Chapter 18: Neurological Disorders and Therapeutic Management

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The patient’s wife is upset by the preparations to take a patient suspected of having a suspected to the radiology department for computerized tomography (CT) of his brain. The nurse explains to her:

a.	“We need to find out what part of his brain was involved in the stroke.”
b.	“This is the best way to determine whether his stroke was due to bleeding inside his brain or was the result of a clot.”
c.	“We can get images of the damage to his brain at this point and use them later to see if he has sustained more damage.”
d.	“This procedure will distinguish between a brain tumor and a stroke as the cause of your husband’s problem.”

 

ANS:   B

Confirmation of the diagnosis of ischemic stroke is the first step in the emergent evaluation of these patients. Differentiation from intracranial hemorrhage is vital. Noncontrast CT scanning is the method of choice for this purpose and is considered the most important initial diagnostic study.

 

DIF:    Cognitive Level: Comprehension       REF:    364

OBJ:    Nursing Process: Implementation       TOP:    Neurological Disorders

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

2. The patient’s son asks the nurse if his mother will have to have an arteriovenous malformation removed by surgery. He is concerned because her condition is so unstable that he doesn’t think she can withstand the stress of an operation. The nurse explains:

a.	“If we don’t remove it surgically, she will die.”
b.	“There is a procedure called embolization that can be done to secure the lesion without surgery. When her condition is more stable, an operation might be considered if needed.”
c.	“The operation is necessary, even if it results in further brain damage and possible permanent changes in her neurological status.”
d.	“We can delay interventions until her condition is stable enough to risk surgery.”

 

ANS:   B

Embolization is used to secure a cerebral aneurysm or arteriovenous malformation when surgery is not feasible because of the size or location of the lesion or the medical instability of the patient.

 

DIF:    Cognitive Level: Comprehension       REF:    369

OBJ:    Nursing Process: Implementation       TOP:    Neurological Disorders

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

3. Knowing that the patient has been diagnosed with Guillain-Barré syndrome (GBS), the nurse anticipates that his paralysis will follow which course over the next few days to weeks?

a.	Descend to his lower extremities
b.	Subside and leave no residual effect
c.	Ascend
d.	Be more pronounced on his nondominant side

 

ANS:   C

Most patients diagnosed with Guillain-Barré syndrome report having had a viral infection, usually involving the upper respiratory tract, 1 to 3 weeks before the onset of clinical manifestations. Motor loss usually is symmetric, bilateral, and ascending.

 

DIF:    Cognitive Level: Comprehension       REF:    374

OBJ:    Nursing Process: Assessment TOP:    Neurological Disorders

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

4. The patient’s husband does not understand the diagnosis of ischemic stroke. To enhance his understanding the nurse explains:

a.	“She has had a clot in her brain, and part of the tissue isn’t getting any oxygen.”
b.	“Some bleeding occurred in her brain, and the pressure from the blood is causing her to have problems.”
c.	“The injuries she sustained in the auto accident caused bone to be pressed into her brain, which resulted in the changes that you see.”
d.	“An infection in her brain tissue is making it impossible for electrical impulses to travel in an efficient manner.”

 

ANS:   A

Ischemic stroke results from low cerebral blood flow, usually because of occlusion of a blood vessel. The occlusion can be either thrombotic or embolic. Hypoperfusion resulting from hypotension also produces ischemic stroke.

 

DIF:    Cognitive Level: Comprehension       REF:    362

OBJ:    Nursing Process: Assessment TOP:    Neurological Disorders

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

5. Knowing that a patient has hypoxemia and ischemia in his brain, the nurse anticipates which of the following?

a.	Cerebrovascular dilation
b.	Cardiovascular compensation
c.	Compensation of respiratory alkalosis
d.	Cerebral vasoconstriction

 

ANS:   A

Conditions that cause acidosis (e.g., hypoxia, hypercapnia, and ischemia) result in cerebrovascular dilation.

 

DIF:    Cognitive Level: Comprehension       REF:    381

OBJ:    Nursing Process: Assessment TOP:    Neurological Therapeutic Management

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation