Nervous System | Neurological Disorders NCLEX Quiz 50

1. A client admitted to the hospital with a subarachnoid hemorrhage has complaints of severe headache. nuchal rigidity. and projectile vomiting. The nurse knows lumbar puncture (LP) would be contraindicated in this client in which of the following circumstances?

Vomiting continues

Intracranial pressure (ICP) is increased

The client needs mechanical ventilation

Blood is anticipated in the cerebrospinal fluid (CSF)

Sudden removal of CSF results in pressures lower in the lumbar area than the brain and favors herniation of the brain; therefore. LP is contraindicated with increased ICP.Option A: Vomiting may be caused by reasons other than increased ICP; therefore. LP isn’t strictly contraindicated.Option C: An LP may be performed on clients needing mechanical ventilation.Option D: Blood in the CSF is diagnostic for subarachnoid hemorrhage and was obtained before signs and symptoms of ICP.

Explanation

Sudden removal of CSF results in pressures lower in the lumbar area than the brain and favors herniation of the brain; therefore. LP is contraindicated with increased ICP.Option A: Vomiting may be caused by reasons other than increased ICP; therefore. LP isn’t strictly contraindicated.Option C: An LP may be performed on clients needing mechanical ventilation.Option D: Blood in the CSF is diagnostic for subarachnoid hemorrhage and was obtained before signs and symptoms of ICP.

2. The client is having a lumbar puncture performed. The nurse would plan to place the client in which position for the procedure?

Side-lying. with legs pulled up and head bent down onto the chest

Side-lying. with a pillow under the hip

Prone. in a slight Trendelenburg’s position

Prone. with a pillow under the abdomen.

The client undergoing lumbar puncture is positioned lying on the side. with the legs pulled up to the abdomen. and with the head bent down onto the chest. This position helps to open the spaces between the vertebrae.

Explanation

The client undergoing lumbar puncture is positioned lying on the side. with the legs pulled up to the abdomen. and with the head bent down onto the chest. This position helps to open the spaces between the vertebrae.

3. A client with subdural hematoma was given mannitol to decrease intracranial pressure (ICP). Which of the following results would best show the mannitol was effective?

Urine output increases

Pupils are 8 mm and nonreactive

Systolic blood pressure remains at 150 mm Hg

BUN and creatinine levels return to normal

Mannitol promotes osmotic diuresis by increasing the pressure gradient in the renal tubes.Option B: Fixed and dilated pupils are symptoms of increased ICP or cranial nerve damage.Options C and D: No information is given about abnormal BUN and creatinine levels or that mannitol is being given for renal dysfunction or blood pressure maintenance.

Explanation

Mannitol promotes osmotic diuresis by increasing the pressure gradient in the renal tubes.Option B: Fixed and dilated pupils are symptoms of increased ICP or cranial nerve damage.Options C and D: No information is given about abnormal BUN and creatinine levels or that mannitol is being given for renal dysfunction or blood pressure maintenance.

4. A client with a subdural hematoma becomes restless and confused. with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons?

To reduce intraocular pressure

To prevent acute tubular necrosis

To promote osmotic diuresis to decrease ICP

To draw water into the vascular system to increase blood pressure

Mannitol promotes osmotic diuresis by increasing the pressure gradient. drawing fluid from intracellular to intravascular spaces. Although mannitol is used for all the reasons described. the reduction of ICP in this client is a concern.

Explanation

Mannitol promotes osmotic diuresis by increasing the pressure gradient. drawing fluid from intracellular to intravascular spaces. Although mannitol is used for all the reasons described. the reduction of ICP in this client is a concern.

5. Which of the following signs and symptoms of increased ICP after head trauma would appear first?

Bradycardia

Large amounts of very dilute urine

Restlessness and confusion

Widened pulse pressure

The earliest symptom of elevated ICP is a change in mental status.Option A and D: Bradycardia. widened pulse pressure. and bradypnea occur later.Option B: The client may void large amounts of very dilute urine if there’s damage to the posterior pituitary.

Explanation

The earliest symptom of elevated ICP is a change in mental status.Option A and D: Bradycardia. widened pulse pressure. and bradypnea occur later.Option B: The client may void large amounts of very dilute urine if there’s damage to the posterior pituitary.

6. Which of the following values is considered normal for ICP?

0 to 15 mm Hg

25 mm Hg

35 to 45 mm Hg

120/80 mm Hg

Normal ICP is 0-15 mm Hg.

Explanation

Normal ICP is 0-15 mm Hg.

7. While cooking. your client couldn't feel the temperature of a hot oven. Which lobe could be dysfunctional?

Frontal

Occipital

Parietal

Temporal

The parietal lobe regulates sensory function. which would include the ability to sense hot or cold objects.Option A: The frontal lobe regulates thinking. planning. and judgment.Option B: The occipital lobe is primarily responsible for vision function.Option D: The temporal lobe regulates memory.

Explanation

The parietal lobe regulates sensory function. which would include the ability to sense hot or cold objects.Option A: The frontal lobe regulates thinking. planning. and judgment.Option B: The occipital lobe is primarily responsible for vision function.Option D: The temporal lobe regulates memory.

8. The nurse is assessing the motor function of an unconscious client. The nurse would plan to use which of the following to test the client's peripheral response to pain?

Sternal rub

Pressure on the orbital rim

Squeezing the sternocleidomastoid muscle

Nail bed pressure

Motor testing on the unconscious client can be done only by testing response to painful stimuli. Nail Bed pressure tests a basic peripheral response.Options A. B. and C: Cerebral responses to pain are testing using sternal rub. placing upward pressure on the orbital rim. or squeezing the clavicle or sternocleidomastoid muscle.

Explanation

Motor testing on the unconscious client can be done only by testing response to painful stimuli. Nail Bed pressure tests a basic peripheral response.Options A. B. and C: Cerebral responses to pain are testing using sternal rub. placing upward pressure on the orbital rim. or squeezing the clavicle or sternocleidomastoid muscle.

9. Which of the following symptoms may occur with a phenytoin level of 32 mg/dl?

Ataxia and confusion

Sodium depletion

Tonic-clonic seizure

Urinary incontinence

A therapeutic phenytoin level is 10 to 20 mg/dl. A level of 32 mg/dl indicates toxicity. Symptoms of toxicity include confusion and ataxia.Options B. C. and D: Phenytoin doesn’t cause hyponatremia. seizure. or urinary incontinence. Incontinence may occur during or after a seizure.

Explanation

A therapeutic phenytoin level is 10 to 20 mg/dl. A level of 32 mg/dl indicates toxicity. Symptoms of toxicity include confusion and ataxia.Options B. C. and D: Phenytoin doesn’t cause hyponatremia. seizure. or urinary incontinence. Incontinence may occur during or after a seizure.

10. Problems with memory and learning would relate to which of the following lobes?

Frontal

Occipital

Parietal

Temporal

The temporal lobe functions to regulate memory and learning problems because of the integration of the hippocampus.Option A: The frontal lobe primarily functions to regulate thinking. planning. and judgment.Option B: The occipital lobe functions regulate vision.Option C: The parietal lobe primarily functions with sensory function.

Explanation

The temporal lobe functions to regulate memory and learning problems because of the integration of the hippocampus.Option A: The frontal lobe primarily functions to regulate thinking. planning. and judgment.Option B: The occipital lobe functions regulate vision.Option C: The parietal lobe primarily functions with sensory function.