Nervous System | Neurological Disorders NCLEX Quiz 47

1. A client with a T1 spinal cord injury arrives at the emergency department with a BP of 82/40. pulse 34. dry skin. and flaccid paralysis of the lower extremities. Which of the following conditions would most likely be suspected?

Autonomic dysreflexia

Hypervolemia

Neurogenic shock

Sepsis

Loss of sympathetic control and unopposed vagal stimulation below the level of injury typically cause hypotension. bradycardia. pallor. flaccid paralysis. and warm. dry skin in the client in neurogenic shock.Option A: Autonomic dysreflexia occurs after neurogenic shock abates.Option B: Hypervolemia is indicated by rapid and bounding pulse and edema.Option D: Signs of sepsis would include elevated temperature. increased heart rate. and increased respiratory rate.

Explanation

Loss of sympathetic control and unopposed vagal stimulation below the level of injury typically cause hypotension. bradycardia. pallor. flaccid paralysis. and warm. dry skin in the client in neurogenic shock.Option A: Autonomic dysreflexia occurs after neurogenic shock abates.Option B: Hypervolemia is indicated by rapid and bounding pulse and edema.Option D: Signs of sepsis would include elevated temperature. increased heart rate. and increased respiratory rate.

2. The nurse is discussing the purpose of an electroencephalogram (EEG) with the family of a client with massive cerebral hemorrhage and loss of consciousness. It would be most accurate for the nurse to tell family members that the test measures which of the following conditions?

Extent of intracranial bleeding

Sites of brain injury

Activity of the brain

Percent of functional brain tissue

An EEG measures the electrical activity of the brain.Options A and B: Extent of intracranial bleeding and location of the injury site would be determined by CT or MRI.Option D: Percent of functional brain tissue would be determined by a series of tests.

Explanation

An EEG measures the electrical activity of the brain.Options A and B: Extent of intracranial bleeding and location of the injury site would be determined by CT or MRI.Option D: Percent of functional brain tissue would be determined by a series of tests.

3. During an episode of autonomic dysreflexia in which the client becomes hypertensive. the nurse should perform which of the following interventions?

Elevate the client’s legs

Put the client flat in bed

Put the client in the Trendelenburg’s position

Put the client in the high-Fowler’s position

Putting the client in the high-Fowler’s position will decrease cerebral blood flow. decreasing hypertension.Options A. B. and C: Elevating the client’s legs. putting the client flat in bed. or putting the bed in the Trendelenburg’s position places the client in positions that improve cerebral blood flow. worsening hypertension.

Explanation

Putting the client in the high-Fowler’s position will decrease cerebral blood flow. decreasing hypertension.Options A. B. and C: Elevating the client’s legs. putting the client flat in bed. or putting the bed in the Trendelenburg’s position places the client in positions that improve cerebral blood flow. worsening hypertension.

4. A client has a cervical spine injury at the level of C5. Which of the following conditions would the nurse anticipate during the acute phase?

Absent corneal reflex

Decerebrate posturing

Movement of only the right or left half of the body

The need for mechanical ventilation

The diaphragm is stimulated by nerves at the level of C4. Initially. this client may need mechanical ventilation due to cord edema. This may resolve in time.Options A. B. and C: Absent corneal reflexes. decerebrate posturing. and hemiplegia occur with brain injuries. not spinal cord injuries.

Explanation

The diaphragm is stimulated by nerves at the level of C4. Initially. this client may need mechanical ventilation due to cord edema. This may resolve in time.Options A. B. and C: Absent corneal reflexes. decerebrate posturing. and hemiplegia occur with brain injuries. not spinal cord injuries.

5. Which neurotransmitter is responsible for may of the functions of the frontal lobe?

Dopamine

GABA

Histamine

Norepinephrine

The frontal lobe primarily functions to regulate thinking. planning. and affect. Dopamine is known to circulate widely throughout this lobe. which is why it’s such an important neurotransmitter in schizophrenia.

Explanation

The frontal lobe primarily functions to regulate thinking. planning. and affect. Dopamine is known to circulate widely throughout this lobe. which is why it’s such an important neurotransmitter in schizophrenia.

6. A client with C7 quadriplegia is flushed and anxious and complains of a pounding headache. Which of the following symptoms would also be anticipated?

Decreased urine output or oliguria

Hypertension and bradycardia

Respiratory depression

Symptoms of shock

Hypertension. bradycardia. anxiety. blurred vision. and flushing above the lesion occur with autonomic dysreflexia due to uninhibited sympathetic nervous system discharge. The other options are incorrect.

Explanation

Hypertension. bradycardia. anxiety. blurred vision. and flushing above the lesion occur with autonomic dysreflexia due to uninhibited sympathetic nervous system discharge. The other options are incorrect.

7. An 18-year-old client was hit in the head with a baseball during practice. When discharging him to the care of his mother. the nurse gives which of the following instructions?

“Watch him for keyhole pupil the next 24 hours.”

“Expect profuse vomiting for 24 hours after the injury.”

“Wake him every hour and assess his orientation to person. time. and place.”

“Notify the physician immediately if he has a headache.”

Changes in LOC may indicate expanding lesions such as subdural hematoma; orientation and LOC are frequently assessed for 24 hours.Option A: A keyhole pupil is found after iridectomy.Option B: Profuse or projectile vomiting is a symptom of increased ICP and should be reported immediately.Option D: A slight headache may last for several days after concussion; severe or worsening headaches should be reported.

Explanation

Changes in LOC may indicate expanding lesions such as subdural hematoma; orientation and LOC are frequently assessed for 24 hours.Option A: A keyhole pupil is found after iridectomy.Option B: Profuse or projectile vomiting is a symptom of increased ICP and should be reported immediately.Option D: A slight headache may last for several days after concussion; severe or worsening headaches should be reported.

8. After falling 20'. a 36-year-old man sustains a C6 fracture with spinal cord transaction. Which other findings should the nurse expect?

Quadriplegia with gross arm movement and diaphragmatic breathing

Quadriplegia and loss of respiratory function

Paraplegia with intercostal muscle loss

Loss of bowel and bladder control

A client with a spinal cord injury at levels C5 to C6 has quadriplegia with gross arm movement and diaphragmatic breathing.Option B: Injury levels C1 to C4 leads to quadriplegia with total loss of respiratory function.Option C: Paraplegia with intercostal muscle loss occurs with injuries at T1 to L2.Option D: Injuries below L2 cause paraplegia and loss of bowel and bladder control.

Explanation

A client with a spinal cord injury at levels C5 to C6 has quadriplegia with gross arm movement and diaphragmatic breathing.Option B: Injury levels C1 to C4 leads to quadriplegia with total loss of respiratory function.Option C: Paraplegia with intercostal muscle loss occurs with injuries at T1 to L2.Option D: Injuries below L2 cause paraplegia and loss of bowel and bladder control.

9. A 40-year-old paraplegic must perform intermittent catheterization of the bladder. Which of the following instructions should be given?

“Clean the meatus from back to front.”

“Measure the quantity of urine.”

“Gently rotate the catheter during removal.”

“Clean the meatus with soap and water.”

Intermittent catheterization may be performed chronically with clean technique. using soap and water to clean the urinary meatus.Option A: The meatus is always cleaned from front to back in a woman. or in expanding circles working outward from the meatus in a man.Option B: It isn’t necessary to measure the urine.Option C: The catheter doesn’t need to be rotated during removal.

Explanation

Intermittent catheterization may be performed chronically with clean technique. using soap and water to clean the urinary meatus.Option A: The meatus is always cleaned from front to back in a woman. or in expanding circles working outward from the meatus in a man.Option B: It isn’t necessary to measure the urine.Option C: The catheter doesn’t need to be rotated during removal.

10. A client arrives at the ER after slipping on a patch of ice and hitting her head. A CT scan of the head shows a collection of blood between the skull and dura mater. Which type of head injury does this finding suggest?

Subdural hematoma

Subarachnoid hemorrhage

Epidural hematoma

Contusion

An epidural hematoma occurs when blood collects between the skull and the dura mater.Option A: In a subdural hematoma. venous blood collects between the dura mater and the arachnoid mater.Option B: In a subarachnoid hemorrhage. blood collects between the pia mater and arachnoid membrane.Option D: A contusion is a bruise on the brain’s surface.

Explanation

An epidural hematoma occurs when blood collects between the skull and the dura mater.Option A: In a subdural hematoma. venous blood collects between the dura mater and the arachnoid mater.Option B: In a subarachnoid hemorrhage. blood collects between the pia mater and arachnoid membrane.Option D: A contusion is a bruise on the brain’s surface.