NURS250 CS 3

Question 1

Damage to the VII cranial nerve results in?

Accepted Answer

Facial pain

Question 2

The nurse is caring for a client with a closed head injury. A late sign of increased ICP is?

Accepted Answer

Changes in pupil equality and reactivity

Question 3

Three objects are named. The client is later asked to name the same three objects.

Accepted Answer

Recall

Question 4

Which assessment finding is a normal response in a craniotomy client post-op?

Accepted Answer

Temperature range of 98.8-99.6 degrees F the 1st 2-3 days

Question 5

A client fell striking the right side of their head & has right sided epidural hematoma.

Accepted Answer

Coup

Question 6

The client with a C5 fx, halo vest, & O2 @ 40% via trach mask, R 40, O2 sat 88%, and restless.

Accepted Answer

Perform tracheal suctioning

Question 7

Which assessment finding is most indicative of increasing ICP in a client with a head injury?

Accepted Answer

Papilledema

Question 8

A client with a closed head injury has an ICP reading of 17mmHg. What should the nurse do?

Accepted Answer

The ICP is elevated , notify the doctor

Question 9

Which finding is consistent with an injury to the frontal lobe?

Accepted Answer

Failure to recognize touch

Question 10

Which set of vital signs would best indicate to the nurse that a client has an increase in ICP?

Accepted Answer

BP 180/70, P 50, R 16, T 101 degrees F

Question 11

To prevent autonomic hyperreflexia in a client with C3 spinal cord injury, the nurse should?

Accepted Answer

Make sure the catheter is patent

Question 12

A client reports having, “the worse headache I’ve ever had.” Which action is highest priority?

Accepted Answer

Performing neuro checks

Question 13

A client is admitted with a tumor in the parietal lobe. Which symptoms would be expected?

Accepted Answer

Paresthesia

Question 14

A client with ICP is placed on mechanical vent with hyperventilation. What is the rational?

Accepted Answer

Decrease cerebral blood flow

Question 15

A client sustained a severe head injury to the occipital lobe. The nurse should assess for?

Accepted Answer

Changes in vision

Question 16

Spinal fluid obtained from a LP of a client with Guillian-Barre syndrome typically shows:

Accepted Answer

Increased protein concentration with a normal cell count

Question 17

The nurse notes a positive Babinski reflex. The nurse should:

Accepted Answer

Notify the physician of the finding

Question 18

What is the best explanation for an elevated temp in a client after a motor vehicle accident?

Accepted Answer

There was damage to the hypothalamus

Question 19

On a neurological unit, which client would receive priority?

Accepted Answer

A cerebral aneurysm client has sudden weakness on the R side

Question 20

Which finding indicates direct effectiveness of Osmitrol(mannitol) for a client with ICP?

Accepted Answer

Increased urinary output

Question 21

A positive Kernig’s sign is charted if the patient has?

Accepted Answer

Pain on flexion of the hip and knee

Question 22

IV Solu-Medrol has been ordered for a client with a spinal cord injury. What is the rational?

Accepted Answer

Improving motor and sensory functioning

Question 23

Which lobe of the brain is responsible for taste, smell, and hearing?

Accepted Answer

Temporal

Question 24

A client with a closed head injury has fluid leaking from the ear. What is the first action?

Accepted Answer

Test the drainage for glucose

NURS250 CS 3

Questions 24

NURS250 CS 3

Questions 24