-PRACTICE TESTMEDICAL-SURGICAL NURSING:

NEUROLOGIC DISTURBANCES
1. The client with suspected meningitis is admitted to the unit. The doctor is performing an
assessment to determine meningeal irritation and spinal nerve root inflammation. A positive
kernigs sign is charted if the nurse notes:
a. pain on flexion of the hip and knee
c. pain when the head is turned to the
left side
b. nuchal rigidity on flexion of the neck
d. dizziness when charging positions
2. a client has been admitted for meningitis. In reviewing the laboratory analysis of cerebrospinal
fluid (CSF), the nurse would expect to note?
a. high protein
c. elevated sedimentation rate
b. clear color
d. increased glucose
3. what is the mode of transmission of meningitis?
a. droplet
b. airborne c. contact
d. fecal-oral
4. the nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is
usually associated with diagnosis of myasthenia gravis?
a. visual disturbances including diplopia
c. cogwheel rigidity and loss of
coordination
b. ascending paralysis and loss of motor function
d. progressive weakness that at the
days end
5. Diagnose of myasthenia gravis is frequently based on the clients response to an intravenous
injection of endrophonium (tensilon). If the client responds positively to this drug, the nurse
should expect:
a. relief of ptosis , but not of weakness, in other facial muscles
b. a promt and dramatic increase in muscle strength
c. exacerbation of symptomatology
d. a slight increase in muscle strength that is countered by an increase of muscle fatigability
6. the client is scheduled for a tensilon test to check for myasthenia gravis. Which medication
should be kept available during the test?
a. atropine sulphate
b. furosemide
c. prostigmin
d. promethazine
7. which nursing diagnosis is the highest priority when caring for a client with myasthenia gravis
(MG)?
a. pain
c. ineffective coping
b. risk of injury
d. ineffective airway clearance
8. a diagnosis of multiple sclerosis is often delayed because of varied symptoms experienced by
those affected with the disease. Which symptom is most common in those with multiple sclerosis
a. resting tremors
c. flaccid paralysis
b. double vision
d. pill-rolling tremors
9. a client with respiratory complications of multiple sclerosis (MS) is admitted to the medicalsurgical unit. Which equipment is most important for the nurse to keep at the clients bedside?
a. sphygmomanometer
c. nasal cannula and oxygen
b. padded tongue blade
d. suction machine with catheters
10 ms. Minchin presents to the health unit with complaints of fatigue, weakness and loss of
balance. Assessment and diagnostic test result shows that Ms. Minchin has multiple sclerosis.
She asks the nurse if there is a cure for her condition. The nurse is correct in saying that:
a. no cure exists for her condition
b. surgical incision and aspiration has been found to be effective in treating multiple sclerosis
c. large doses of antimicrobial therapy has been found to be effective in treating multiple
sclerosis
d. surgical removal of the thyroid gland has been found to be effective in treating multiple
sclerosis
11. Ms. Minchin complains of having vision disturbance. The health care provider further
assesses Ms Minchin. A common vision problem that occurs in clients with multiple sclerosis
resulting patchy blindness is known as:

