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1. During a health fair, the nurse takes an adult’s blood pressure and it is 200/120 mm Hg. The nurse should base the next nursing intervention on the understanding that:

• there is an increased risk for having a brain attack.
• walking around the fair probably raised the blood pressure.
• the elevated blood pressure reflects the “white coat syndrome.”
• information should be obtained regarding prescribed medications.

2. When helping a client with Parkinson disease to ambulate, what instructions should the nurse give the client?

• Avoid leaning forward.
• Hesitate between steps.
• Rest when tremors are experienced.
• Keep arms close to the center of gravity.

3. A nurse administers carbidopa-levodopa (Sinemet) to a client with Parkinson disease. Which therapeutic effect does the nurse expect the medication to produce?

• Increase in acetylcholine production
• Regeneration of injured thalamic cells
• Improvement in myelination of neurons
• Replacement of a neurotransmitter in the brain

4. What is the maximum amount of time the nurse should allow an older adult with a brain attack to remain in one position?

• 1 to 2 hours
• 3 to 4 hours
• 15 to 20 minutes
• 30 to 40 minutes

5. A client with myasthenia gravis continues to become weaker despite treatment with neostigmine (Prostigmin). What reason should the nurse identify for the health care provider’s prescription for edrophonium (Enlon)?

• Rule out cholinergic crisis
• Promote a synergistic effect
• Overcome neostigmine resistance
• Confirm the diagnosis of myasthenia

6. Which statement by a client with multiple sclerosis indicates to the nurse that the client needs further teaching?

• “I use a straw to drink liquids.”
• “I will take a hot bath to help relax my muscles.”
• “I plan to use an incontinence pad when I go out.”
• “I may be having a rough time now, but I hope tomorrow will be better.”

7. A client has left hemiplegia because of a brain attack. What can the nurse do to contribute to the client’s rehabilitation?

• Begin active exercises.
• Make a referral to the physical therapist.
• Position the client to prevent contractures.
• Avoid moving the affected extremities unless necessary.

8. A nurse is caring for a client in the home who has the diagnosis of amyotrophic lateral sclerosis (ALS). Which position should the nurse recommend that the client assume after eating?

• Sims
• Sitting
• Side-lying
• Semi-Fowler

9. A client is diagnosed with Parkinson disease and asks the nurse what causes the disease. On which underlying pathology does the nurse base a response?

• Disintegration of the myelin sheath
• Breakdown of the corpora quadrigemina
• Reduced acetylcholine receptors at synapses
• Degeneration of the neurons of the basal ganglia

10. Which clinical indicator is the nurse most likely to identify when assessing a client with a ruptured cerebral aneurysm?

• Tonic-clonic seizures
• Decerebrate posturing
• Sudden severe headache
• Narrowed pulse pressure

11. What actions should the nurse include when planning for the long-term care of a client with expressive aphasia?

• Begin helping the client to associate words with physical objects.
• Encourage the client to acknowledge that this disability is permanent.
• Wait for communication to be initiated by the client even if it takes a long time.
• Assist family members to accept the fact that they cannot communicate verbally with the client.

12. A client with a brain attack becomes incontinent of feces. What is the most important nursing action to support the success of a bowel training program?

• Using medication to induce elimination
• Adhering to a definite time for attempted evacuations
• Considering previous habits associated with defecation
• Timing of elimination to take advantage of the gastrocolic reflex

13. A client with a brain attack has dysarthria. What should the nurse include in the plan of care to address this problem?

• Routine hygiene
• Liquid formula diet
• Prevention of aspiration
• Effective communication

14. A nurse is caring for a client with the diagnosis of Guillain- Barre syndrome. The nurse identifies that the client is having difficulty expectorating respiratory secretions. What should be the nurse’s first intervention?

• Auscultate for breath sounds.
• Suction the clients oropharynx.
• Administer oxygen via nasal cannula.
• Place the client in the orthopneic position.

15. What should the nurse include in the plan of care for a client who just had a posterior lumbar laminectomy?

• Encourage the client to cough.
• Reposition the client by log rolling.
• Assess the client for indications of peritonitis.
• Instruct the client to bend the knees when turning.

16. For which clinical indicator should the nurse assess a client who just had a microdiskectomy for a herniated lumbar disk?

• Cerebral edema
• Sensory loss in legs
• Spasms of the bladder
• Pain referred to the flanks

17. A client with the diagnosis of Parkinson disease asks the nurse, “Why do I drool so much?” Which is the nurse’s best response?

