| 111. | The nurse is caring for a client who complained of a severe headache prior to becoming unconscious. Which ordered diagnostic exam will best confirm the suspected cause of the loss of consciousness?
 | A. | CT scan | | B. | Serum electrolytes | | C. | EKG | | D. | Protime |
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| 112. | A client has been scheduled for a lumbar puncture. Which would the nurse include in the implementation plans?
| A. | Get the consent form signed for the lumbar puncture procedure | | B. | Place the client in the prone position during the procedure | | C. | Instruct the client that there will be no pain or discomfort | | D. | Encourage fluid intake to assure a full bladder |
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| 113. | A client experiencing migraine headaches has been placed on abortive therapy. Which drug would the nurse expect the client to receive?
| A. | Sumatriptan succinate (Imitrex) | | B. | Propranolol (Inderal) | | C. | Nifedipine (Procardia) | | D. | Divalproex (Depakote) |
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| 114. | A client with myasthenia gravis, who has been taking pyridostigmine (Mestinon), tells the nurse, “This medication’s side effects are making me uncomfortable.” The nurse would expect the client to complain of the medication causing which of the following effects?
| A. | Muscle cramps | | B. | Dry mouth | | C. | Decreased lacrimation | | D. | Hyperactivity episodes |
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| 115. | A client has a head injury due to a motor vehicle accident. What would be the earliest indicator of increased intracranial pressure that the nurse would observe for?
| A. | Seizures | | B. | Ipsilateral pupils | | C. | Headache | | D. | Restlessness |
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| 116. | The nurse is observing a nursing student performing client care to a client after a craniotomy. Which action by the student would require nurse intervention?
| A. | The student elevates the head of the bed 30°. | | B. | The student instructs the client to cough forcefully. | | C. | The student is preparing to perform a cranial dressing change with sterile gloves. | | D. | When turning the client, the student keeps the head in a neutral position. |
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| 117. | A nurse is caring for a client scheduled for a CT scan with contrast. Which action is most appropriate?
| A. | Checking the history for and asking the patient about metal or clips in or on the body | | B. | Keeping the patient NPO after midnight the night before the procedure | | C. | Assessing the client’s hemoglobin and hematocrit | | D. | Checking the client’s creatinine level |
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| 118. | The nurse is caring for a client with myasthenia gravis who might have swallowing impairment. Which diet selection would require intervention by the nurse?
| A. | Boiled potatoes | | B. | Soft scrambled eggs | | C. | Green peas | | D. | Macaroni and cheese |
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| 119. | The nurse is caring for a client with a spinal cord injury at the C7 level. Which would not be included in the nursing care plan?
| A. | Monitor neurological status every two hours | | B. | Assess for changes in respiratory function | | C. | Telling the client to turn himself every two hours | | D. | Administering ordered dextran IV to increase capillary blood flow |
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| 120. | A client with a stroke has been diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which physician’s prescription would the nurse question?
| A. | Weigh the client daily | | B. | Demeclocycline (Declomycin) 300 mg PO bid | | C. | Monitor neurological status every four hours | | D. | Force fluids three to four liters/day |
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| 121. | A client with a cervical spinal cord injury is experiencing a loss of motor function below the level of injury with sensation, touch, position, and vibration intact. The nurse recognizes that the client has damage in which area of the following areas?
| A. | Anterior cord injury | | B. | Posterior cord injury | | C. | Central cord injury | | D. | Brown-Sequard’s paralysis |
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| 122. | The nurse caring for a client with multiple sclerosis would expect which of the following medications to be included in the treatment plan?
| A. | Meperidine (Demerol) | | B. | Interferon, Beta 1a (Avonex) | | C. | Infliximab (Remicade) | | D. | Mannitol (Osmitrol) |
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| 123. | The nurse is caring for a client in the ER with a spinal cord injury at T4. Assessment reveals a BP of 76/48, heart rate of 52, and no reflex activity below the T4 area. The nurse should further assess the client for which of the following complications?
| A. | Neurogenic shock | | B. | Autonomic dysreflexia | | C. | Meningitis | | D. | Increased intracranial pressure |
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| 124. | The nurse is called to the room of a client experiencing a tonic-clonic seizure. Which action would the nurse perform first?
| A. | Loosen restrictive clothing | | B. | Turn the client to the side-lying position | | C. | Ensure patency of the client’s airway | | D. | Document the sequence of the client’s movements |
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| 125. | The nurse is evaluating cerebrospinal fluid (CSF) results on a client with suspected meningitis. Which would correlate with the suspected diagnosis?
| A. | Increased white blood cell count | | B. | Protein level decreased | | C. | Glucose normal | | D. | Numerous red blood cells |
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| 126. | The nurse would expect to find which information when reviewing the history of a client diagnosed with multiple sclerosis?
| A. | Visual problems | | B. | Increased sensitivity to pain | | C. | Ascending weakness and numbness | | D. | Confusion and disorientation |
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| 127. | The nurse is caring for a client with a head injury. Which of the following assessment findings cause the nurse the most concern?
| A. | Sluggish-to-react pupil | | B. | Negative babinski reflex | | C. | Bilateral decreased hand grips | | D. | Decerebrate posturing |
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| 128. | The nurse is caring for a client with multiple sclerosis who is experiencing diplopia. Which intervention would the nurse implement?
| A. | The use of an eye patch | | B. | Moving the furniture to one side of the room | | C. | Instructing the client to stay in bed | | D. | Administering ordered antibiotic eye ointment |
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| 129. | The nurse working on the neurological unit has received a report of decorticate posturing in a client with a head injury. Nursing assessment now reveals the bilateral extension of extremities after stimuli. What does the nurse deduce from this assessment finding?
| A. | The client’s ICP is lower. | | B. | The client probably has brain stem dysfunction. | | C. | The client should be evaluated for meningitis. | | D. | This is a normal assessment finding for clients who are comatose. |
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| 130. | The nurse is observing a detailed neurological assessment on a client with a suspected brain tumor. When performing the Romberg test, the client sways when the eyes are both open and closed. What does this indicate?
| A. | The problem is probably in the cerebellum. | | B. | It is a position sense abnormality. | | C. | This is not an abnormal test result. | | D. | The client has lost proprioception. |
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| 131. | A client is admitted with low back pain. Which position would the nurse place the client in to provide the most comfort?
| A. | Flat with the head of the bed elevated on 6” blocks | | B. | Semi-Fowler’s with the foot of the bed elevated | | C. | Prone with a pillow under the knee | | D. | Semi-Fowler’s with the knee gatch raised slightly |
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| 132. | A client arrives at the emergency room after being hit in the head with a baseball. Which question is most important for the nurse to ask during history data collection?
| A. | “Do you have a headache?” | | B. | “Did you lose consciousness?” | | C. | “How often do you play baseball?” | | D. | “Are you upset with the person who hit you?” |
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| 133. | A client with a cerebral aneurysm has been prescribed the drug nimodipine (Nimotop). What does the nurse explain as the purpose of this drug?
| A. | Treat spasm of the blood vessel | | B. | Cause bleeding at the vessel site | | C. | Stabilize the clot that has developed at the vessel | | D. | Reduce the client’s blood pressure |
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| 134. | A client with a history of a stroke has been prescribed the drug clopidogrel (Plavix). What is the action of this drug?
| A. | Prevents platelet aggregation | | B. | Dissolves clots | | C. | Increases the coagulation of blood | | D. | Provides diuresis |
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| 135. | A client with a brain tumor is exhibiting symptoms of hyperthyroidism. Which of the following would the nurse expect the client to exhibit?
| A. | Restlessness | | B. | Decreased libido | | C. | Weight gain | | D. | Bradycardia |
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| 136. | The physician is in route to perform a lumbar puncture on a client with encephalitis. The nurse assesses lethargy and sluggish pupil reactions. Which action is most appropriate?
| A. | Notify the charge nurse of the assessment findings | | B. | Obtain the lumbar puncture tray from supply | | C. | Explain the lumbar puncture procedure to the family | | D. | Elevate the head of the bed to high Fowler’s |
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| 137. | The nurse is participating in preparation to teach a group of clients who experience migraine headaches. Which would not be included in the teaching plans?
