You are on page 1of 16

ST.

DOMINIC COLLEGE OF ASIA
NCM 104 SECTION A (SUMMATIVE TEST – PRELIM)
1. A 65-year-old right-handed man presents to the emergency department (ED) for evaluation of a possible transient ischemic attack. He reports right arm weakness and unsteady walking. The patient also states that he had difficulty speaking for 10 minutes on the previous day. A computed tomography (CT) angiogram reveals 60% and 80% stenosis of the right internal carotid artery and left middle cerebral artery, respectively. He takes no medications. In addition to assessing relevant risk factors, which intervention is most appropriate at this time? A. Initiate aspirin B. Initiate aspirin-dipyridamole and refer for carotid endarterectomy (CEA) C. Initiate clopidogrel and refer for intracranial angioplasty and stenting D. Initiate warfarin E. Refer for intracranial angioplasty and stenting 2. A 75-year-old woman presents to the ED with abrupt onset of left-sided weakness that began 1 hour ago. Assuming all imaging tests are immediately available and there are no contraindications to the following imaging modalities, which test should initially be performed in routine clinical care? A. CT angiogram of the head and neck B. CT scan of the head without contrast C. Magnetic resonance image (MRI) of the brain D. MRI of the brain and magnetic resonance angiogram (MRA) of the head and neck 3. A 57-year-old woman presents to the ED 45 minutes after the onset of severe expressive aphasia, right hemiparesis, and hemisensory loss. Her National Institutes of Health Stroke Scale (NIHSS) score is 16. Past medical history is significant for coronary artery disease, coronary angioplasty and stent placement 4 years ago, and surgery on her left foot 5 days ago. On initial presentation, the patient’s blood pressure was 190/100 mm Hg and is now 170/90 mm Hg. The patient reports taking aspirin and clopidogrel for coronary artery disease. Emergent laboratory studies, electrocardiogram, and CT scan of the head performed over the next half hour are normal. After the initial evaluation and testing, the patient’s symptoms improve to a NIHSS score of 3. Which of the following is a contraindication to this patient receiving intravenous (IV) recombinant tissue plasminogen activator (rt-PA)? A. Current use of aspirin and clopidogrel B. Fluctuating blood pressure readings between 190/110 and 170/90 mm Hg C. NIHSS score of 3 D. Rapidly resolving symptoms E. Recent minor surgery Situation: Questions for 4 and 5. A 50-year-old woman with no past history of venous or arterial thrombosis presents to the ED with acute-onset left hemiparesis. The patient takes lisinopril for hypertension and a daily multivitamin. Brain MRI confirms an infarct in the right frontal lobe. MRA of the head and neck is normal. Cardiac rhythm on Holter monitor is also normal. Hypercoagulability studies are unremarkable. The patient is scheduled for echocardiography. 4. For an accurate diagnosis, which of the following stroke-associated cardiac conditions requires transesophageal echocardiography (TEE) rather than transthoracic echocardiography (TTE)? A. Dilated cardiomyopathy B. Interatrial shunt C. Left atrial thrombus D. Left ventricular thrombus E. Valvular vegetation 5. A small patent foramen ovale (PFO) is discovered on echocardiography. Minimal right to left shunting is seen only on Valsalva maneuver. Which of the following is the most appropriate treatment for this patient?

The patient averages approximately 3 to 4 seizures per month. These EEG findings are most likely to result from infection by what organism? A. The patient stops seizing with institution of anticonvulsant therapy. Fresh frozen plasma B. What is the most appropriate next step in the management of this patient? A. All of the following are indicated in the management of this patient EXCEPT A. Initiate warfarin with a target international normalized ratio (INR) of 1. A friend observed the patient suddenly falling at home and convulsing for 45 seconds. Initiate aspirin 325 mg/day B. 32 red blood cells. She has had neck stiffness and fever for the past several days and has been somewhat confused and not “acting like herself.5 C. Blood pressure is 195/120 mm Hg.A. Partial seizures originating in the temporal lobe . Obtain an EEG and a neuroimaging study C. the patient was lethargic for 15 minutes but then recovered completely without residual neurologic deficit. Initiate warfarin with a target INR of 2 to 3 6. Initiate warfarin with a target INR of 1. Phenobarbital 20 mg/kg IV C. Afterwards. Cytomegalovirus C. She sustained a tongue bite during the seizure and was incontinent of urine. Cryptococcus neoformans B. Prothrombin time is elevated beyond therapeutic range. Initiate an antiepileptic drug B. and a glucose level of 65 mg/dL. and analysis of the cerebrospinal fluid (CSF) reveals 9 white blood cells with a lymphocytic predominance. A 66-year-old man with a history of atrial fibrillation presents to the ED with acute onset of right-sided weakness and sensory loss that occurred 25 minutes prior to presentation. What is this patient’s most likely diagnosis? A.1 mg/kg intravenously (IV) B. Atypical absence seizures B. Partial seizures originating in the frontal lobe D.5 and refer for PFO closure E. Phenytoin Situation: A 28-year-old woman is brought to the emergency department (ED) by ambulance after she developed a generalized convulsive seizure at home. Emergent noncontrast CT scan of the head is performed (Figure). A 21-year-old woman presents to the ED after experiencing a first-time convulsive seizure. and heart rate is irregular at approximately 90 bpm. 7. a protein level of 63 mg/dL. IV labetalol D. 10. Perform a lumbar puncture for CSF analysis Situation: A 25-year-old man presents to the neurologist for follow-up evaluation of epilepsy that started in his teens. Insulin C. Myoclonic absence seizures C.5 to 2. His seizures are preceded by a warning of déjà vu and a rising abdominal sensation.” The patient is still convulsing when she arrives in the ED 20 minutes later. IV vitamin K E. Phenytoin 7 mg/kg IV D.5 to 2. Streptococcus pneumoniae 9. Phenytoin 20 mg/kg IV 8. Initiate warfarin with a target INR of 1. Which anticonvulsant should be used to treat this patient? A. Herpes simplex virus (HSV) D.5 to 2. He is alert and swallows normally. A lumbar puncture is emergently performed. Lorazepam 0. The patient currently takes warfarin.5 and aspirin 81 mg/day D. followed by lip smacking and speech arrest for 1 to 2 minutes and then postictal disorientation and amnesia. Obtain a serum neuron-specific enolase level D. Serum glucose level is 358 mg/dL. An electroencephalogram (EEG) shows sharp wave discharges in the temporal lobes but no electrographic seizures.

