Neurology

The nurse anticipates administering cobalamin and folic acid to the patient presenting with which symptoms? Select all that apply.

The nurse more closely assesses patients with which conditions for signs of pernicious anemia? Select all that apply.  

Four hours after a rectal resection for treatment of rectal cancer, the patient is noted to be pale and diaphoretic. Which assessments are the priority? Select all that apply.  

The 21-year-old patient with a body mass index of 10.1 undergoes placement of a peripherally inserted central catheter (PICC) at 1000 and total parenteral nutrition (TPN) is initiated at 1200. At 1600, 160 mL have infused and the patient is noted to be breathing shallowly, there is blood oozing from the PICC insertion site, and the patient is exhibiting confusion. Which action does the nurse perform first? 

The nurse is supervising the student nurse in performing a cap change for a peripherally inserted central catheter (PICC) in a patient who recently sustained a traumatic brain injury. Which action by the student nurse best indicates effective learning?

The nurse assesses the patient being treated for bipolar disorder for which signs of toxicity?  

The 1-year-old with sickle cell disease is in crisis following gastroenteritis. While hospitalized, the patient abruptly exhibits seizures, decreased level of consciousness, right-sided facial asymmetry when crying, coughing and sputtering during a bottle feeding, and decreased movement of the right leg and arm. The nurse contacts the provider and prepares to provide which initial interventions? Select all that apply.  

The nurse is providing discharge education to the parents of the 7-day-old neonate who required a blood transfusion due to blood loss following circumcision. Which instruction is most important?  

The 12-year-old child who weighs 35 kg with hemophilia B is brought to the emergency department with signs of increased intracranial pressure after being hit in the head at a baseball game. The nurse prepares to carry out which order?  

The 18-year-old female patient reports menorrhagia, easy bruising, and epistaxis. Her family history is notable for maternal hypertension, a brother with hemophilia A, and a father who died of stroke at age 48. Which question is most important to ask the patient?   

The nurse is evaluating the patient’s response to therapy with 1-deamino-8-ᴅ-arginine vasopressin (DDAVP) for treatment of mild bleeding caused by hemophilia A. Which assessment indicates the patient is experiencing an adverse effect to therapy?  

The nurse assessing the 4-month-old brought to the emergency room for poor feeding and signs of dehydration notes the infant seems to be looking down and sclera is visible superior to the iris. The nurse reports this assessment to the provider and receives orders for care. Which order does the nurse question? 

The 18-day-old neonate has musty-smelling urine and vomits with almost every feeding. The patient, who was born after an uncomplicated pregnancy and delivery, had a normal newborn screening that was drawn in the hospital after birth. Which action by the nurse is most appropriate?   

The patient in the emergency department begins projectile vomiting. Which intervention is most important?  

The nurse overhears a colleague preparing a dose of naltrexone. The nurse offers to assist and ensures the colleague takes which actions? Select all that apply.  

The 71-year-old patient with a history of hypertension, hypercholesterolemia, and type 2 diabetes mellitus is brought to the emergency department 3 hours after exhibiting right-sided facial weakness, drooping of the right eye, and slurring of the words. Appendicular tone is normal and the patient has no issues walking or standing from a sitting position. The nurse prepares the patient for which intervention first? 

The nurse is planning care for the 78-year-old patient with recurrent fecal impaction. The patient has prostate cancer that has metastasized to the bone. In addition to palliative chemotherapy, the patient receives a fentanyl transdermal patch and intravenous hydromorphone. The patient is neutropenic and thrombocytopenic. The nurse works with the provider to plan which intervention to manage the opioid-induced constipation and subsequent fecal impaction? 

The 11-month-old, previously healthy infant is brought to the emergency department after becoming increasingly lethargic over the past 24 hours. The infant’s vital signs are notable for a temperature of 40.8°C, heart rate 138 bpm, respiratory rate 31, and blood pressure 84/50 mmHg. Upon assessment, the nurse notes sensitivity to light and sound, bulging anterior fontanelle, and significant resistance to turning the head. Place the interventions in the correct order.  

