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Adult Neuro NCLEX QUESTIONS WITH COMPLETE
SOLUTIONS BEST GRADED A+
is common after anesthesia Correct Answer: Diminished gag reflex Altered in moods (anxiety, agitation) will resolve as it wears off Drowsiness and somnolence during purposeful interaction- following commands cause of botulism Correct Answer: Improperly canned foods Block acetylcholine cause muscle paralysis; descending flaccid paralysis (face downward), dysphasia, constipation Occur if small infant (<1) eat honey, raw wild honey Cause of Giardia Correct Answer: Contaminated water Cause of E-coil Correct Answer: Water and food ingestion that is contaminated by feces- HAND WASHING Multiple Sclerosis (MS) Correct Answer: Chronic, autoimmune disease, progressive Demyelination of cranial nerve and spinal cord (CNS) system Period of remission and exacerbation S/s: spasticity and incoordination, muscle weakness, and fatigue Care: No cure, reduce symptoms. Steroid. Immunosuppressant like interferon Assistive device, walking with feet apart, ROM, strengthening exercise, and stretching, balance rest with exercise, avoid increase duration; dehydration and extreme temp-stressor cause exacerbation; self-catch as spastic bladder Guillian-Barre syndrome Correct Answer: Acute, autoimmune attack in the PNS cause ascending muscle weakness and absent DTR, ARDS-life threatening complication (inability to cough, shallow breath, difficulty breathing, hypoxia), inability to lift head or eye brows MONITOR RESPIRATORY STATUS IS MOST IMPORTANT FVC golden standard for assessing ventilation- decline mean respiratory arrest require ET intubation ALSO sth important is that they cause impaired mobility, increase risk for DVT, paralytic illeus, and even severe ANS-causing that headache and flushing TX: respiratory support, plasmaphresis, IVIG Tonic Correct Answer: Body stiffening
Clonic Correct Answer: Muscle jerking Atomic Correct Answer: Loss of muscle tone Supraglottic swallow Correct Answer: Technique that allows them to have voluntary control over vocal cords to protect themselves from aspiration CN IX decrease risk of Ad Correct Answer: Smoking cessation, avoid excessive alcohol intake, exercise reg, and participate in mental activities Frontal lobe Correct Answer: Related to knowledge thing Broca aphasia or expressive aphasia: inability to express words- after TIA or stroke Executive function and personality Behavioral change Temporal Correct Answer: Auditory and past experience Wernickle aphasia- receptive aphasia Report a is a priority for GCS even if it is only change by Correct Answer: negative trends 1 Initial (means acute) phase of suspected stroke Correct Answer: CT scan, baseline neuro assessment, and prepare tpA Medulla oblongata Correct Answer: Rate and depth of respiration Parietal lobe Correct Answer: Sensory problems-touch Occipital lobe Correct Answer: Visual problems- coup-counter coup Straining or Valsalva maneuver Correct Answer: Holding breathing when bearing down Contraindicated for pt with increased ICP, head injury, stroke, pt with anything can increase abdominal and thoracic pressure- glaucoma, eye surgery, cirrhosis-portal HTN, abdominal surgery, heart disease like MI Spinal immobilization Correct Answer: NSAIDS
Sensory test Correct Answer: ifentify the number 8 traced on the palm-fine touch (graphesthesia). Other tests like identifying object in the hand (stereognosis) and two point discrimination CN I-III Correct Answer: smells or vision (three O) CN IV Correct Answer: trochlea- eyes and motor CN V, VII, IX Correct Answer: trigeminal, facial, and glossopharyngeal- most commonly ask cranial nerves CN IX Correct Answer: glosso is tongue and pharyngeal is pharynx: assess gag reflex- freaking out about it because it concerns AIRWAY. Sensory posterior taste .Test: swallowing water CN VII Correct Answer: facial nerve-unilateral paralysis- bell's palsy or facial nerve palsy. S/s: decreased nasolabial folds, drooping mouth (asymmetrical). Nursing care: can't close their eyes- so we worry about corneal abrasion- keep it lubricate and close it for them or put a patch for them, don't let them dry out-same with the mouth- at risk for dental caries Cn V Correct Answer: trigeminal-temporal