On examination. Discontinue valproate sodium and monitor for seizure recurrence B. the patient states that she wants to stop birth control and start a family. A second seizure occurred 6 months later. hoping that symptoms would improve. Administer a different antiepileptic B. The patient states that his right leg suddenly became weak while walking and he had great difficulty being helped to a chair. but they have not. Her first seizure was a generalized tonic-clonic seizure that occurred on awakening from sleep 2 years ago. Noncontrast computed tomography (CT) of the head performed within 30 minutes of arrival in the ED reveals no acute findings. and chronic neck and low back pain for the past 5 years. Previous medications have included carbamazepine. What is the most appropriate next step in this patient’s treatment? A. What is the most appropriate next step in this patient’s care? A. hypertension. There is no interaction between valproate sodium and oral contraceptive pills 13. Obtain an EEG D. Two EEGs and an MRI of the brain were unremarkable. Acute compression fracture of the L2 vertebral body C. Refer to an epilepsy surgery center Situation: A 23-year-old woman with a history of epilepsy is in a new relationship and seeks advice about birth control. magnetic resonance imaging (MRI) of the brain showed a discrete lesion that was compatible with mesial temporal sclerosis (Figure).11. He has not taken any medications for the past month due to financial hardship. has mild weakness in the right arm. Add a second antiepileptic drug since pregnancy may affect seizure control B. Acute left anterior cerebral artery (ACA) stroke D. Insert a vagal nerve stimulator C. but the patient continues to have frequent seizures. Intravenous (IV) ketorolac 30 mg . Three years later. alone and in combination. Acute C6-C7 disk herniation B. the patient is profoundly weak with all movements of the right leg. She has not had any seizures and remains on valproate sodium. and topiramate. 12. Discontinue valproate sodium and monitor for seizure recurrence D. He delayed seeking medical help. Take a birth control formulation containing at least 50 μg of ethinyl estradiol C. Acute left middle cerebral artery stroke 15. She has considered many available options and conveys that her preferred method of birth control is a combined oral contraceptive pill. Continue valproate sodium and begin folic acid supplementation C. what is the most appropriate treatment? A. Obtain a repeat EEG and MRI to help guide decisions on continued use of valproate sodium prior to pregnancy Situation: A 62-year-old man presents to the emergency department (ED) for evaluation of leg weakness that started 4 hours prior to arrival. What is this patient’s most likely diagnosis? A. 14. Assuming that the patient’s reported medical history is complete and accurate. An electrocardiogram shows normal sinus rhythm. Which of the following is an appropriate recommendation regarding birth control in this patient? A. Past medical history is significant for a heart attack 3 years ago. valproate sodium. Aspirin 325 mg B. Take a progesterone-only pill instead D. type 2 diabetes mellitus. Coordination and gait seem to be limited by his weakness. hyperlipidemia. and has sensory loss over the entire right leg. Two years prior. She was started on valproate sodium and has since been seizure-free.