a. diplopia
b. nystagmus
c. hordeolum
d. scotoma
12. which of the following signs and symptoms are considered principal symptoms of
amyotrophic lateral sclerosis (AML)
a. drooping of the mouth, incomplete eye closure, and inability to puff out his cheek
b. muscle weakness, muscle atrophy of the feet and hands, and fasciculation
c. alteration in mental function, asymmetrical weakness of limb and fasciculation
d. progressive weakness in the muscles of the arms, legs, and trunk and increase breath sound
upon auscultation
13. a client with a head injury has an intracranial pressure (ICP) monitor in place. Cerebral per
fusion pressure calculations are ordered. If the clients ICP is 22 and the mean pressure reading
is 70 what is the clients cerebral perfusion pressure?
a. 92
b. 72
c. 58
d. 48
14. when monitoring a client for early signs of increasing ICP the nurse should be particularly
alert for which of the following?
a. papillary changes
c. decreasing bp
b. difficulty arousing the client
d. elevated temperature
15. the nurse qis caring for a client with brain tumor and increase intracranial pressure. Which
intervention would the nurse include in the plan of care to reduce ICP?
a. encourage couching and deep breathing
c. administer stool softeners
b. posision with the head turned towards the side of the brain tumor
d. provide sensory
stimulation
16. the nurse is monitoring a client for increasing intracranial pressure (ICP). Early signs of
increased ICP include:
a. pupillary changes
c. decreasing blood pressure
b. diminished responsiveness
d. elevated pressure
17. the client is admitted after a motor vehicle accident wuth pressure of 102 rectally . the
most likely explainations for the elevated temperature ids that:
a. there was damage to the hypothalamus
b. he has an infection from the abrasions to the head and face
c. he will require a cooling blanket to decrease the temperature
d. there was damage to the frontal lobe of the brain
18. for a client with head injury whose neck has been stabilized, the preferred bed position is
a. trendelenburg
c. flat
b. 30-degree head of bed elevation
d. side-lying
19 a nurse assessing client with head injury. The client has a clear drainage from the nose and
ears. How can the nurse determine if the damage if the drainage is cerebrospinal fluid (CSF)?
a. Measure the pH of the fluid
c. test for glucose
b. measure the specific gravity of the fluid
d. test chloride
20. a client who has been severally beaten is admitted to the emergency department. The nurse
suspects basilar skull fracture after assessing:
a. raccoons eyes and battles sign
c. motor less in the legs that exceeds
that in the arms
b. nuchal rigidity and kernigs sign
d. pupillary changes
21 a client is admitted to the hospital with seizures. The client has jerking of the right arm and
switching of the face, but alert and aware of the seizures. This behavior is characteristics of
which type of seizure?
a. absence
b. complex partial
c. simple partial
d tonic-clonic
22. a client with seizure disorder is admitted for pneumonia. If the client has a generalized tonicclonic seizure what is the appropriate action for the nurse to perform during seizure episode?
a. ventilate the client with an ambu bag if apneic
c. suction secretions
b. move hard objects away from the clients head
d. open the mouth to insert oral
airway
23. one of the most important things for the nurse to do during the ictal phase is to:
a. protect the patients head
b. leave the patient alone
c. give water to the patient to avoid dehydration.

d. put your finger in the patients mouth to avoid swallowing the tongue
24. the nurse caring for a client with cerebrovascular accident (CVA) who is complaining of being
nauseated and is requesting an emesis basin. Which action would the nurse take first?
a. administer an ordered antiemetic
c. turn the client to one side
b. obtain an ice bag and apply to the clients throat
d. notify the physician
25. a 70 year old male who is recovering from a stroke exhibits signs of unilateral neglect. Which
behaviour is suggestive of unilateral neglect?
a. the clients is observed shaving only one side of his face
b. the client is unable to distinguish between two tactile stimuli presented simultaneously
c. the client unable to complete a range of vision without turning his head side to side
d. the clients is unable to carry out connective and motor activity at the same time.
26. a nurse is developing a plan of care for a client whose experiencing homonymous
hemianopsia afte a cerebrovascular accident (CVA) the nurse documents interventions that will
promote a safe environment knowing that in this disorder
a. the client is unable to carry out skilled act such as dressing in absence of paralysis
b. the client has lost the ability to recognize familiar objects through the senses
c. the client has paralysis of the sympathetic nerves of the eye, causing sinking of the eyeball
d. the client has a visual loss in the same half of the visual field of each eye
27. the nurse caring for the client following a cerebral vascular accident. Which portion of the
brain is responsible for taste, smell, and hearing?
a. occipital
b. frontal
c. temporal
d. parietal
28. where would the nurse place the call light for a client with a right-sided brain attack and left
homonymous hemianopsia?
a. where the clients prefers
c. on the clients left side
b. directly in front of the client
d. on the clients right side
29. mrs. Palm cerebrovascular accident (CVA) resulted from the most common cause ischemic
brain injury, which was known as:
a. thrombosis
c. subarachnoid haemorrhage
b. cerebral hematoma
d. cerebral hypertension
30. Mary palm, age 76, was admitted to the medical-surgical floor with a cerebrovascular
accident in the right hemisphere. Her daughter states that before this episode her mother was
experiencing periods of left-sided weakness that would resolve in less than a day. This type of
neurologic problem is called:
a. completed CVA
c. stroke-in-evolution
b. transient ischemic attack
d. progressive bleeding aneurysm
31. the nurse doing bowel and bladder retaining for the client with paraplegia. Which of the
following is not a factor for the nurse to consider
a. diet pattern
b.mobility
c. fluid intake
d. sexual function
32. the nurse is caring for a client with an unstable spinal cord injury at the t7 level. Which
intervention should take priority in planning care?
a. increase fluid intake to prevent dehydration
b. place client on a pressure reducing support surface
c. use skin care products designed for use with incontinence
d. increase caloric intake to aid healing
33. a nurse is caring for a client with thoracic spinal injury. As part of the nursing care plan the
nursing care plan, the nurse monitor for spinal shock. In the event that spinal shock occurs, the
nurse anticipates the most likely intravenous (IV) fluid to prescribe would be:
a. 5%dextrose in water
c. 5% dextrose in 0.9% normal saline
b. dextran
d. 0.9% normal saline
34. a client admitted to the nursing unit from the emergency department has a C-4 spinal cord
injury. Which assessment should the perform first when admitting the client to the nursing unit?
a. take the clients temperature
c. observe for dyskinesias
b. assess extremely muscle strength
d. listen to breath sound
35. a client with a c3 spinal cord injury experiences automatic hyperreflexa. After placing the
client in high fowlers position, the nurses next action should be to:
a. notify the doctor
c. administer an antihypertensive

b. make sure the catheter is patent

d. provide supplemental oxygen
36. the nurse is caring for a client hospitalize with a facial stroke. Which diet section would be
suited to the client?
a. roast beef sandwich, potato chips, pickle spear, iced tea
b. spit pea soup, mashed potatoes, pudding, milk
c. tomato soup, cheese toast, jello, coffee
d. hamburger, baked beans, fruit cup, iced tea
37. a 35 year old woman who just recently gave birth suffers from bells palsy. A nurse who is in
charge of providing discharge teaching would include which the following instruction?
a. chew on the unaffected side of the mouth and eat semisolid foods
b. to reduce pain, apply moist cold packs to the affected side of the face
c. ware eye glasses when going outdoors to protect the eyes
d. avoid massaging the face
38. a client with bells palsy asks the nurse why artificial tears were ordered by a physician.
Select the best reply by the nurse
a. when your affected eye fails to make tears, the eye can become irritated and ulcerated
b. because your eyes remains close foreign matter can be trapped beneath the lid
c. artificial tears will remove the purulent drainage from your eye, which speed healing
d. because you cannot blink your affected eye, it can became dry and irritated
39. The nurse is caring for a client with trigeminal neuralgia (tik douloureaux). To assist the client
with nutrition needs, the nurse should?
a. offer small meals of high calorie soft food
c. provide additional servings of fruits and
raw vegetables
b. assist the client to sit in a chair for meals
d. encourage the client to eat fish, liver and
chicken
40. a client with trigeminal neuralgia has a dysfunction of:
a. cranial nerve IV b. cranial nerve V c. cranial nerve VI d. cranial nerve VII
41. The client with Alzheimers disease is being assisted with activities of daily living when the
nurse notes that the client uses her toothbrush to her hair. The nurse is aware that the client is
exhibiting:
a. agnosia b. apraxia
c. anomia
d. aphasia
42. the client with dementia is experiencing confusion late in the afternoon and before bedtime.
The nurse is aware that the clients experiencing with what is known as:
a. chronic fatigue syndrome
c. sundowning
b. normal aging
d. delusions
43. a 78 year old Alzheimers client is being treated for malnutrition and dehydration. The nurse
decides to place him closer to the nurses station because of his tendency to:
a. forget to eat
c. exhibit acquiescent behaviour
b. not change his position often
d. wander
44. the nurse should instruct the patent with Parkinsons disease to avoid which of the following?
a. walking in an indoor shopping mall
c. Walking to the car on a cold winter day
b. sitting on the deck on a cool summer evening.
D. Sitting on the beach in the sun on a
summer day.
45. Which nursing diagnosis takes highest priority of a client with Parkinsons?
a. Imbalanced nutrition. Less than body requirements
c. Impaired urinary elimination
b. Ineffective airway clearance
d. Risk of injury
SITUATION: Parkinsons disease and Alzheimers disease are progressive neurologic disease that
causes disability which usually happens later in a persons life. Though very different disorders,
they are often defined interchangeably. Nurse Marshal was assigned to care for these patients.
46. During the evaluation of the quality of home are for a patient with Alzheimers disease, the
priority for Nurse Marshal is to reinforce which statement by a family member?
a. We have safety bars installed in the bathroom and have 24 hour alarms on the doors.
b. At least 2 full meals a day are eaten.
c. We go to a group discussion every week at our community center.

d. The medication is not a problem to have it taken 3 times a day.

47. A patient with Parkinsons has been taking levodopa (Larodopa) for bradykinesia, shuffling
gait, and rigidity. To evaluate the effectiveness of the medication, Nurse Marshal would document
which change in the chart?
Patient has:
a. been more ambulatory.
c. less resistance to a respiratory infections.
b. an increase of 2 lbs. in weight.
d. no tremors or shuffling gait.
48. when evaluating the extent of Parkinsons disease, a nurse observes for which of the
following conditions?
a. bulging eyeballs
c. increased dopamine levels
b. diminished distal sensation
d. muscle rigidity
49. which of the following symptoms occurs initially in Parkinsons disease?
a. pill rolling movements of the hand
c. aspiration of food
b. akinesia
d. dementia
50. which assessment would assessment would indicate a patient with Alzheimers is
disoriented? The patient:
a. cannot provide the name of her physician
c. does not know where she is or what day it
is
b. is unable to list her current medication
d. asks repeatedly to be allowed to go home
Medical-surgical nursing-brain bullets neurological disturbances
1. the nervous system is the sensory control apparatus consisting of a network of nerve cells
2. the nerve cells are called nervous which coordinate the actions of the transmit electrical and
chemical transmission signals between different parts of its body
3. the nervous system has 2 parts: the central nervous system and the peripheral nervous
system
The central nervous system is comprised of the brain, retina and spinal cord
The peripheral nervous system is the nerve tissue that transmits sensation and motor
information back and forth from the body to the central nervous system.
4. Neurons sends signals to other cells as electrochemical waves travelling along thin fibers
called axons.
5. Axons cause chemicals, called neorotransmitters, to be released at junctions which are called
synapses
6. The frontal lobe is responsible for emotions, reasoning, planning, movement, and parts of
speech. It is also involved in purposeful acts such as creativity, judgment, problem solving, and
planning
7. the parental is responsible for the processing of nerve impulse related to sense, such as touch,
pain, taste, pressure, and temperature. They also have language functions
8. the occipital is responsible for the brains ability to recognize objects. It is responsible for our
vision
9. the temporal is responsible for hearing, memory, meaning, and language. They also play a
role in emotion and learning. The temporal lobes are concerned with interpreting and processing
auditory stimuli.
10. the cerebral cortex controls your thinking, voluntary movements, language, reasoning, and
perception.
11. the cerebellum controls your movement, balance, posture, and coordination. New research
has also linked it to thinking, novelty, and emotions. ( the word cerebellum comes from the Latin
word little brain )
12. the hypothalamus controls your body temperature, emotions, hunger , thirst, appetite,
digestion and sleep.
13. the thalamus controls your sensory integration. And motor integration.
14. the pituitary gland controls your sensory hormones and it helps to turn food to energy.
15. the pineal gland controls your growing and maturing.

Answers & rationales

Medical-surgical nursing
Neurologic disturbances
1. answer: a kernigs sign is a positive if pain occurs on flexion of the hip and knee. The
brudzinski reflex is positive if pain occurs on flexion of the head and neck onto the chest so
answer b is incorrect c and d- might be present but are not related to kernigs sign
2. answer : a- high protein a positive CSF for meningitis would include presence of protein, a
positive blood culture, decreased glucose, cloudy color with an increase opening pressure, and
elevated white blood cell count.
3. answer: a meningitis is transmitted through droplet thus patient should wear facial mask to
promote reserve isolation.
4. answer: d the client with myasthenia develops progressive weakness that worsens during
the day; A refers to symptoms of multiple sclerosis b refers to symptoms of guillain barre
syndrome; c refers to Parkinsons disease
5. answer: b endometrium(tesilon) is a short acting the anticholinesterase compound. A
positive tensilon test result( a prompt and dramatic increase in muscle strength) is consistent
with the diagnostics of myasthenia gravis
6. answer: a a tropine sulfate is the antidote for tensilon and is given to treat cholinergic crises;
b furosemide is a diuretic; c prostigmin is a treatment for myasthenia gravis; and d
promethazine is an antiernetic , antianxiety medication.
7. answer: d client with MG have respiratory muscle failure.
8. answer: b the most common symptoms reported by clients with multiple sclerosis is double
vision; a, c, d are not symptoms commonly reported by clients with multiple sclerosis, so they
are wrong.
9. answer: d Ms weakness the respiratory muscles and impairs swallowing, putting the client at
risk for aspiration. To ensure a patient oral airway, the nurse should keep a suction machine and
suction catheters at the bedside, a sphygmomanometer is no more important for this client than
for any other. A padded tongue blade is an appropriate seizure precaution but shouldnt be used
in this client because its large size could cause oral airway obstruction. A nasal cannula and
oxygen would be ineffective to ensure adequate oxygen delivery; this client requires a
mechanical ventilator.
10. answer: a - there is no cure for MS. An individualized, organized and rational treatment
program is indicated to relieve the clients with myasthenia gravis.

11 answer: d there are usually visual disturbance due to the lessons in the optic nerve.
Scotoma is known as patchy blindness
12. answer: b signs and symptoms of ALS depends on the location of the affected neurons and
the severity of the disease. Muscles weakness, atrophy, and fasciculation are the principal
symptoms of the disorder. Unlike any degenerative disease, ALS doesnt affect mental function.
As the disease progress, the patient may report progressive weakness in muscles of arms, legs,
and trunk. Neurological examination reveals brisk and overactive stretch reflexes. When the
disease progress to the brain stem and cranial nerve, the patient has difficulty speaking.
Chewing, swallowing, and ultimately breathing. In these patients auscultation may reveal
decreased breath sounds a- is s/sx of bell palsy.
13 answer: d the cerebral perfusion pressure is obtained by subtracting the ICP from the mean
arterial pressure (MAP). A client must have a CCP of 70-100 to have a normal reading and
adequate cerebral perfusion. A, b, and c are all incorrect calculations.
14 answer: b the first sign of pressure on the reticular activating system in the brain stem is a
decrease in responsiveness, evidenced by difficulty arousing the client.
15 answer: c stool softeners reduce of straining during bowel movement which can increase ICP
by raising the intrathoracic pressure and interfering with a venous return; a coughing increases
ICP; b keeping the head in midline and avoiding extreme neck flexion prevent obstruction of
venous blood flow from the brain; d sensory stimulation can increase ICP.
16. answer: b usually, diminished responsiveness is the first sign of ICP; a- pupillary changes
occur later, c increased ICP causes systolic blood pressure to rise; d temperature changes vary
and may not occur even with a serve decrease in responsiveness.
17. answer: a damage to the hypothalamus can result in an elevated temperature because this
is portion of the brain helps regulate body temperature; b, c, and d are incorrect because there
is no data to support the possibility of an infection, a cooling blanket might not be required, and
the frontal lobe is not responsible for regulation of the body temperature
18. answer: b with increased ICP, HOB, is elevated to promote venous outflow; a trendelenburg
is contraindicated; c flat or neutral position is indicated when elevating the head of bed would
increase the risk of neck injury or airway obstruction; d not therapeutic treatment for increase
ICP
19. answer; c cerebrospinal fluid is positive for glucose
20. answer: a a basilar skull fracture commonly causes only periorbital ecchymosis( racoons
eyes) and postmastoid ecchymosis (Battles sign); however, it sometimes also causes otorrhea,
rhitorrhea, and loss of cranial nerve I (olfactory nerve) function. Nuchal rigidity and kernigs sign
are associated with meningitis. Motor loss in the legs that exceeds that in the arms suggest
central cord syndrome. Pupillary changes are common in skull fractures with associated
meningeal artery bleeding and truncal herniation.
21. answer: c- a simple partial seizure, there is characterized by jerking of extremities, twitching
of the face, and mental alertness; a, b, d are not characterized with these clinical
manifestation. Answer b is differentiated by the clients awareness of the seizure.
22 answer: b with a tonic-clonic seizure, there is muscle rigidity, then muscle jerking. The nurse
must provide for the safety of the client by clearing the environment. During seizure there should
be nothing in the clients mouth; doing so could cause injury to the client or nurse. Resistant can
further cause injury.
23. answer: a one the most important interventions for a nurse to perform during seizure is to
protect the patients head from injury. Never give a patient a drink during seizure. Putting youre
your finger your finger in the patients mouth could be very dangerous to the patient and the
nurse.
24. answer: c turning the client to the side will allow any vomit to drain the from the mouth and
decrease the risk for aspiration; a, b, and d are all appropriate nursing interventions, but a
patient airway the prevention of aspiration are priorities.
25. answer: a the client with unilateral neglect will neglect one side of the body; b, c, and d are
not associated with unilateral neglect.
26. answer: d homonymous hemianopsia is a visual loss in the same half of the visual field of
each eye, so the clients has only half of normal vision; a describes apraxia; b describes
agnosia; c describes homer syndrome

27. answer: c the temporal lobe is responsible for taste, smell, and hearing. The occipital lobe is
responsible for vision. The frontal lobe is responsible for judgment, foresight, and behavior. The
parietal lobe is responsible for ideation, sensory functions, and language.
28. answer: d the client with right sided brain attack has left visual field blindness. The client
will see only from the right side.
29. answer: a ischemic brain injury most commonly results from thrombosis caused by plaque
build-up in the cerebral arteries.
30. answer: b a TIA elicits symptoms of a stroke, but they usually disappear within 24 hours.
31. answer: d - when assisting the client with bowel and bladder training, the least helpful factor
is the sexual function. Dietary history, mobility, and fluid intake are important factors, these must
be taken into consideration because they relate to constipation, urinary function, and the ability
to use the urinal or bedpan.
32. Answer: B This client is at greatest risk for skin breakdown because of immobility and
decreased sensation. The first action should be to choose and then place the client on the best
support surface to relieve pressure, shear and friction forces.
33. Answer: D Normal saline 0.9% is an isotonic solution that primarily remains in the
intravascular space, increasing intravascular volume. This IV fluid would increase the clients
blood pressure. Dextran is rarely used in spinal shock because isotonic fluid administration is
sufficient. Additionally, Dextran has potentially serious side effects. Dextrose 5% in water is a
hypotonic solution that pulls fluid out of the intravascular space and is not indicated for shock.
Dextrose 5% in normal saline 0.9% is hypertonic and indicated for shock resulting from
hemorrhage or burns.
34. Answer: D Because compromise of respiration is a leading cause of death in cervical cord
injury, respiratory assessment is the highest priority. Assessment of temperature and strength
can be done after adequate oxygenation is assured. Dyskinesias occur in cerebellar disorders, so
they are not as important in cord-injured clients, unless head injury is suspected.
35. Answer: B After raising the clients head to lower the blood pressure, the nurse should make
sure that the client is not lying on the catheter; A and C are not the first or second actions the
nurse should take; D- The client with autonomic hyperreflexia has an extreme elevation in blood
pressure. The use of supplemental oxygen is not indicated.
36. Answer: B The client with a facial stroke will have difficulty swallowing and chewing, and
the foods in answer B provide the least amount of chewing. The foods in Answer A, C, and D
would require more chewing and, thus, are incorrect.
37. Answer: A Patient teaching for clients with Bells palsy includes protecting the eyes with an
eye patch, especially when outdoors. Tell the client to keep warm and avoid exposure to dust and
wind. When exposure is unavoidable, instruct him to cover his face. To help client cope with
difficulty in eating and drinking, instruct him to chew on the unaffected side of the mouth and to
eat semisolid foods. To reduce pain, moist heat compress can be applied to the affected side. To
help maintain muscle tone, massage the clients face with a gentle upward motion two to three
times daily for 5 to 10 minutes.
38. Answer D Bells palsy may cause paralysis of the eyelid and loss of the blink reflex on the
affected side. The eye may not close completely. These problems render eye susceptible to
drying the irritation from dust or other debris.
39. Answer A Offer small meals of high calorie soft food. If the client is losing weight because of
poor appetite due to the pain, assist in selecting foods that are high in calories and nutrients, to
provide more nourishment with less chewing. Suggest that frequent, small meals be eaten
instead of three large ones. To minimize jaw movements when eating, suggest that foods be
pureed.
40. Answer B A client with trigeminal neuralgia has a dysfunction of Cranial nerve V; A client
with Bells palsy has a dysfunction of Cranial nerve VII
41. Answer B Apraxia is the inability to use objects appropriately. A, C and D Agnosia is loss of
sensory comprehension, anomia is the inability to find words, and aphasia is the inability to
speak or understand
42. Answer C Increased confusion at right is known as sundowning syndrome. This increased
confusion occurs when the sun begins to set and continues during the night. A fatigue is not

