Neurology

Local anesthetics have which mechanism of action?

The physician writes an order for diphenhydramine 250 mg PRN for sleep. Which part of the order does the nurse question?

The patient with chronic obstructive pulmonary disease (COPD) is brought to the post-anesthesia care unit (PACU) after abdominal surgery. Which symptom alerts the nurse to an impending complication?

The patient is admitted due to concern for a cerebrovascular accident in the brainstem. Which reflexes does the nurse use to assess the integrity of the brainstem? Select all that apply.

Following a motor vehicle accident, the patient is brought to the emergency department with concern for a brainstem injury. Which tests are performed to assess the integrity of this patient’s brainstem? Select all that apply.

The nurse uses the caloric and doll’s eyes reflex tests to assess the functions of which cranial nerves in the comatose patient? Select all that apply.

The nurse on the neurological intensive care unit would intervene if the provider attempted to assess the oculovestibular reflex in the patient with which recent injury?

The patient has signs of dangerously increased intracranial pressure following a traumatic brain injury. The nurse prepares the patient for the insertion of which intracranial pressure monitoring device considered to be the gold standard?

The patient with a traumatic brain injury has symptoms of life-threatening elevated intracranial pressure. The provider instructs the nurse to prepare the patient for the insertion of an intraventricular catheter to monitor intracranial pressure (ICP) and drain cerebrospinal fluid as necessary. Which lab value prompts the nurse to clarify the safety of the procedure with the patient?

The drowning victim is admitted to the intensive care unit (ICU) after being without oxygen for 10 minutes. When he was found, he did not have a pulse and was resuscitated at the site. Once return of spontaneous circulation (ROSC) occurred, he was transported to the hospital. He was found to be profoundly hypotensive and was fluid resuscitated in the ambulance. In the ICU, his Glasgow coma score is found to be 7. He is intubated and has a central line and a peripheral arterial catheter in place. Which constellation of symptoms concern the nurse the most?

The 38-year-old patient has increased intracranial pressure following a massive stroke. Select the vital signs that together indicate the patient is at an immediate risk for brainstem herniation.

The 16-year-old patient presents to the emergency department (ED) complaining of a headache, fever, malaise, and nuchal rigidity. The patient is found to have a fever of 106°F, heart rate 132 bpm, and blood pressure 135/62 mmHg. A complete blood count is normal with the exception of leukocytosis. Additional assessment reveal sunsetter eyes and papilledema. Which test, if instructed to perform first, prompts the nurse to question the order?

The unconscious patient with elevated intracranial pressure secondary to an ischemic stroke has a jugular bulb catheter in place to monitor cerebral oxygenation (SJO₂). The patient’s oxygen saturation (read by peripheral pulse oximetry probe) is 98% on 30% FiO₂ administered via endotracheal tube. The SJO₂ is 85%. How does the nurse interpret these results?

The patient with global cerebral ischemia requires the placement of a jugular venous catheter to measure cerebral oxygen saturation. The nurse prepares the patient for the provider to insert the catheter into which location?

Determine the Cᴇᴏ₂ (cerebral oxygen extraction) for the patient receiving 100% FiO₂ whose jugular vein oximetry reads 54% and the peripheral pulse oximetry reads 92%. Input your answer using a whole number.

Which test does the nurse expect will be used to determine the effectiveness of the fosphenytoin dose?

The patient comes to the clinic for an evoked potential study. The nurse understands the patient is being examined for which condition?

The patient is receiving therapeutic hypothermia treatment following a massive myocardial infarction with return of spontaneous circulation (ROSC) after 30 minutes of cardiopulmonary resuscitation (CPR). It is most important to plan care to address which complication of therapeutic hypothermia?

The nurse is supervising the care of the patient who is alert but has increased intracranial pressure following head trauma. Which action by the unlicensed assistive personnel (UAP) prompts the nurse to intervene immediately?

The nurse learns the patient who takes fosphenytoin was prescribed apixaban two months ago. The nurse assesses the patient for which complication caused by taking these two medications together?

The nurse observes the following pupils in the patient: (R,L) The nurse alerts the provider to which possible scenario?

The nurse observes the following pupils in the patient just brought into the emergency department by ambulance: (R,L) The nurse immediately prepares the patient for which test?

The unresponsive patient is brought to the emergency department via ambulance. During an abbreviated neurologic exam, the nurse notes the following pupils, estimated to be 1 mm and fixed: The nurse prepares to administer which medication?