hypertension. He has not taken any medications for the past month due to financial hardship. She has an 18-year history of multiple sclerosis (MS). type 2 diabetes mellitus. IV dexamethasone 24 mg C. On examination. describes feeling feverish overnight. hypertension. He reports chronic neck and low back pain for the past 5 years. and lung cancer. What is this patient’s most likely diagnosis? A. Glatiramer is her only medication. She has new urinary incontinence.9 mg/kg as 10% dose bolus then infusion D. A relapse 2 years ago caused profound weakness in her legs. He has slight sensory loss over the dorsum . Change from glatiramer to high-dose interferon beta-1a D. Past medical history is significant for a heart attack 3 years ago. After 15 minutes. T10 vertebral body metastatic lesion causing epidural spinal cord compression 18. low back pain for the past 5 years due to degenerative disk disease. IV alteplase 0. An evaluation 3 months ago revealed no evidence of metastatic disease. but it was difficult. The patient also describes increasing pain in his mid-back over the past few weeks. How should this patient be treated? A. symptoms had not improved. He has diminished sensation from the level of the umbilicus down. he has complete inability to dorsiflex or evert the right foot but normal strength elsewhere. but after months of physical therapy. Two hours prior to arrival. He denies any pain accompanying these symptoms. hyperlipidemia. Magnetic resonance imaging (MRI) of the spine with and without contrast is performed (Figure). A 62-year-old man presents to the ED for evaluation of right leg weakness. IV heparin drip with weight-based dosing to the therapeutic partial thromboplastin time goal 16. When the patient awoke. the patient is profoundly weak with all movements of both legs but has no weakness in his arms. which is not relieved by pain medication. the patient fell asleep in a chair with his legs crossed while watching television. CT of the spine with and without contrast B. What is the most appropriate next step in this patient’s management? A. hyperlipidemia. IV methylprednisolone 250 mg every 6 hours for 3 days Situation: A 62-year-old man presents to the ED for evaluation of a 1-day history of leg weakness. and he had to be helped back to his chair by his wife. MRI of the spine with and without contrast D. She now describes worsening weakness in her legs over the last 24 hours similar to that experienced during the relapse 2 years ago. Coordination and gait seem to be limited by his weakness. He reports weakness in both legs while walking. type 2 diabetes mellitus. Past medical history is significant for a heart attack 3 years ago. L2 vertebral body metastatic lesion causing epidural cauda equina compression C. and he now needs help standing up from a seated position. A 43-year-old woman presents to the ED for evaluation of weakness in both legs. Acute C6-C7 disk herniation B. and sciatica in the right lower extremity. he realized that his right leg had become weak. Transverse myelitis at the T9 level of the spinal cord D. He tried walking. Reflexes are brisk in the legs and Babinski’s sign is present in both feet. 17. she was able to ambulate steadily with a walker. and is preoccupied with an intense ache in her left flank that has been present for the last 2 days. and she has had several clinical relapses.C. Antibiotics for treatment of a UTI and concurrent IV methylprednisolone 250 mg every 6 hours for 3 days C. On examination. Antibiotics for treatment of a urinary tract infection (UTI) B. Neurosurgical consultation for immediate surgical management 19.

He first noticed the tremor 9 months ago. Family history is significant for dementia at young age and suicide. Parkinson’s disease 27. bradykinesia. the patient has resting tremor with rigidity that is worse on the left side and decreased facial expressions. mostly when he is at rest. but he has generalized rigidity (mostly axial). What is the patient’s most likely diagnosis? A. Parkinson’s disease 25. All of the following are appropriate treatment options for this patient EXCEPT A. Symptoms may improve with alcohol intake D. Laboratory tests. What is this patient’s most likely diagnosis? A. Which of the following movement disorders persists during sleep? A. Tremor is typically postural and kinetic 26. What is this patient’s most likely diagnosis? A. Multiple system atrophy C. Rigidity D. Duloxetine C. Progressive supranuclear palsy 24. Selegiline 23. including complete blood count C. Gait is affected by a right foot drop. Huntington’s disease C. increased gag reflex. Trauma history 21. A 72-year-old man presents to the emergency department after a fall. Corticobasal degeneration B.of the right foot. he has no tremor. 20. Parkinsonism-dementia-amyotrophic lateral sclerosis D. Magnetic resonance imaging (MRI) reveals atrophy of the caudate nucleus. HIV history B. All of the following are cardinal features of Parkinson’s disease EXCEPT A. Essential tremor B. Corticobasal degeneration B. Pressure palsy (neurapraxia) of the right peroneal nerve Situation: A 56-year-old man with a history of hypertension presents to the clinic with complaints of progressive hand tremor. Alien limb phenomenon is typically seen in which of the following disorders? A. Huntington’s disease C. Rapid alternating movements are slow on the left side. Paranoid schizophrenia . On examination. All of the following statements regarding essential tremor are correct EXCEPT A. Multiple system atrophy D. Manganese exposure D. Amantadine B. On examination. Tremor 22. All of the following may help to identify this patient’s diagnosis EXCEPT A. Essential tremor is the most common adult-onset movement disorder B. A 37-year-old man presents to the clinic with clumsiness and infrequent jerking of all limbs. Lacunar infarct in the left internal capsule D. Dementia with Lewy bodies B. L5 vertebral body compression fracture C. Essential tremor is secondary to decreased dopaminergic neurotransmission in the basal ganglia C. Pramipexole D. Palatal tremor D. Huntington’s disease C. Flare of right lower extremity sciatica B. and difficulty with vertical gaze. Sporadic Parkinson’s disease is suspected. He states that he has fallen frequently over the past 8 months. Dementia B. The patient is left-handed. Postural instability C. He has a recent history of admission to the psychiatry unit for paranoia.

What test is most likely to be diagnostic in this child? A. The patient’s symptoms started 1 year ago. and lurching gait. past-pointing on finger-nose-finger test. Physical examination shows dysarthric speech. Which of the following medications is the most appropriate for the long-term management of the patient’s visual hallucinations and agitation? A. Lipid panel. disorganization on rapid pronation-supination of the hand. she wakes up normal. Vomiting also helps relieve symptoms transiently. Quetiapine D. If she falls asleep after onset of an attack.” looks scared. Physical examination reveals tremor and rigidity. and 6 months later.” She will grab at the walls. the patient started to have fluctuating cognitive impairments. She has these episodes about once every few weeks to few months. A 4-year-old girl presents for involuntary writhing movements in her arms with small. Her parents have noticed that sometimes with an attack. and. past-pointing on finger-nose-finger test. Thioridazine 30. Strength is intact. Dementia with Lewy bodies D. Frontal lobe epilepsy 33. Physical examination is normal. Urinary copper excretion 31. Plasma amino acids and urine organic acids 34. but he cannot balance while standing. What is this child’s most likely diagnosis? A. Magnetic resonance imaging (MRI) of the brain and lumbar puncture B. her eyes will appear to “wobble. He has mild nystagmus on lateral gaze bilaterally. What is this child’s most likely diagnosis? A. Benign paroxysmal positional vertigo B. forced . Miller Fisher syndrome D. Developmental milestones are normal. but he is otherwise healthy. jerky and illegible handwriting. and his gait is wildly lurching. An 11-year-old boy still cannot ride a bike and has become increasingly clumsy over the past 4 to 5 years. Biopsy of the liver B. Ependymoma D. and turns pale. Alzheimer’s disease B. Haloperidol C.D. Acute postinfectious cerebellitis B. in between which she is normal. she “walks like she’s drunk. superimposed twitches. Benign paroxysmal vertigo (BPV) of childhood C. Computed tomography C. Wilson’s disease is most accurately diagnosed with which of the following? A. and normal reflexes. grab at the floor. On examination. 28. Corticobasal degeneration C. apolipoproteins A and B C. Multiple sclerosis 32. Tardive dyskinesia Situation: A 72-year-old woman is admitted to the psychiatry unit with agitation and visual hallucinations. Physical examination shows hypometric saccades. Medulloblastoma C. She has a history of asthma and frequent pneumonia and sinusitis. Test for trinucleotide repeat of FRDA gene D. he looks scared but is well-spoken and cooperative. During these attacks. MRI D. when on the floor. but there is no loss of consciousness. A 6-year-old boy awakens in his normal state. A distant uncle was also clumsy and died in young adulthood of heart disease. Deep tendon reflexes are not elicitable. Chlorpromazine B. A 2-year-old girl has sudden attacks of falling multiple times a day. head thrusts with visual tracking. random. Which of the following is this patient’s most likely diagnosis? A. Multi-infarct dementia 29. He developed chicken pox 10 days ago. but by noon becomes so unsteady that he cannot walk.

A 67-year-old man with no significant past medical history. she is easily engaged. and confrontational naming. visuospatial function. who reports that over the past 2 years her mother has had slowly progressing forgetfulness of recent conversations and events. A mild form of a primary neurodegenerative cognitive disorder E. but she enjoys her grandchildren. neuropsychological (NP) testing reveals deficits only in learning and recall of new information. slowness of thought and general movements. She has been widowed for 3 years and is a nonsmoker. 35. and magnetic resonance imaging (MRI) of the brain shows mild age-appropriate general cerebral atrophy and mild leukoaraiosis. Chest radiograph C. Urine for catecholamines Situation:A 76-year-old retired English professor is brought to the clinic by her daughter. Normal aging B.” Her past medical history is significant for hypertension. Results of laboratory tests and brain MRI are unremarkable. and manages her own finances. The patient denies being depressed or forgetful but admits to “occasional senior moments. NP testing and examination show preserved memory function but moderate executive and visuospatial dysfunction. periods of confusion lasting minutes to hours. family history. balancing her checkbook. Mild cognitive impairment (MCI)-amnestic type C. What is the most likely primary cause of this patient’s presentation? A. Mini-Mental State Exam (MMSE) score is 27/30 (-2 item recall. Vitamin B12 deficiency D. Combination of vitamin B12 deficiency and chronic excessive alcohol intake 38.blinking to initiate saccades. and has normal affect and mood. Which of the following diagnoses would be consistent with this presentation? A. NP testing shows not only deficits in new learning and remembering but also mild deficits in executive function. She also appears more withdrawn and less interested in longstanding social activities. Her family history is significant for “senility” (mother) and stroke (brother). Alzheimer’s disease (AD) B. has sharp social wit. Skin examination shows telangiectasias on the bulbar conjunctivae. truncal ataxia. NPH D. and within the flexor creases of the elbows and knees. Instead. and doing her taxes. suppose that the patient has had difficulty with planning large family meals and long trips. lives alone. Electroencephalogram (EEG) shows mild bilateral posterior slowing but no spikes. Vitamin B12 deficiency 36. and she has mildly diminished light touch. and the location of personal items. and she takes a diuretic. Results of laboratory tests are within normal limits except for a borderline (lownormal) vitamin B12 level. MRI of the brain and lumbar puncture D. Chronic excessive alcohol intake D. along the malar prominences of the face. and choreoathetosis. Review of systems is negative. What test is most likely to be diagnostic? A. Which of the following diagnoses would be consistent with this presentation? A. AD C. MCI-multiple domains type B. She has had 1 or 2 mixed drinks in the evening for 30 years. On examination. Pseudodementia C. or history of toxic exposure presents with a 1-year history of gradually increasing wellformed visual hallucinations. on the tops of the ears. -1 date). Alpha-fetoprotein (AFP) and carcinoembryonal antigen (CEA) B. pinprick. and mildly diminished finger dexterity and postural reflexes. cold. drives locally. results of a general and elementary neurologic examination are unremarkable for her age. people’s names. Otherwise. Suppose that a detailed assessment of the above patient shows normal basic and complex activities of daily living (ADL). A . and vibration sensation in the feet. but denies history of alcoholism. and increasing slowness of movement and imbalance. Normal pressure hydrocephalus (NPH) 37.