necessarily present. B Increased confusion at night is not part of normal aging, D A delusion is
a firm, fixed belief.
43. Answer: D a client with Alzheimers disease is at risk for injury because of its tendency to
wander. Placing him closer to the nurses station makes it easier to monitor him and better
insures his safety if he begins to wander . placing the client to the nurses station wont help the
client remember to eat, change his position often, or modify his behavior
44. answer: D the patient with parkinsons disease may be hypertensive to heat, which increases
the risk of hypethermia and he should be instructed to avoid sun exposure during hot weather .
45. Answer: B in parkinsons crisis, dopamine-related symptoms are severely exacerbated,
virtually immobilizing the client. A client confined to bed during such as crisis is at risk for
aspiration and pneumonia. Also, excessive drooling increases the risk of airway obstruction.
Because of these concerns, the nursing diagnosis of ineffective airway clearance takes highest
priority. Although the other option also are appropriate. They arent immediately life-threating.
46. Answer: B we have safety bas installed in the bathroom and have 24 hour alarms on the
doors. Ensuring safety of the patient with increasing memory loss is a priority of home care. Note
all options are correct statements. However, safety is most important to reinforce.
47. Answer: A there is no cure for this symptoms, but levodopa (lerodopa) does reduce the
rigidity and bradykinesis which facilities mobility for the patient. B, c are incorrect; d
unrealistic
48. answer: D parkinsons disease is characterized the slowing of voluntary muscle movement,
muscular, rigidity, and resting tremor. Bulging eyeballs(exopthalamos) occur in graves disease.
Diminished distal sensation doesnt occur in parkinsons disease. Dopamine is deficient in this
disorder
49. Answer: A - early symptoms of parkinsons disease include coarse resting tremors of the
fingers and thumb. Akinesia and aspiration are late signs of parkinsons disease. Dementia
occurs in only 20% of the patients with parkinsons disease.
50. Answer: C the ability to identify person, place, and time correctly are the cardinal signs of
orientation status; a and b may be form memory and not disorientation; d the patient may be
very oriented and wants to go hme.

- PRCTICE SET
MEDICAL-SURGICAL NURSING:
NEURO-SENSORY DISTURBANCES
1. an elderly client with glaucoma has been prescribed timoptic eyedrops. Timoptic should be
used with caution in clients with a history of:
a. diabetes
b. gastric ulcers
c. emphysema
d. pancreatic
2. a client who has glaucoma is to have miotic eyedrops installed in both eyes. The nurse knows
that the pupose of the medication is to:
a. anesthetize the cornea
c. constrict the pupils
b. dilate the pupils
d. paralyze the muscles of accommodation
3. an early client with glaucoma is scheduled for a cholecystectomy. Which medication order
should the nurse question?
a. meperidine
b cimetadine
c. atropine
d. promethazine
4. a client has recently been diagnose with open-angle glaucoma. The nurse should tell the client
to avoid talking:
a. aleve (naprosyn)
c. Tylenol (acetaminophen)
b. Benadryl( diphenhydramine)
d. robitussin(guaifenesin)
5. which of the following risk factors would the nurse assess for in the client with glaucoma

a. family history. Increased intraocular pressure, and age of 45-65.