A 16-year-old boy is brought to the clinic by his mother with complaints of strange noises and movements. The boy states, “I can’t stand that I make this weird noise with my mouth. I can feel it coming, and I try to stop it for as long as I can, but eventually it just comes out. The other kids at school make fun of me. It’s so embarrassing.” The mother reports that the boy gets good grades and has no trouble concentrating at home when doing homework. Which information does the nurse give the patient and his mother about the medication he will be prescribed?  

The 48-year-old patient is brought via ambulance to the emergency room after being found unresponsive by her son. She has a prescription for transdermal fentanyl patches for treatment of cancer pain related to her breast cancer that has metastasized to her pelvis. The patient’s heart rate is 72 bpm, respiratory rate is 4 breaths per minute, and her oxygen saturation is 88%. Her arterial blood gas results are: pH 7.21, PaCO₂ 72 mmHg, PaO₂ 74, HCO₃¯ 23. A thorough assessment reveals 2 fentanyl patches on the patient’s skin. The nurse advocates for which initial action?  

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. Vital signs are normal and the patient seems to be breathing well. The nurse anticipates which finding on the lumbar puncture result?  

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. Vital signs are normal and the patient seems to be breathing well. There is increased protein in the cerebrospinal fluid found after a lumbar puncture. The patient is admitted to the intensive care unit for further management and observation. The ICU nurse includes which interventions in the plan of care? Select all that apply.  

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. There is increased protein in the cerebrospinal fluid found after a lumbar puncture. The patient begins taking more shallow breaths and becomes confused. The patient is intubated and mechanically ventilated. Once the patient is stable, the nurse anticipates administering which medication? 

The 24-year-old male patient presents to the clinic to request a consultation for rhinoplasty. He reports his unsightly nose ruined his most recent relationship because his girlfriend would not stop staring at it; he has missed work due to embarrassment and has started to use makeup to make it look smaller. Upon assessment, the nose appears normal and proportional to his face. Which course of action is the most appropriate?  

During the provider’s exam of the 6-hour-old neonate, the provider reports observing a red reflex in the neonate’s right eye, but not the left. The provider observes whiteness at the back of the eye. Enucleation is performed and the diagnosis of retinoblastoma with clear tumor margins is confirmed. No chemotherapy or radiation is required. The infant is ready to be discharged home as a healthy baby. Which health screening information is most relevant to this family? 

The 7-year-old child is being evaluated for attention deficit or learning disability. The child’s teachers report a lack of attention to detail and an inability to follow direction. The child’s parents report issues at home, too – not doing what is asked and not remembering what has been said. While being evaluated, the child begins to blink rapidly for 20 seconds. Once the episode ends, the child does not remember what happened or the purpose of the appointment. The nurse prepares education for the parents about which medication? 

The 7-year-old child is being evaluated for attention deficit or learning disability. The child’s teachers report a lack of attention to detail and an inability to follow direction. The child’s parents report issues at home, too – not doing what is asked and not remembering what has been said. While being evaluated, the child begins to blink rapidly for 20 seconds. Once the episode ends, the child does not remember what happened or the purpose of the appointment. The nurse educates the parents about which adverse effects of first line therapy? Select all that apply.  

The 28-year-old patient checks himself into a center for detoxification from opiates, which he has used daily for 3 years. The patient begins to experience pain, diarrhea, salivation, and diaphoresis and is started on buprenorphine. Worsening pain throughout the body and uncontrollable diarrhea prompts stepwise increase of buprenorphine dose to the maximum dose without relief of withdrawal symptoms. The nurse contacts the provider to request an order for which medication?  

The patient is brought to the emergency department after sudden onset slurring of the words, confusion, and right-sided weakness that started 3 hours ago. Aspirin was given by emergency response. He has a history of diabetes mellitus, hypertension, and hyperlipidemia for which he is compliant with therapy. He smokes 2 packs of cigarettes per day. Upon assessment, the patient’s temperature is 37.4°C, heart rate is 118 bpm, and blood pressure is 204/118 mmHg.  A stat computed tomography (CT) scan shows an area of hyperechogenicity on the left side of the brain. The nurse prepares to provide which medication?  

The nurse is caring for the patient with prostate cancer that has metastasized to the bone. The physician has prescribed extended-release oxycodone to treat severe bone pain. The patient expresses to the nurse he is concerned he will become addicted to the opioid pain medication given what you see on television. Which response from the nurse is most appropriate?