Neurology

Which order does the nurse clarify for the patient in the intensive care unit following a hemorrhagic stroke?

The nurse is supervising the care of the patient who suffered an embolic stroke of the right middle cerebral artery after a clot formed on the patient’s prosthetic mitral valve. Which instruction does the nurse provide to the unlicensed assistive personnel that will be most important to prevent bacterial endocarditis?

During a comprehensive neurologic exam, the provider brushes a wisp of cotton over the patient’s cornea, which causes the patient to blink. The nurse notes that which cranial nerve is intact based on this test?

The nurse is testing the patient’s eyes for accommodation by holding a finger in front of the eyes and asking the patient to look at a point over the nurse’s shoulder then look at the finger. The nurse documents which bilateral response as normal?

The nurse assesses the patient for which signs of complications of a parathyroidectomy?

The nurse is performing an admission assessment on the 73-year-old patient. Which question does the nurse ask to determine if the patient is experiencing cataract development?

The patient walks into to the emergency department (ED) complaining of significant pain in the right eye. It appears red and swollen. The pupils are not equal in size or reactivity – the right pupil remains dilated despite the bright exam room and the flash light. The patient cringes from the bright light, though, and complains the bright lights are hurting his head. He reports that over the last week, both eyes have been aching and he has been seeing halos around lights. The nurse prepares for which test to be performed first?

The fetuses of mothers with which infections during pregnancy are at an increased risk for hearing loss? Select all that apply.

The nurse assesses the patient with acute ethmoid sinusitis for which symptom that indicates the patient is experiencing a severe complication of the condition?

The nurse is assigned to care for a large for gestational age neonate with respiratory distress and significant tachypnea that is requiring continuous positive airway pressure at 12 hours of life. The nurse notes the patient has good muscle tone with flexed bilateral legs and a flexed right arm. The left arm is extended and adducted. The nurse is MOST concerned about which condition?

The mother of the healthy baby born 12 hours ago at 42 weeks’ gestation asks the nurse why the baby’s arms and legs quiver when she cries. Which response by the nurse is most appropriate?

The mother of a 1-month-old neonate brings the child to the clinic with concerns that the child’s head seems large. The nurse measures the occipitofrontal circumference (OFC) and notes a 4 cm increase in the OFC since birth. When reporting this information to the provider, the nurse requests which test?

On the initial assessment after birth, the neonate is found to have a 1 cm x 0.5 cm hemangioma on the right cheek. Which additional assessment does the nurse make related to this finding?

The 76-year-old patient with atrial fibrillation tells the nurse in a slurred voice that the right arm “just isn’t working right.” Which action does the nurse take first?

The patient with a brain neoplasm reports experiencing visual misperceptions. The nurse suspects the brain tumor is in which lobe of the brain? 

The nurse is assigned to the patient with a brain neoplasm who has been experiencing symptoms of depression. During shift report, the off-going nurse reports observing the patient in a trance-like state. The nurse suspects that the tumor is in which lobe of the brain?

The patient with a brain neoplasm is combative and cursing at the staff. The family reports that this is a drastic change in the patient's personality. The nurse suspects the tumor is in which lobe of the patient's brain?

The patient presents to the emergency department exhibiting stiff, jerky movements of the face and neck. The nurse reviews the patient's medical history for a prescription for which medication? 

After failing to experience symptom relief from other antidepressants, the patient is prescribed a tricyclic antidepressant. The nurse instructs the patient to expect which side effect? 

The elderly patient with hypertension, hyperlipidemia, arthritis, diabetes, and improving cellulitis is being discharged home after a stay in a sub-acute care facility. The caregiver asks the nurse about the patient's risk for falls. The nurse reviews the patient's medical history for which risk factors for falls? Select all that apply.

Which information does the nurse provide to the patient with epilepsy who has been prescribed phenytoin?

The nurse is using the Finnegan scoring system to assess a neonate for opioid withdrawal. The first score is 9 and the second score is 14. Which statement is accurate?

A high school wide receiver suffered substantial head trauma during a tackle. The school nurse is concerned about concussion. The nurse provides which information to the adolescent and parents? Select all that apply.

Intoxication with which drug is most commonly associated with aggressive and violent behavior?

The nurse is admitting a patient with an extensive mental health history. The nurse’s knowledge of which system guides intervention planning?

The nurse is providing education to the patient newly diagnosed with major depressive disorder. The nurse includes information on which derangement of neurotransmitters?

The nurse suspects severe anxiety in the patient who reports which symptoms? Select all that apply.

The partner of a patient with obsessive-compulsive disorder is seeking information. Which information does the nurse provide for compulsions?

The nurse is assessing a patient who was reported to have an altered level of consciousness. The patient presents with rapid speech, impaired judgement, and rapidly fluctuating emotional state. After admission and treatment, the patient returns to a functional baseline. Which diagnosis best describes the patient’s behavior?

The nurse is reviewing the chart of a patient recently admitted to the hospital. The patient’s medication review includes bosentan, glyburide, praziquantel, and ergotamine. The nurse expects to observe which symptom in the patient?

The nurse is evaluating the arterial blood gas results of the patient on hospice with the following respiratory pattern: The patient’s PaCO₂ is 62 mm Hg, which is 20 mm Hg higher than the previous ABG. The nurse understands the patient’s blood gas was drawn at which period in the patient’s respiratory cycle?

The patient with Raynaud’s phenomenon presents with which characteristic during an exacerbation?

Which patients are at an increased risk for Raynaud’s phenomenon? Select all that apply.

The patient with Raynaud’s phenomenon has received teaching on how to manage the disorder. Which statement by the patient indicates a need for further teaching?

The nurse is providing education to the patient recently diagnosed with Raynaud’s phenomenon. Which information does the nurse include in teaching?

The patient being treated for seizures has developed Raynaud’s phenomenon. The nurse anticipates the provider to order which medication for this patient?

Which hormone is produced in the mother as a result of breastfeeding?

Which reflex is demonstrated by allowing the infant to fall a few inches to a padded surface?

Following a major natural disaster, the charge nurse receives instruction from superiors to pair patients as roommates to increase the number of available rooms. The first patient to be paired is a 42-year-old patient with cellulitis who has a 103°C fever and tachycardia. The charge nurse places her in a room with which patient?

The unit is experiencing increased patient census. Which patients, if suggested for pairing with the 28-year-old patient with epilepsy, does the bedside nurse question? Select all that apply.

Which patient in the emergency department (ED) must be treated first?

The adult child of the patient with dementia who is the patient’s in-home caregiver reports the patient exhibits increased confusion and agitation after 1600 each day. Which statement by the nurse will be most helpful to the caregiver?

The nurse is planning care for the elderly patient with dementia who experiences increased agitation and confusion during the evening hours. Which interventions does the nurse include to decrease evening agitation and confusion? Select all that apply.

The 60-year-old patient who was recently laid off from his factory job of 38 years presents to the emergency department complaining of severe superficial pain over the flank. Which assessment will be most important for diagnosis?

The patient with shingles presents to the clinic for reassessment following treatment. The nurse asks the patient to perform which action to assess for complications of the condition?

The patient in Arizona calls the nurse line to report being stung by a scorpion. Which follow-up question by the nurse is most important?

Several tenants from an apartment building are brought to the emergency department with concern for carbon monoxide poisoning. One patient presents with reddish-purple skin, a blood pressure of 94/48 mmHg, heart rate of 118 bpm, and altered consciousness (arouses when his name is shouted). The nurse anticipates testing will reveal which carbon monoxide level?

The patient with third degree burns to bilateral lower legs is undergoing hydrotherapy to debride eschar tissue from the wounds. Prior to the procedure, the patient received a bolus of intravenous morphine in addition to the continuous infusion for pain control. During the procedure, the patient’s level of consciousness decreases to only rousable by painful stimuli. The patient’s temperature is 36.4°C, respiratory rate is 14 breaths per minute, heart rate is 82 bpm, and oxygen saturation is 93% on room air. The nurse ends the hydrotherapy session and contacts the provider to request which intervention?

The 32-year-old female patient (60 kg) is brought via ambulance to the emergency department following a water drinking competition. The patient has a Glasgow Coma score of 6, oxygen saturation of 94% on room air, heart rate of 62 bpm, and respiratory rate of 16 breaths per minute. The nurse anticipates administering which medication?

The 22-year-old patient is brought to the emergency room with decreased level of consciousness after ingesting 3,4-methylenedioxymethamphetamine. The patient is noted to have a rectal temperature of 40°C. The nurse performs which interventions? Select all that apply.