• “We don’t know why this happens.”
• “There is a paralysis of the throat muscles.”
• “You have a loss of involuntary movements.”
• “Muscle rigidity prevents normal swallowing.”

18. What should the nurse instruct the client to do to limit triggering the pain associated with trigeminal neuralgia?

• Drink iced liquids.
• Avoid oral hygiene.
• Apply warm compresses.
• Chew on the unaffected side.

19. What action should the nurse take to prevent precipitating a painful attack in a client with tic douloureux?

• Avoid walking swiftly by the client.
• Keep the client in the prone position.
• Discontinue oral hygiene temporarily.
• Massage both sides of the face frequently.

20. A client with a hemiparesis is reluctant to use a cane. The nurse explains to the client that the cane is needed to:

• maintain balance to improve stability.
• relieve pressure on weight-bearing joints.
• prevent further injury to weakened muscles.
• aid in controlling involuntary muscle movements.

21. A client is diagnosed as having expressive aphasia. What type of impairment does the nurse expect the client to exhibit?

• Speaking and/or writing
• Following specific instructions
• Understanding speech and/or writing
• Recognizing words for familiar objects

22. Bed rest is ordered after a client’s brain attack results in hemiplegia. Which exercises should the nurse incorporate into the client’s plan of care 24 hours after the brain attack?

• Passive range-of-motion exercises
• Active exercises of the extremities
• Light weight-lifting exercises of the right side
• Isotonic exercises that will capitalize on returning muscle function

23. A client with myasthenia gravis asks the nurse, “What is going to happen to me and to my family?” What information about what the client can anticipate should be incorporated into the nurse’s response?

• High cure rate with proper treatment
• Slowly progressive course without remissions
• Chronic illness with exacerbations and remissions
• Poor prognosis, with death occurring in a few months

24. A client develops hydrocephalus 2 weeks after cranial surgery for a ruptured cerebral aneurysm. The nurse concludes that the hydrocephalus probably is related to which physiologic response?

• Vasospasm of adjacent cerebral arteries
• Ischemic changes in the Broca speech center
• Increased production of cerebrospinal fluid
• Blocked absorption of fluid from the arachnoid space

25. A client is diagnosed with trigeminal neuralgia. Which medication should the nurse anticipate will be prescribed for this client?

• Ascorbic acid
• Morphine sulfate
• Allopurinol (Zyloprim)
• Carbamazepine (Tegretol)

26. To what does the nurse attribute the increased risk of respiratory complications in clients with myasthenia gravis?

• Narrowed airways
• Impaired immunity
• Ineffective coughing
• Viscosity of secretions

27. A client had a brain attack and bed rest is ordered. What can the nurse use to best prevent footdrop in this client?

• Splints
• Blocks
• Cradles
• Sandbags

28. A client with myasthenia gravis has been receiving neostigmine (Prostigmin) and asks about its action. What information about its action should the nurse consider when formulating a response?

• Stimulates the cerebral cortex
• Blocks the action of cholinesterase
• Replaces deficient neurotransmitters
• Accelerates transmission along neural sheaths

29. What nursing action is essential when a client experiences hemianopsia as the result of a left ischemic stroke?

• Place objects within the visual field.
• Teach passive range of motion exercises.
• Instill artificial tear drops into the affected eye.
• Reduce time client is positioned on the left side.

30. What should the nurse assess for in the immediate postoperative period after a client has brain surgery?

• Tachycardia
• Constricted pupils
• Elevated diastolic pressure
• Decreased level of consciousness

31. What nursing intervention is anticipated for a client with Guillain-Barre syndrome?

• Providing a straw to stimulate the facial muscles
• Maintaining ventilator settings to support respiration
• Encouraging aerobic exercises to avoid muscle atrophy
• Administering antibiotic medication to prevent pneumonia

32. A nurse enters the room of a client with myasthenia gravis and identifies that the client is experiencing increased dysphagia. What should the nurse do first?

• Administer oxygen.
• Raise the head of the bed.
• Perform tracheal suctioning.
• Call the health care provider.

33. A nurse may find that, for optimum nutrition, a client with a brain attack needs assistance with eating. What should the nurse do?

• Request that the client’s food be pureed.
• Feed the client to conserve the client’s energy.
• Have a family member assist the client with each meal.
• Encourage the client to participate in the feeding process.