The patient in the intensive care unit is intubated, sedated, and chemically paralyzed following decompensation due to necrotizing pneumonia. During the routine neurological check, the nurse notes these pupils: How does the nurse interpret this assessment?

The unconscious patient presents with the following respiratory pattern: The nurse anticipates further testing will reveal which condition?

Following a motor vehicle accident, the unconscious patient presents with a respiratory rate of 28 and the following respiratory pattern: The nurse expects which acid-base derangement?

In which location of the spine does the provider introduce the needle for a lumbar puncture?

The patient has been taking apixaban for 4 weeks. Which monitoring test does the nurse review to evaluate the efficacy of the medication?

The 2.1 kg neonate with hypoxic ischemic encephalopathy is in status epilepticus that is refractory to 2 loading doses of phenobarbital. The provider has ordered 20 mg/kg to be administered intravenously STAT. The pharmacy dispenses the medication in a concentration of 50 mg/mL. How many milliliters does the nurse administer? Input your answer to the hundredth decimal.

The 4.5 kg neonate with hypoxic ischemic encephalopathy is in status epilepticus that is refractory to 2 loading doses of phenobarbital. The provider has ordered 20 mg/kg to be administered intravenously over 15 minutes STAT. The pharmacy dispenses the medication in a concentration of 50 mg/mL. What rate will the nurse program the pump to administer the medication? Round your answer to the tenth decimal place.

The patient who has severely elevated intracranial pressure following a traumatic brain injury is intubated, sedated, and chemically paralyzed. Which intervention does the nurse include in the plan of care?

What is the rationale for using hyperventilation as management for acute elevated intracranial pressure?

The nurse is educating a middle-aged wellness group on lifestyle changes that may prevent Alzheimer’s disease. Which diet does the nurse recommend?

The nurse questions the order for an infusion of 0.45% NaCl in the patient with which condition?

The success of distraction and massage as pain management techniques is described by which theory of pain?

During an admission assessment, the patient reports burning pain that shoots up the leg. The nurse uses which term to document this patient’s pain?

The patient with poorly controlled type II diabetes mellitus reports burning pain in the feet and legs that keep him up at night. The nurse passes this report along the provider and advocates for which medication for the patient?

The 18-year-old patient presents to the emergency department (ED) complaining of severe pain in the ankle after falling at work. Range of motion in the ankle is decreased and +1 edema is present. On x-ray, the bones of the foot and ankle are intact and the patient is diagnosed with a mild sprain. How does the nurse assess this patient’s pain?

Which assessments indicate the patient is experiencing chronic pain? Select all that apply.

Fentanyl must be used with caution in which patient?

The elderly patient receiving a continuous morphine infusion for the treatment of cancer pain is at risk for opioid-induced respiratory depression. The nurse selects which monitoring device to most quickly detect a change in the patient’s respiratory drive?

The patient receiving a continuous hydromorphone infusion for severe cancer pain is found to be unconscious with a respiratory rate of 7 breaths per minute. Which action does the nurse take first?

The patient has been taking oral oxycodone for 5 months and has experienced relief of pain caused by a bulging disc in the lower back. The patient presents to the clinic to report breakthrough pain that is more severe than before treatment. Which action by the nurse is most appropriate?

What is the main rationale for prescribing hydrocodone with acetaminophen?

The patient with scoliosis experiences severe pain due to muscle spasms related to the misalignment of the spine. Which medication does the nurse anticipate to be ordered for this condition?

The nurse recommends transcutaneous electrical nerve stimulation (TENS) to which patients? Select all that apply.

The nurse plans care to assist the patient with cognitive-behavioral strategies to reduce pain at which time?

The patient with damage to the anterior horn of the spinal cord will have which deficiency?

The patient is brought to the emergency department (ED) after falling down and being briefly unconsciousness. The patient’s wife is with him and tells the nurse in private, “He’s not been like himself. He’s verbally abusive, now, and mean. He was always the sweetest man I ever knew.” The nurse suspects testing will reveal a lesion in which lobe of the brain?

The patient presents to the emergency department (ED) after cutting off the tip of his middle finger while using a butcher’s knife. Of note, the patient’s vital signs are normal and the patient reports the pain to be a 0 out of 10. The nurse suspects the patient has a lesion in which lobe of the brain?