b. history of diabetes and age greater than 50
c. female gender, cigarette smoking, age greater than 65
d. myopia, history of diabetes, and sudden serve physical exertion.
6. an elderly client with glaucoma has been prescribe timoptic eyedrops. Timoptic should be used
with caution in clients with a history of:
a. diabetes
b. gastric ulcer
c. emphysema
d. pancreatitis
7. which symptom is not associated with glaucoma?
a. veil-like loss of vision
c. seeing halos around lights
b. foggy loss of vision
d. complains eye pain
8. the nurse is preparing to discharge a client following a trabeculoplasty for the treatment of
glaucoma. The nurse should instruct the client to:
a. wash her eyes with baby shampoo and water twice a day
b. take only tub baths for the first month following surgery
c. begin using her eye makeup again 1 week after surgery
d. wear eye protection for several months after surgery
9. a client has recently been diagnose with open-angle glaucoma. The nurse should tell the client
to avoid talking?
a. aleve (naprosyn)
c. Tylenol (acetaminophen)
b. Benadryl( diphenhydramine)
d. robitussin(guaifenesin)
10. a client who has glaucoma is to have miotic eyedrops installed in both eyes. The nurse knows
that the purpose of the medication is to:
a. anesthetize the cornea
c. constrict the pupils
b. dilate the pupils
d. paralyze the muscles of accommodation
11. what is the normal range of intraocular pressure?
a. 10 to 15 mmHg
b5 to 10 mmHg
c. 10 to 21 mmHg
15 to 31 mmHg
12. a client had cataract surgery should be told to call his physician if he has which of the
following conditions?
a. blurred vision
b. eye pain
c. glare
d. itching
13. cataracts result in opacity of the crystalline lens. Which of the following best explains the
functions of the lens?
a. the lens controls stimulations of the retina.
c. the lens focuses light rays on the
retina
b. the lens orchestrates eye movement
d. the lens magnifies small
objects
14. the nurse is preparing a client for cataract surgery. The nurse is aware that the procedure will
use:
a. mydriatrics to facilitate removal
c. a laser to smooth and reshape the
lens
b. miotic medications such as timoptic
d. silicone oil injections into the
eyeball
15. the nurse is preparing a client for discharge following the removal of cataract. The nurse
should tell the client to:
a. take aspirin for discomfort
c. remove the eye shield before going
to sleep
b. avoid bending over to put on his shoes
`
d. continue showering as usual
16. mr. boohlagh is diagnose with retinal detachment. Which intervention is the most important
for this patient?
a. admitting him to the hospital on strict bed rest
c. referring him to an ophthalmologist
b. patching both of his eyes
d. preparing him for a surgery
17. signs and symptoms of retinal detachment include:
a. painless decrease in vision, veil over the visual field, and flashing lights
b. veil over the visual field, increase intraocular pressure, and yellow-green halos around visual
images
c. photophobia, yellow-green halos around visual images, and blurred vision

d. unilateral eye inflammation, cloudy cornea, and moderately dilated pupil

18. Gretchen suffered a cerebrovascular accident that left his/her unable to comprehend speech
and unable to speak. This type of aphasia is known as:
a. receptive aphasia
b. expressive aphasia
c. global aphasia
d.
condition aphasia
19. the nurse is explaining cryotherapy to a client who has a detached retina. The nurse should
explain that the MAJOR purpose of cryotherapy in the treatment of detached retina is to:
a. create a scar that promotes healing
c. freeze small blood vessels
b. disintegrates debris in the eye
d. halt secretions of the lacrimal duct
20 a client is admitted with a detached retina of the left eye. The nurse patches about eyes what
is the rationale for patching the eyes?
a. To prevent eye infection
c. to prevent photophobia
b. to decrease eye movement
d. to prevent nystagmus
21. the nurse is caring for a client with Menieres disease. When teaching the client about the
disease, the nurse should explain that the client should avoid foods high in?
a. calcium
b. fiber
c. sodium
c. carbohydrate
22. a client with otosclerosis is scheduled for a stapedectomy. Which finding suggest a
compilation involving the seventh cranial nerve?
a. diminishing hearing
c. inability to move the tongue side to
side
b. sensation of fullness in the ear
d. changes in facial sensation
23. the nurse doing the assessment for the patient with bells palsy known that the CN affected
is:
a. CN 7
b.CN 8
c. CN 6
d.CN 5
24. which nursing diagnosis takes highest priority for a client admitted for evaluation for
Menieres disease?
a. pain related vertigo
b. imbalanced nutrition: less than the body requirements related to nausea and vomiting
c. risk for deficient fluid volume related to vomiting
d. risk for injury related to vertigo
SITUATON: Menieres disease is a disorder of the inner ear. Menieres episode may occur in
clusters and several attacks may occur within a short period of time
25 a patient is diagnosed with Menieres disease. Which of the following nursing diagnoses would
take priority for tis patient?
a. ineffective tissue perfusion (cerebral)
c. imbalanced nutrition: more
than body requirements
b. risk of injury
d. impared social interaction
26. which of the following symptoms would the nurse expect to find when assessing a patients
Menieres disease?
a. epistaxis
b. ptosis
c. tinnitus
d. facial pain
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