Obesity d. Dementia with Lewy bodies 39. avoid naps during the day 48. Serotonin 40. Which history finding is a risk factor for CVA? a. exogenous obesity. What is the gene mutation present in Huntington’s disease? A. the nurse should tell the client to: a. When teaching the client how to reduce fatigue. Tremor 46. A white female client is admitted to an acute care facility with a diagnosis of cerebrovascular accident (CVA). Resting tremor 42. d. and iron deficiency anemia. Frontotemporal dementia C. Frameshift mutation B. Action tremor B. The nurse is teaching a female client with multiple sclerosis. Lewy bodies C. Multiple motor and phonic tics present for 12 months D. Her history reveals bronchial asthma. take a hot bath. Coprolalia B. Corpora amylacea B. increase the dose of muscle relaxants. Autosomal recessive C. Pick bodies 41. X-linked 44. Trinucleotide repeat expansion 45. . What should the nurse do first? a. Chorea B. Dopamine C. Glutamate D. Elevate the head of the bed. Autosomal dominant B. drug-induced movement disorder? A. What is the genetic inheritance pattern of Huntington’s disease? A. The primary neurochemical disturbance in idiopathic Parkinson’s disease involves which of the following neurotransmitters? A. Parkinson’s disease is characterized by each of the following clinical symptoms EXCEPT: A. rest in an air-conditioned room c. Gamma-aminobutyric acid B. Nuclear point mutation D. A male client is having a tonic-clonic seizures.trial of carbidopa-levadopa did not improve his motor symptoms. Maternal D. b. Bradykinesia C. Postural instability D. Which of the following symptoms or symptom complexes must be present to diagnose Tourette’s syndrome? A. Which of the following is the most common tardive. Which of the following pathologic abnormalities are characteristically found in patients with Parkinson’s disease? A. Vocal tics present for 3 months 43. Female sex c. Caucasian race b. Complex partial epilepsy D. Mitochondrial DNA deletion C. Neurofibrillary tangles D. Orolingual dyskinesia D. Bronchial asthma 47. What is this patient’s most likely diagnosis? A. Myoclonus C. Multiple motor tics present for 6 months C. Idiopathic Parkinson’s disease with dementia B.

A female client with a suspected brain tumor is scheduled for computed tomography (CT). b. laminectomy. A female client is admitted in a disoriented and restless state after sustaining a concussion during a car accident. During a routine physical examination to assess a male client’s deep tendon reflexes.” b. Place a tongue blade in the client’s mouth. b. The nurse rushes to the victim and determines the need to opens the airway in this victim by using which method? a. “You’ll have to accept the fact that you’re permanently paralyzed. Risk for disuse syndrome 55. d. d. cystectomy. Risk for injury 54. but the paralysis caused by this disease is temporary. When the client asks the nurse about the paralysis.” d. Nurse Maureen witnesses a neighbor’s husband sustain a fall from the roof of his house. promote carbon dioxide elimination. a most appropriate respiratory goal is to: a.” 50. Self-care deficient: Dressing/grooming c. c. 51. contrast dyes. thoracotomy. 52. d. you won’t have any sensory loss. Administer a sedative as ordered. Place a cap over the client’s head. c. A female client with amyotrophic lateral sclerosis (ALS) tells the nurse. c. 53. I can’t do anything without help!” This comment best supports which nursing diagnosis? a. What should the nurse do when preparing the client for this test? a. Modified head tilt-chin lift . maintain partial pressure of arterial oxygen (PaO2) above 80 mm Hg 56. Ineffective denial d. Immobilize the neck before the client is moved onto a stretcher. b. Take measures to prevent injury. Restrain the client’s arms and legs. “It must be hard to accept the permanency of your paralysis. hemorrhoidectomy. Impaired verbal communication d. “You’ll first regain use of your legs and then your arms. The nurse must logroll a male client following a: a. b. 49. Disturbed sensory perception (visual) b.” c. lower arterial pH. “You may have difficulty believing this. Jaw thrust maneuver d. Determine whether the client is allergic to iodine. For a male client with suspected increased intracranial pressure (ICP). Powerlessness c. how should the nurse respond? a. However. Which nursing diagnosis takes highest priority in this client’s plan of care? a. prevent respiratory alkalosis. hold the reflex hammer tightly.b. The nurse is working on a surgical floor. Flexed position b. or shellfish. support the joint where the tendon is being tested. A female client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. C. “Sometimes I feel so frustrated. d. Head tilt-chin lift c. use the pointed end of the reflex hammer when striking the Achilles tendon. tap the tendon slowly and softly d. c. Anxiety b. the nurse should make sure to: a.