34. A client with Guillain-Barre syndrome has been hospitalized for 3 days. Which assessment finding indicates a need for more frequent monitoring?

• Localized seizures
• Skin desquamation
• Hyperactive reflexes
• Ascending weakness

35. On which principle should a nurse base client teaching when planning to assist a client to reestablish a regular pattern of defecation?

• Sedentary activities produce muscle atony.
• Increased fluid promotes ease of evacuation.
• Peristalsis is initiated by the gastrocolic reflex.
• Increased potassium is needed for normal neuromuscular irritability.

36. A nurse is interviewing a client with a tentative diagnosis of Parkinson disease. What should the nurse expect the client to report about how the onset of symptoms occurred?

• Suddenly
• Gradually
• Overnight
• Irregularly

37. A recently hospitalized client with multiple sclerosis is concerned about generalized weakness and fluctuating physical status. What is the priority nursing intervention for this client?

• Encourage bed rest.
• Space activities throughout the day.
• Teach the limitations imposed by the disease.
• Have one of the clients relatives stay at the bedside.

38. A client with a brain attack has right hemiplegia. What occurs if the nurse uses the client’s right arm to obtain a blood pressure reading?

• Produces inaccurate readings
• Hinders restoration of function
• Precipitates the formation of a thrombus
• Causes excessive pressure on the brachial artery

39. Which health problem does the nurse identify from an older client’s history that increases the client’s risk factors for a brain attack?

• Glaucoma
• Hypothyroidism
• Continuous nervousness
• Transient ischemic attacks

40. A client with myasthenia gravis asks the nurse why the disease has occurred. What pathology underlies the nurse’s reply?

• A genetic defect in the production of acetylcholine
• An inefficient use of the neurotransmitter acetylcholine
• A decreased number of functioning acetylcholine receptor sites
• An inhibition of the enzyme AChE, leaving the endplates folded

41. A client with myasthenia gravis experiences dysphagia. What is the priority risk associated with dysphagia that must be considered when planning nursing care?

• Aspiration
• Dehydration
• Nutritional imbalance
• Impaired communication

42. Which nursing action is specific to the plan of care for a client with trigeminal neuralgia?

• Be alert to prevent dehydration or starvation.
• Initiate exercises of the jaw and facial muscles.
• Apply ice compresses to the affected body area.
• Emphasize the importance of brushing the teeth.

43. The spouse of a client with a brain attack insists on doing everything for the client during visits. After these visits, the client seems to be depressed. The nurse understands that these visits probably have what effect on the client?

• Losing faith in the future
• Feeling the loss of independence
• Experiencing guilt about being a burden
• Recognizing that the spouse is now the leader in the relationship

44. Which clinical indicator does the nurse expect to identify when assessing a client admitted with a herniated lumbar disk?

• Pain radiating to the hip and leg
• Bowel and bladder incontinence
• Paralysis of both lower extremities
• Overgrowth of tissue on the lower back

45. The spouse of a client who had a brain attack seems unable to accept the concept that the client must be encouraged to participate in self-care. What is the best response by the nurse?

• Tell the spouse to let the client do things independently.
• Allow the spouse to assume total responsibility for the client’s care.
• Explain that the nursing staff has full responsibility for the client’s activities.
• Ask the spouse for assistance in planning those activities most helpful to the client.

46. What should the nurse include when planning care for a client with Bell palsy?

• Managing incontinence
• Assisting with ambulation
• Preventing corneal damage
• Maintaining seizure precautions

47. A nurse is caring for a client who has urinary incontinence as the result of a brain attack. What action should the nurse include in the plan of care to limit the occurrence of urinary incontinence?

• Insert a urinary retention catheter.
• Institute measures to prevent constipation.
• Encourage an increase in the intake of caffeine.
• Suggest that a carbonated beverage be ingested daily.

48. A client with a brain attack is comatose on admission. Which clinical indicator is the nurse most likely to identify?

• Twitching motions
• Purposeful motions
• Urinary incontinence
• Unresponsiveness to pain

49. Which function must be addressed in the plan of care when a client has dysphagia?

• Writing
• Focusing
• Swallowing
• Understanding

50. What does the nurse understand that clients with myasthenia gravis, Guillain-Barre syndrome, and amyotrophic lateral sclerosis (ALS) share in common?

• Progressive deterioration until death
• Deficiencies of essential neurotransmitters
• Increased risk for respiratory complications
• Involuntary twitching of small muscle groups