| A. | Clients who have migraines should avoid alcoholic beverages. | | B. | Some medication, such as birth control pills and Tagamet, can trigger an attack. | | C. | Stress, anger, and conflict have no effect on the headaches. | | D. | Eating foods made with yeast or preservatives can trigger an attack. |
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| 138. | A client arrives at the ER exhibiting right-sided weakness and expressive aphasia of one hour duration. Several exams are ordered by the physician. Which exam should the nurse make sure is done first?
| A. | CT scan | | B. | CBC | | C. | Chest X-ray | | D. | Carotid Doppler study |
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| 139. | A nurse is assisting a consultant on interior construction details for a long-term care facility’s Alzheimer’s unit. Which environmental stimulus would the nurse recognize as being the least helpful to a client with Alzheimer’s disease?
| A. | Muted colors | | B. | Quiet surroundings | | C. | Television | | D. | A waterfall |
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| 140. | The nurse is working on a neurological unit. A client with a hemorrhagic stroke develops a fever of 101.8° F. Which drug is best for the nurse to administer?
| A. | Naproxen (Naprosyn) | | B. | Ibuprofen (Advil) | | C. | Acetaminophen (Tylenol) | | D. | Salicylates (Aspirin) |
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| 141. | A client is admitted with Guillain-Barré syndrome. The doctor performs a lumbar puncture. What would the nurse expect the CSF to reveal?
| A. | Increased glucose and decreased protein | | B. | Increased protein and normal cell count | | C. | Increased red blood cells and elevated WBCs | | D. | Normal protein with increased WBC count |
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| 142. | A client with epilepsy who had a vagal nerve stimulator (VNS) inserted two days ago calls the neurological unit complaining of hoarseness. Which is the appropriate nurse response?
| A. | “Hoarseness is a side effect of the procedure but generally improves over time.” | | B. | “Come to the emergency room immediately. The VNS will have to be removed because of the hoarseness.” | | C. | “Are you having any seizure activity with the hoarseness? This would mean another surgery is required.” | | D. | “Gargle with warm, salty water every hour, and the hoarseness should soon go away.” |
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| 143. | The nurse is reviewing the orders of a client with a severe head injury due to a fall. Which order would the nurse question?
| A. | Prepare for insertion of an ICP monitor | | B. | Maintain D5W IV at 200 mL/hour | | C. | Maintain head of bed 25°–30° elevation | | D. | Keep the head in neutral alignment |
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| 144. | The nurse is collecting data for an admission history on a client with Guillain-Barré syndrome. Which would the nurse expect to find in the client’s history?
| A. | Surgical procedure three months ago | | B. | A recent virus | | C. | Anticonvulsant medications | | D. | Recent seizure activity |
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| 145. | A client on oncology has a sodium level of 120 mEq/L. Which sympton does the nurse expect the client to exhibit?
| A. | Lethargy | | B. | Increase in saliva | | C. | Agitation | | D. | Low heart rate |
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| 146. | The nurse is caring for a 23-year-old client with a diagnosis of a thrombotic stroke. Which element in the client’s history is a risk factor for strokes?
| A. | Seizure disorder | | B. | Influenza | | C. | Cocaine abuse | | D. | Childhood rheumatic fever |
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| 147. | Which of the following actions would the nurse perform for a bladder scan procedure?
| A. | Positioning the patient left Sim’s | | B. | Inserting the wand rectally | | C. | Application of gel on the abdomen | | D. | Ask the client to perform the Valsalva maneuver |
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| 148. | A client with myasthenia gravis is receiving plasmapheresis. Which assessment finding correlates to a complication of the procedure?
| A. | Pulse rate of 50 | | B. | BP of 80/42 | | C. | Potassium of 5.4 mEq/L | | D. | INR of 3.0 |
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| 149. | A client is transferred from the ER to the neurological unit with a diagnosis of ischemic stroke. The nurse is assisting in preparation to begin a heparin infusion. Which piece of equipment is essential?
| A. | 18-gauge IV catheter | | B. | Bag of normal saline | | C. | IV regulation device | | D. | Extension tubing |
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| 150. | A client with cancer metastatic to the brain is scheduled for an MRI. The spouse states, “I don’t know that she will be able to be still for the procedure.” Which medication would the nurse expect to be ordered prior to the procedure?
| A. | Diphenhydramine (Benadryl) | | B. | Lorazepam (Ativan) | | C. | Ciprofloxacin (Cipro) | | D. | Propofol (Diprivan) |
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