The nurse plans care knowing that this condition: a. Sternal rub b. Keeping the linen wrinkle-free under the client c. A male client is having a lumbar puncture performed. Pressure on the orbital rim d. Strict adherence to a bowel retraining program b. Removing the pillow and raising padded side rails d. d. The client has lost the ability to move the right arm but is able to walk independently. Limiting bladder catheterization to once every 12 hours 63. Is clear and tests negative for glucose b.57. A male client with a spinal cord injury is prone to experiencing automatic dysreflexia. Head turned to the side c. Clumps together on the dressing and has a pH of 7 d. Loosening restrictive clothing b. including the face and tongue. Side-lying. c. Prosthetic valve replacement d. Squeezing of the sternocleidomastoid muscle 58. Hypertension b. The nurse would avoid which of the following measures to minimize the risk of recurrence? a. Prone. Restraining the client’s limbs c. Which of the following positions would the nurse avoid? a. The client has complete bilateral paralysis of the arms and legs. A female client has clear fluid leaking from the nose following a basilar skull fracture. The client has lost the ability to move the right arm but is able to walk independently. if possible. Preventing unnecessary pressure on the lower limbs d. The nurse would plan to use which plan to use which of the following to test the client’s peripheral response to pain? a. The nurse assesses that this is cerebrospinal fluid if the fluid: a. Head mildline b. Heart failure c. b. Head of bed elevated 30 to 45 degrees 61. Prone. with a pillow under the abdomen c. Positioning the client to side. The nurse is assigned to care for a female client with complete right-sided hemiparesis. A female client admitted to the hospital with a neurological problem asks the nurse whether magnetic resonance imaging may be done. The nurse is caring for the male client who begins to experience seizure activity while in bed. The nurse interprets that the client may be ineligible for this diagnostic procedure based on the client’s history of: a. Which of the following actions by the nurse would be contraindicated? a. Separates into concentric rings and test positive of glucose 62. The nurse is positioning the female client with increased intracranial pressure. 60. with the head flexed forward 64. with the legs pulled up and head bent down onto chest. . The nurse would plan to place the client in which position? a. The nurse is assessing the motor function of an unconscious male client. with a pillow under the hip b. Nail bed pressure c. in slight-Trendelenburg’s position d. Side-lying. Neck in neutral position d. Is grossly bloody in appearance and has a pH of 6 c. Chronic obstructive pulmonary disorder 59. The client has weakness on the right side of the body.

65. Meningitis during the last 5 years c. but possibly includes long-term tissue malnutrition and cellular hypoxia c. triggered by exposure to meningitis d. Getting too little exercise b. Completing the sentences that the client cannot finish d. viral infection. The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse assesses that the client is adapting most successfully if the client: a. Primary genetic in origin. or an autoimmune problem b. A male client with Bell’s palsy asks the nurse what has caused this problem. Giving the client thin liquids b. The nurse tells the client that this is most effectively done by: a. the nurse avoids doing which of the following? a. The nurse would assess whether the client has precipitating factors such as: a. Which of the following strategies would the nurse incorporate in the plan of care to help the client cope with this illness? a. The nurse has given the male client with Bell’s palsy instructions on preserving muscle tone in the face and preventing denervation. Providing positive feedback and encouraging active range of motion . Omitting doses of medication d. Which of the following actions by the nurse would be least helpful to the client? a. Wrinkle the forehead. but possibly includes ischemia. well-balanced meals b. The nurse determines that the client needs additional information if the client states that he or she will: a. Experiences bouts of depression and irritability c. and whistle 72. Eating large. Female client is admitted to the hospital with a diagnosis of Guillain-Barre syndrome. Gets angry with family if they interrupt a task b. Massage the face with a gentle upward motion c. Back injury or trauma to the spinal cord d. Doing all chores early in the day while less fatigued d. triggered by exposure to neurotoxins 71. The client with a brain attack (stroke) has residual dysphagia. Giving client full control over care decisions and restricting visitors b. A female client has experienced an episode of myasthenic crisis. blow out the cheeks. Looking directly at the client during attempts at speech 68. Allowing plenty of time for the client to respond c. Speaking to the client at a slower rate b. Consistently uses adaptive equipment in dressing self 67. Placing food on the unaffected side of the mouth d. Respiratory or gastrointestinal infection during the previous month. Allowing plenty of time for chewing and swallowing 66. Primarily genetic in origin. Increasing intake of fatty foods 69. Exposure to cold and drafts b. Seizures or trauma to the brain b. Unknown. When a diet order is initiated. Perform facial exercises d. The nurse’s response is based on an understanding that the cause is: a. 73. The nurse inquires during the nursing admission interview if the client has history of: a. A female client with Guillian-Barre syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Nurse Kristine is trying to communicate with a client with brain attack (stroke) and aphasia. Taking excess medication c. Has difficulty with using modified feeding utensils d. Taking medications on time to maintain therapeutic blood levels 70. Unknown. The nurse is assessing the adaptation of the female client to changes in functional status after a brain attack (stroke). Thickening liquids to the consistency of oatmeal c. Doing muscle-strengthening exercises c.

