestation of multiple sclerosis?
A. Weakness of extremities
B. Double vision
C. Sudden bursts of energy
D. Muscle tremors
35. A client spills her coffee twice at lunch and cannot get her dress fastened securely because of the tremors she experiences with her right hand during
voluntary actions. Which is the best legal documentation in nurses' notes of the chart for this client assessment?
A. “Slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup.”
B. “Has an intention tremor of the right hand.”
C. “Right-hand tremor worsens with purposeful acts.”
D. “Needs assistance with dressing and eating due to severe trembling and clumsiness.”
36. What should a nurse include in his discharge teaching for a client with multiple sclerosis?
A. “Practice using the mechanical aids that you will need when future disabilities arise.”
B. “Keep active, use stress reduction strategies, and avoid fatigue.”
C. “You will need to accept the necessity for a quiet and inactive lifestyle.”
D. “Follow good health habits to change the course of the disease.”
37. When caring for a client with myasthenia gravis (MG), which of the following signs and symptoms indicate a cholinergic crisis? Select all that apply.
I. Decreased secretions and saliva
II.Ptosis A.I, II, III
III.RR of 6 breaths/min with irregular rhythm B.II, IV, VI
IV.Fasciculation C. II, III, IV
V. Abdominal cramps D. II, III, V
VI. Increased HR
38. After teaching a client about MG, the nurse would know that the client has formed a realistic concept of her health problem when she says that by taking her
medication and pacing her activities,:
A. She can control her symptoms and eventually cure the disease
B. She should be able to control the disease and enjoy a healthy lifestyle
C. She will live longer, but ultimately the disease will lead to death
D. Her fatigue will be relieved but occasional periods of muscle weakness are expected
39. A client with refractory myasthenia gravis (MG) undergoes plasmapheresis therapy. The therapy effectiveness would be evident in the improvement of which
parameter?
A.Diplopia
B. Ptosis
C. Vital capacity
D. Leg strength
40. What is a safe practice in administering pyridostigmine to a client with MG?
A.Asking the client to look up at the ceiling for 30 seconds
B.Asking the client to lie down on her right side
C.Asking the client to take sips of water
D.Instructing the client to void before taking the medication
41. Patients with myasthenia gravis usually experiences fatigue during which time?
A. Early in the morning and late in the day
B. Early in the morning and before lunch
C. Following exertion and at the end of the day
D. Before meals and at the end of the day
42. Which CSF finding from a lumbar tap would most likely confirm diagnosis of bacterial meningitis?
A. Cloudy CSF with low protein and low glucose
B. Cloudy CSF with high protein and low glucose
C. Clear CSF with low protein and low glucose
D. Decreased pressure and cloudy CSF with high protein

43. A nurse is admitting a client with a diagnosis of meningitis. The nurse expects to assess which of the
following manifestations? SELECT ALL THAT APPLY.
I.Severe headache A. I, II, III, VI
II.Nuchal rigidity B. II, III, IV
III.Photophobia C. I, II, III, V
IV.Micrographia D. I, II, IV, V
V.Fever
VI.Pill-rolling tremor
44. Which finding would indicate the presence of Kernig’s sign?
A. The inability of the child to extend the legs fully when lying supine
B. The flexion of the hips when the neck is flexed from a lying position
C. Calf pain when the foot is dorsiflexed
D. Pain when the chin is pulled down to the chest
45. The nurse is evaluating the status of a client who had a craniotomy 3 days ago. Which assessment finding would indicate that the client is developing
meningitis as a complication of surgery?
A. Positive Brudzinski sign
B. Negative Kernig’s sign
C. GCS score of 15
D. A & B
46. A client who has meningococcal meningitis is at risk for the complication of septic emboli. Which intervention by a nurse will directly address this risk?
A. Assessing neurological function with the Glasgow coma 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 apply.
I. Administer oxygen and prepare for endotracheal intubation. A. II, III, IV, V
II.Administer dexamethasone intravenously. B. I, II, IV V, VI
III.Prepare for immediate defibrillation. C. II, III, V, VI
IV.Continue to protect the patient from injury. D. I, IV, V
V.Administer lorazepam
VI.Transfer to a facility with expertise in treating status epilepticus.
50. A client with epilepsy is prescribed with phenytoin sodium 100 mg 3 times per day orally as part of his anticonvulsant therapy. The most precise method for a
nurse to determine if this is the proper dose for the client is:
A. monitoring serum phenytoin levels.
B. observation of the client for seizures.
C. observation of the client for adverse effects.
D. determining whether the client is able to participate in usual activities.