*Data regarding mobility, strength, coordination, and activity tolerance are important for the nurse to obtain because:
*a. Many neurologic diseases affect one or more of these areas.
*b. Patients are less able to identify other neurologic impairments.
*c. These are the first functions to be aff...
NUR 202 Exam 4 Questions and
Answers
*Data regarding mobility, strength, coordination, and activity tolerance are important for
the nurse to obtain because:
*a. Many neurologic diseases affect one or more of these areas.
*b. Patients are less able to identify other neurologic impairments.
*c. These are the first functions to be affected by neurologic diseases.
*d. Aspects of movement are the most important function of the nervous system. -
Answer-*a. Many neurologic diseases affect one or more of these areas.
The most common cause of changes in the older patient's mental state is:
A. Infection
B. Sedative agents
C. Insufficient oxygen
D. Electrolyte imbalance - Answer-A. Infection
A 27-year-old male suffered a frontal lobe infarction secondary to a car crash. What is
the appropriate nursing intervention?
A. Enable the bed alarm safety system.
B. Place all items directly in front of the patient.
C. Use a picture board to assist with communication.
D. Instruct the patient to use a call light prior to getting out of bed. - Answer-A.Enable
the bed alarm safety system
The nurse administers mannitol to the Patient with increased ICP. Which parameter
requires close monitoring?
*A. Blood sugar
*B. Intake and output
*C. Widening of the pulse pressure
*D. Serum electrolytes - Answer-*B. Intake and output
An hour later after a CT scan, the patient is diagnosed with a left hemisphere stroke.
Which manifestations would you expect?
(Select all that apply)
A. Disorientation to time, place, and person
B. Inability to discriminate words and letters
C. Constant smiling
D. Intellectual impairment
E. Neglect of left visual field
F. Deficits in the right visual field - Answer-B. Inability to discriminate words and letters
, D. Intellectual impairment
F. Deficits in the right visual field
The nurse is assessing the motor and sensory function of an unconscious client who
sustained a head injury. The nurse should use which technique to test the client's
peripheral response to pain?
1.Sternal rub
2.Nailbed pressure
3.Pressure on the orbital rim
4.Squeezing of the sternocleidomastoid muscle - Answer-2.Nailbed pressure
The nurse is caring for the client with increased intracranial pressure as a result of a
head injury? The nurse would note which trend in vital signs if the intracranial pressure
is rising?
A client recovering from a head injury is participating in care. The nurse determines that
the client understands measures to prevent elevations in intracranial pressure if the
nurse observes the client doing which activity?
1.Blowing the nose 2.Isometric exercises 3.Coughing vigorously 4.Exhaling during
repositioning - Answer-4.Exhaling during repositioning
A client has clear fluid leaking from the nose following a basilar skull fracture. Which
finding would alert the nurse that cerebrospinal fluid is present?
1.Fluid is clear and tests negative for glucose.
2.Fluid is grossly bloody in appearance and has a pH of 6.
3.Fluid clumps together on the dressing and has a pH of 7.
4.Fluid separates into concentric rings and tests positive for glucose. - Answer-4.Fluid
separates into concentric rings and tests positive for glucose.
A client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The
nurse should include which measures in the plan of care to minimize the risk of
occurrence? Select all that apply.
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