d. c. nausea. give the client privacy during meals. Providing information. The nurse is performing a mental status examination on a male client diagnosed with subdural hematoma. d. reducing distractions and limiting visitors 74. If a male client experienced a cerebrovascular accident (CVA) that damaged the hypothalamus. phenytoin (Dilantin) b. headaches. Specific to this impairment. the nurse would anticipate that the client has problems with: a. body temperature control. This test assesses which of the following? . Give him a barbiturate. 80. frequent episodes of double vision. 82. b. 79. and time b. Provide a clear path for ambulation without obstacles 75. Ineffective airway clearance c. the nurse would document which of the following information related to the client’s behavior. A female client admitted to an acute care facility after a car accident develops signs and symptoms of increased intracranial pressure (ICP). 77. Test the temperature of the shower water c. d. To prevent a further rise in ICP caused by suctioning. Demonstrate inability to add and subtract. Providing intravaneously administered sedatives. the nurse anticipates administering which drug endotracheally before suctioning? a. help the client fill out his menu. Risk for injury 81. and encouraging relaxation d. Check the temperature of the food on the delivery tray. Specific to this type of deficit. A male client has an impairment of cranial nerve II. stay with the client and encourage him to eat. d. a recent driving accident while changing lanes. a young man age 18 is admitted to the emergency department. The client is intubated and placed on mechanical ventilation to help reduce ICP. b. After striking his head on a tree while falling from a ladder. Perform a lumbar puncture. b. the nurse would plan to do which of the following to ensure client to ensure client safety? a. Imbalanced nutrition: Less than body requirements b. c. He’s unconscious and his pupils are nonreactive. When obtaining the health history from a male client with retinal detachment. furosemide (Lasix) 78. A female client has a neurological deficit involving the limbic system. To encourage adequate nutritional intake for a female client with Alzheimer’s disease. fill out the menu for the client. light flashes and floaters in front of the eye. Is disoriented to person. Which nursing diagnosis takes highest priority for a client with Parkinson’s crisis? a. the nurse expects the client to report: a. Which intervention would be the most dangerous for the client? a. visual acuity. giving positive feedback.c. b. does not know who is president 76. Affect is flat. and redness of the eyes. Impaired urinary elimination d. lidocaine (Xylocaine) d. d. a. thinking and reasoning. Cannot recall what was eaten for breakfast today d. with periods of emotional lability c. Place him on mechanical ventilation. Elevate the head of his bed. place. mannitol (Osmitrol) c. c. the nurse should: a. Speak loudly to the client b. balance and equilibrium. c.

Dexamethasone exerts its therapeutic effect by: a. tearing. Shortly after admission to an acute care facility. c. if needed and prescribed? a. In 30 to 45 minutes d. blurred vision. and then take him to the emergency department of a nearby hospital. Assessing the pupils c. the physician prescribes atropine sulfate (Atropisol). Cerebellar function b. How soon can the nurse administer a second dose of diazepam. His coworkers irrigate his eyes with water for 20 minutes. two drops of 0. Assessing the left leg b.a. decreasing leukocyte infiltration at the site of ocular inflammation. 0. As part of the client’s therapeutic regimen. More back pain than the first postoperative day b. Cerebral function d. The physician orders diazepam (Valium) 10 mg I. Which of the following findings should the nurse consider abnormal? a. Adrenergic blocker d. nonreactive pupil — a condition resulting from acute iris inflammation (iritis).” Which intervention by the nurse has the highest priority? a. Parasympathomimetic agent b. In 1 to 2 hours 84. two drops of 0. Intellectual function c. irregular.1% solution to be instilled initially into the conjunctival sacs of both eyes every hour.V. Placing the client in Trendelenburg’s position d. producing a miotic reaction by stimulating and contracting the sphincter muscles of the iris. where he receives emergency care for corneal injury. He has a compound fracture of his left femur and he’s comatose. Assessing level of consciousness 86. increasing the exudative reaction of ocular tissue. Nurse April is caring for a client who underwent a lumbar laminectomy 2 days ago. He has a large contusion on his left chest and a hematoma in the left parietal area. In 30 to 45 seconds b. and photophobia in her right eye. d. We intubated him and he’s maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manualresuscitation bag. Cholinergic blocker 85. In 10 to 15 minutes c. 87. A female client complains of periorbital aching. Sensory function 83. and polymyxin B sulfate (Neosporin Ophthalmic). They tell the nurse. Sympatholytic agent c. inhibiting the action of carbonic anhydrase. stat. Emergency medical technicians transport a 27-year-old iron worker to the emergency department. An auto mechanic accidentally has battery acid splashed in his eyes. Ophthalmologic examination reveals a small. a male client with a seizure disorder develops status epilepticus.5% ointment to be placed in the conjunctival sacs of both eyes every 3 hours.5% solution in the right eye twice daily. The physician prescribes dexamethasone (Maxidex Ophthalmic Suspension). Atropine sulfate belongs to which drug classification? a. Paresthesia in the dermatomes near the wounds . b. “He fell from a two-story building.

To document the client’s gait. To assess gait. including possible Ménière’s disease. A physician diagnoses a client with myasthenia gravis. 89. “Try to ambulate independently after about 24 hours.c. 60 mg P. with each step. The client repositions only after being reminded to do so. a male client is diagnosed with open-angle glaucoma. The client hangs the left arm over the side of the wheelchair.3° C) 88. and nystagmus c. The physician prescribes pilocarpine ophthalmic solution (Pilocar). instilling one drop of pilocarpine 0.” b. Intestinal obstruction d. vertigo. OU q. Before administering this anticholinesterase agent. “Shampoo your hair every day for 10 days to help prevent ear infection. the client’s feet make a half circle.” . vertigo. pain.i. A private room down the hall from the nurses’ station b. The client leaves the side rails down. b. 90. vertigo. A male client in the emergency department has a suspected neurologic disorder. blurred vision. A female client who’s paralyzed on the left side has been receiving physical therapy and attending teaching sessions about safety. Helicopod d. vertigo. instilling one drop of pilocarpine 0. c. d. Urine retention or incontinence d. d. Which hospital room would be the best choice for this client? a. age 22. b. is admitted with bacterial meningitis. Blood dyscrasia c. An isolation room three doors from the nurses’ station c. instilling one drop of pilocarpine 0. Which preexisting condition would contraindicate the use of pyridostigmine? a. 94.25% gtt i. Based on this prescription. d. the nurse should use which term? a.25% into the left eye four times daily. A two-bed room with a client who previously had bacterial meningitis 92. A female client is admitted to the facility for investigation of balance and coordination problems. Ulcerative colitis b. Dystrophic c. A semiprivate room with a 32-year-old client who has viral meningitis d. and hearing impairment.d. “Lie in bed with your head elevated. prescribing pyridostigmine (Mestinon). c. and refrain from blowing your nose for 24 hours.25% into the right eye daily. Spinal cord injury 93. Ataxic b.” c. After the stapedectomy.25% into both eyes four times daily. the nurse expects to note: a. the nurse reviews the client’s history.O. After an eye examination. and fever. vomiting.2° F (37. instilling one drop of pilocarpine 0. the nurse asks the client to take a few steps. A client. the nurse should teach the client or a family member to administer the drug by: a. 0. the nurse should provide which client instruction? a. A male client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. b.25% into both eyes daily. Temperature of 99. tinnitus. and hearing loss. every 3 hours. The client uses a mirror to inspect the skin. Steppage 91. Which behavior indicates that the client accurately understands safety measures related to paralysis? a. When assessing this client.

b. Muscle weakness d. turning the client’s head suddenly while holding the eyelids open. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction? a. Apnea 97. twice daily. b. Nurse Oliver is monitoring a client for adverse reactions to dantrolene (Dantrium). A female client who was found unconscious at home is brought to the hospital by a rescue squad. continuous muscle spasms. Succinylcholine shouldn’t be used. the nurse checks the client’s oculocephalic (doll’s eye) response by: a. Urine retention c. Which of the following statements about neuromuscular blocking agents is true for a client with this condition? a. Hypotension d. touching the cornea with a wisp of cotton.O. introducing ice water into the external auditory canal. Pancuronium shouldn’t be used. d. In the intensive care unit. A male client is admitted with a cervical spine injury sustained during a diving accident. c. The client may be less sensitive to the effects of a neuromuscular blocking agent. A male client has a history of painful. He has taken several skeletal muscle relaxants without experiencing relief. the nurse notices that the female client has myasthenia gravis. Disturbed sensory perception (tactile) d. b. Excessive tearing b. 2 mg P. Which adverse reaction is most common? a. Increased salivation c. postoperative pain management of diskectomy clients d. d. 99. Slurred speech 96. c. make sudden movements. Self-care deficient: Dressing/grooming 98. the nurse should assign highest priority to which nursing diagnosis? a. The nurse is monitoring a male client for adverse reactions to atropine sulfate (Atropine Care) eyedrops. His physician prescribes diazepam (Valium). treatment of spasticity associated with spinal cord lesions. diazepam also is recommended for: a.” 95. When planning this client’s care. or expose yourself to loud sounds for 30 days. “Don’t fly in an airplane. succinylcholine may be used in a lower dosage. 100. c.d. While reviewing a client’s chart. postoperative pain management of laminectomy clients. Tachycardia b. . shining a bright light into the pupil. long-term treatment of epilepsy. Pancuronium and succinylcholine both require cautious administration. pancuronium may be used in a lower dosage. climb to high altitudes. Impaired physical mobility b. Ineffective breathing pattern c. In addition to being used to relieve painful muscle spasms.