region, 3 branches, one go to eye, 1 cheek, 1 down the jawline. sensory-face, motor: chewing. So these patients are extremely sensitive to touch and temperature. So if a pt has a problem with this, extremely sensitive to touch and temperature (feel like a knife stabbing a patients). Tx: carbamazepine- side effect: SJS and agranulocytosis-sepsis risk-presentation: muscle cramps, hypokalemia, cold, pale peripheral edema, HF, UTI, sore throat,...) (clozapine can also cause agranulocytosis as well) Cn VI Correct Answer: abducens: motor, eyes Cn VIII Correct Answer: sensory, hearing, and balance CN X Correct Answer: Vagus sensory: throat; motor: swallowing, speech, cardiac innervation (slow down) Cn XI Correct Answer: motor: throat, neck muscles, upper back accessory test: shrugging the shoulder against resistance
CN XII Correct Answer: hypoglossal motor-tongue Posturing Correct Answer: decorticate and decerebrate decorticate (flexion) Correct Answer: ARMS to the core of the body (middle). decerebrate Correct Answer: extension: EXTENDED. The arms are going to be extended rather than flexed. decerebrate than decorticate Correct Answer: worse Deep tendons reflexes Correct Answer: biceps, tricep, brachioradial, quadricep Superficial reflex Correct Answer: plantar, abdominal, Babinski GCS score Correct Answer: eye opening (4), verbal response (5), motor response (6) (score ranging from 3-15) Lumbar puncture Correct Answer: insert the needle in the supraarchnoid space for CSF analysis Preop lumbar puncture Correct Answer: Preop: IPE Informed consent Empty bladder and bowel Position-on the side with knee pull toward the chest and chin tucked downward
- Post-op Correct Answer: SEEM o Sim position-lie flat on the side for at least 4 hours. Prone or supine is to prevent headache. HEADACHE IS EXPECTED o Site: redness, swelling, clear drainage o Encourage fluid o Extremities movement o Monitor complication Computed tomography (CT) scan Correct Answer: Pre-op
- Informed consent
- Allergy to iodine, contrast dye, or shellfish
- Assess BUN, creatine
- Lie still and flat
- No metal thingy Correct Answer:
- Assess for claustrophobia Correct Answer:
- Informed consent Correct Answer: III. Disorder Correct Answer: Head injury Correct Answer: Concussion Correct Answer: temporary loss of neuro function with no damage S/s Correct Answer: Brief disruption of consciousness, amnesia and headache Worsening is when visual problems, weakness and humbling on one side of the body, worsening headache and vomit, sleepiness or confusion-after 1-2 days so you need to monitor closely avoid strenuous activities-rest and light diet Correct Answer: Contusion Correct Answer: brain bi damage, loss of consciousness and confused DAI Correct Answer: diffuse axonal injury: shearing and tearing force Basilar skull fracture Correct Answer: Bleeding nose and ears (otorrhea, rhinorrhea), racoon eyes-periorbital edema and ecchymosis, and battle's sign Correct Answer: postauricular ecchymosis Hematoma Correct Answer: Correct Answer: Epidural Correct Answer: brief loss of consciousness, followed by lucid interval, then rapid deterioration Tx Correct Answer: burr hole and placement of drain to relieve increased ICP Subdural Correct Answer:
Acute Correct Answer: develop over 24-48 hours, change in LOC, pupillary changes, and hemiparesis Subacute Correct Answer: develop from 48 hours to 2 wks Chronic Correct Answer: frequently in elderly Tx Correct Answer: surgical evacuation and burr hole and drain placement Increased ICP Correct Answer:
- Factors increased ICP Correct Answer: hypercapnia, extreme temperature- too hot or too cold, shivering, lousy places
- When pt has concussion, you check if they have s/s of increased ICP Correct Answer:
- s/s Correct Answer: o Early signs such as restlessness, confusion, drowsiness, lethargy, or stupor; motor and sensory changes Correct Answer: o Headache, diplopia, irritability Correct Answer: o Worsening headache or stiff neck, unrelieved with OTC meds Correct Answer: o Visual change like blurring, slurred speech, difficulty walking-motor change, seizure Correct Answer: o N/V often projectile Correct Answer: o Pupillary changes Correct Answer: dilated, unequal, nonreactive(i psi lateral pupil dilation) o Change in vital signs Correct Answer: Cushing's triad Correct Answer: HTN with widening pulse pressure, bradycardia, and irregular breathing (Cheyne-Stokes respirations) Ineffective thermoregulation Correct Answer:
o Prevent shivering Correct Answer: o Med Correct Answer: Benzodiazepine Correct Answer: Chlorpromazine Correct Answer: disorder Correct Answer:
- Generalized seizure Correct Answer: o Tonic-clonic Correct Answer: o Absence Correct Answer: Absence seizure Correct Answer:
- stare into space, caretaker said they are not paying attention to me (< seconds) Correct Answer:
- Absences of warning and poetical phase Correct Answer:
- Absence of other form of epileptic activity, unresponsive during seizure and no memory of the seizure Correct Answer:
- educate caregiver on how it is present Correct Answer:
- GET AN EEG Correct Answer: o It doesn't hurt Correct Answer: o Electrode Correct Answer: you need to wash it prior to stick to a child scalp o Make sure they are not on any epileptic drugs Correct Answer:
- Treatment Correct Answer: Ethosuximide (Zarontin)- E-FGHIJ-
- Note Correct Answer: when a drug is PO or has a toxicity level- the onset symptoms of toxicity is usually GI problems-like N/V/diarrhea/abdominal pain/stomach flu/they think they have flu position
- Side effect to concern Correct Answer: Fatigue, GI distress, headache, itching, Steven-Johnson syndrome-third degree burn (desquamation- this s/s is commonly found in neuro drugs/antiepileptic drugs) o Myoclonic Correct Answer: o Atonic or akinetic Correct Answer:
- Partial Seizures Correct Answer: o Complex Correct Answer: o Simple Correct Answer:
- Nursing care Correct Answer: o Maintain airway patency (position side-lying) Correct Answer: o Respiratory status and loosen restrictive clothing Correct Answer: o Medication Correct Answer: Phenytoin Correct Answer: Carbamazepine Correct Answer: Valproic acid Correct Answer: Phenobarbital Correct Answer: Levetiracetam Correct Answer: topiramate Correct Answer: o Seizure precaution Correct Answer:
DASH diet (high in fruits and vegetables, moderate in low-fat dairy products, and low in animal protein) Correct Answer: Avoid alcohol and smoking Correct Answer: Med Correct Answer:
- Clopidogrel, dipyridamole plus aspirin Correct Answer:
- Anticoagulation- warfarin Correct Answer:
- Lipid-lowering agents Correct Answer: Therapeutic measurement Correct Answer: angioplasty or cartectomy-removal of plague from one or both carotid arteries
- Assess for worsening or new alteration in mental status-> stroke risk Correct Answer:
- F-facial droopingL numbness or droppings on one side of the face Correct Answer:
- A-arm weakness Correct Answer: drifting or weakness of one arm when raised to shoulder level
- S-speech difficulty Correct Answer: slurring of words, incomprehensible speech, inability to understand others
- T-tine Correct Answer: ONSET Cerebrovascular accident (CVA) Correct Answer: stroke
- Change in mental status Correct Answer:
- F Correct Answer: facial drooping, A: arm dripping, S: slurred speech, T: time
- Slurred speech, aphagia, dysphagia, numbness and weakness usually one sided, visual problems, loss of balance or coordination, sudden headache-usually bleeding one Correct Answer:
- Two types Correct Answer: Ischemic stroke Correct Answer: Hemmorrhagic stroke Correct Answer:
- Treatment Correct Answer: Maintain airway Correct Answer: Dysphagia precautions-monitor for aspiration-place food in unaffected side and back of the mouth Correct Answer: Achieving bowel and bladder control Correct Answer: Hemianopsia Correct Answer: place article in a position of extension or neutrality Collaborative with speech patho, occupational and physical therapy Correct Answer: Medication Correct Answer:
- TpA <4.5 hours- ischemic only but prepare for the both case of emergency Correct Answer:
- Surgical management for hemorrhagic Correct Answer: o Embolectomy and carotid artery angioplasty/stent Correct Answer: Spinal cord injury Correct Answer: partial or complete disruption of nerve tracts or neuron, lead to paralysis, sensory loss, altered activity, and ANS dysfunction
- S/s Correct Answer: Cervical Correct Answer:
- respiratory problems- ventilators dependent Correct Answer:
- Partial or complete extremities paralysis Correct Answer:
- Headache/flushing Correct Answer:
- Nasal congestion Correct Answer:
- Piloerection-goose bumps and sweating Correct Answer:
- Nursing care Correct Answer: o High Fowlers to decrease BP, get rid of the cause/stimuli Correct Answer: o Teach pt about bowel and bladder management Correct Answer: Multiple Sclerosis Correct Answer: chronic, progressive, autoimmune disease- demyelination in brain and spinal cord, period of remission and exacerbation (CNS)
- Manifestation Correct Answer: o Slurred speech Correct Answer: o Visual disturbance Correct Answer: o Spasticity muscle and bladder Correct Answer: o Muscle weakness Correct Answer: o In coordination Correct Answer: o Loss of balance Correct Answer: o Fatigue Correct Answer: o Impaired mobility so increase risk of injury Correct Answer:
- Management Correct Answer: o NO CURE Correct Answer: o Administer corticosteroids Correct Answer:
- Nursing care Correct Answer: o Teach pt to self-catherization Correct Answer: o Avoid stress, esp during exacerbation Correct Answer: o Walking with feet apart to improve steadiness and guilt, assisted devices needed Correct Answer: o ROM, strengthening, and stretching exercise helps limit spasticity and contracture in pt with MS Correct Answer: o DEHYDRATION and EXTREME TEMP cause exacerbation-balance with rest and avoid build strength with duration Correct Answer: o Med Correct Answer: Immunosuppressant like interferon Correct Answer: Urinary problems like oxybutynin, Correct Answer: Parkinson's disease Correct Answer: chronic, progressive neurological disorder
- S/s Correct Answer: o Be- Bending forward/ tilt Correct Answer: o Shuffling gait Correct Answer: o Mask-like face-fixed gait, expressionless Correct Answer: o Akinesia-loss of voluntarily movement Correct Answer: Rigidity Correct Answer: o Tremor Correct Answer:
- Nursing care Correct Answer:
Support respiratory function Correct Answer: Medication to relieve excessive salivation, pain, muscle cramps, constipation, and depression Correct Answer: Med Correct Answer:
- Glutamate antagonist Correct Answer: Riluzole
- Manage spastiscity Correct Answer: baclofen Myasthenia gravis Correct Answer: autoimmune disorder that results in voluntary muscle weakness increased with activity, improved with rest, and period of remission and exacerbation
- Early manifestation Correct Answer: risk of aspiration because diplopia, ptosis, dysphagia, dysphonia
- Muscle weakness worsening with activity and improve with rest Correct Answer:
- Muscle wasting, especially respiratory muscle Correct Answer:
- Dx Correct Answer: o Edrophonium chloride Correct Answer: an acetylcholineastrase inhibitor IV that immediately improve symptoms that last 5 mins is considered a positive test Differentiate between cholinergic and myasthenic crisis Correct Answer: Antidote Correct Answer: atropine readily available to counter bradycardia, sweating, and cramping Cholinergic crisis Correct Answer: overmedication
- Respiratory distress, increased GI motility, hypersecretion and hypotension Correct Answer: Myasthenic crisis Correct Answer: inadequate medication or period of exacerbation: increase that s/s of this disease also respiratory distress. Symptoms improve during the Tensilon test
- Factors to cause exacerbation Correct Answer: pregnancy, infection, stress, hyperthermia, inconsistency with med administration
- Nursing care Correct Answer: o Airway patency Correct Answer: prevent aspiration and suction and manual bag bedside o Plan activities earlier in the day to avoid fatigue Correct Answer: o Small, frequent, high-calories meals during peak time of med within 45 minutes) Correct Answer: o Give medication ON TIME, head flexed forward, food with thickening consistency, suction available Correct Answer: o Referrals to speech therapy Correct Answer: o Provide eyecare Correct Answer: o Therapeutic interventions Correct Answer: Thymectomy Correct Answer: IVIG Correct Answer: Plasmaphresis Correct Answer:
- Medication Correct Answer: o Anticholinestrase increase acetylcholine Correct Answer: Pyridostigmine Correct Answer: first line therapy Atrope is antidote for anticholinestrase Correct Answer: o Immunosupressants Correct Answer: Steroid and cytotoxic meds Correct
