Neurology Board Review Situation: Warren was admitted to the hospital with a diagnosis of hypertension. 1.

The nurse should carefully evaluate the pulse prior to administering which medication? a) clonidine (catapres) b) propanolol (inderal) c) atorvastitin calcium (lipitor) d) lovastatin (mevinolin) 2. At the time of Warren's physical examination, which finding was indicative of hypertension? a) pupil changes an opthalmoscopic exam b) presence of the second heart sound c) sinus rhythm on auscultation d) cardiac electrocardiogram 3. When teaching Warren on precautions to take while on antihypertensive medication, the nurse should advice him to: a) avoid changing position suddenly b) observe for black and blue marks c) learn to take his blood pressure TID d) take the drugs always on empty stomach 4. Warren has renal damage related to his hypertensive condition. When teaching him about his diet the nurse should advice him to: a) replace whole milk with milk products b) use salt substitute such as potassium chloride c) eliminate protein from his diet d) limit processed foods to fruits and juices 5. Which test should you order for Warren before treatment is indicated? a) creatinine clearance b) serum uric acid c) serum creatinine d) resting electrocardiogram 6. The client is diagnosed to have hypertension. He is on maintenance dose with captopril (capoten). Which of the following manifestations indicate side effects of the medication? a) diarrhea, hypoglycemia b) hyperkalemia, insomnia

c) bruising, bleeding d) headache, dizziness 7. To provide exercise for a client who had cerebral vascular accident (CVA) with hemiplegia, what should the nurse include in the nursing care plan? a) provide gentle, smooth range of motion exercises, 5 times for each joint b) ensure that the arms are always above the shoulders c) provide passive flexion-extension exercises only on the stronger extremities d) massage the legs vigorously to improve muscle tone 8. When the nurse observes that the patient has extension and internal rotation of the arms and wrists and extension, plantar flexion and internal rotation of the feet, she records the patient's posturing as (supply the answer) . . . 9. Bell's palsy is a disorder of which cranial nerve? a) trigeminal (V) b) acoustic (VIII) c) facial (VII) d) vagus (X) 10. A client diagnosed to have Guillain-Barre Syndrome. The client has the following blood gas results: pH is 7.35 and the paCO2 IS 50 mmHg. What acid-base imbalance is the client experiencing? a) respiratory acidosis b) respiratory alkalosis c) metabolic acidosis d) metabolic alkalosis 11. The nurse test for the function of abducens nerve in a client. Which of the following is appropriate nursing action? a) have the client push his arm against a resistance b) have the client shrug his shoulders c) have the client turn his eyes from right to left d) have the client smile and frown 11. Which of the following should the nurse include in the health teachings for the family of a child with meningitis? a) meningitis can be prevented by influenza vaccine b) meningitis does not pose danger to the family c) meningitis can be transferred by droplet

d) meningitis is always fatal 12. A patient with cerebrovascular accident is experiencing dysphagia. Which of the following is appropriately included in the diet? a) broth b) chocolate milk c) canned tuna d) steamed pork chop 14. How does the nurse test for cranial nerve VI? a) asking the patient to close his eyes b) testing the pupillary reflexes using a penlight c) asking the patient to read with the use of Snellen chart d) with the use of penlight, move it different directions and ask the patient to follow it with his eyes 15. Which diagnostic test will be routine or regular for a patient with multiple sclerosis? a) pulmonary function test b) CT scan c) ECG d) myelography 16. Which of the following nursing interventions is best for a patient with Alzheimer's disease? a) providing an unstructured environment b) providing for an environment with less decision making c) providing for flexible environment d) providing for stimulating environment 17. A patient with cerebellar impairment. Which of the following assessment is expected? a) ataxia b) apraxia c) agnosia d) agraphia 18. The client has been diagnosed to have hypertension. Captopril (capoten), an angiotensinconverting-enzyme inhibitor was prescribed by the physician. When is the best time for the client to take the medication? a) one hour before meals b) with meals c) 30 minutes after meals d) at bedtime

19. A nurse should be most concerned with a patient who had closed head injury if she assessed which of the following? a) glascow coma scale rating changes from 10 to 14 b) pupil size changes from 7 mm to 5 mm c) blood pressure changes from 120/80 mmHg to 140/60 mmHg d) pulse rate changes from 90 per minute to 68 per minute 20. The client who had cerebrovascular accident is in coma. He has an advance directive which states DNR (do not resuscitate). Which of the following statements by the wife indicates effective coping? a) I should have taken him to the hospital for regular check-up b) I want to be with him when he dies c) I wish, I'm not around when he draws his last breath d) I don't want him to suffer any longer

21. The client had undergone hypophysectomy. Which of the following findings should the nurse give highest priority? a) rhinorrhea b) body temperature is 99F c) increased specific gravity of urine d) urine output of 40 to 50 mls/hr 22. The home health nurse is visiting a client who had spinal cord injury. Which of the following factors should the nurse include when giving health teachings? a) regular schedule for elimination b) signs and symptoms of constipation c) proper technique of massaging the legs d) use of walker 23. What is the most appropriate nursing action to assess a patient who has spinal cord injury at the level of T6 for possible signs and symptoms of autonomic dysreflexia? a) check the body temperature b) check the blood pressure c) check the pulse rate d) check the respiratory rate 24. Which of the following problems in a client with Guillain-Barre Syndrome (GBS) should be given highest priority by the nurse?

a) renal problems b) neurologic problems c) respiratory problems d) cardiovascular problems 25. The client has history of seizures. He is on dilantin (phenytoin) therapy. Which of the following side effects should the nurse tell the client to report to the physician? a) reddish-brown urine b) overgrowth of gingival tissues c) drowsiness d) hyperpigmentation of the skin 26. The client had been diagnosed to have Parkinson's disease. He is receiving levodopa. Which of the following health teachings should be included by the nurse? a) avoid over exposure to sunlight b) avoid taking pyridoxine and fortified cereals c) increase fluid intake d) discontinue the drug if it causes reddish brown discoloration of urine 27. The client is diagnosed to have amyotrophic lateral sclerosis. Which of the following signs and symptoms should the nurse observe? a) resting tremors, rigidity, shuffling gait b) muscle atrophy, spasticity, difficulty breathing c) intentional tremors, diplopia, scanning speech d) mask-like face, ascending paralysis, paresthesia 28. The client had been diagnosed to have chronic hypertension. His LDL levels are high while HDL levels are low. Which information does the nurse give to the client about factors that may increase HDL levels? a) HDL levels may be increased by physical activity and estrogen b) HDL levels may be increased by antihyperlipidemic agents c) HDL levels may be increased by low cholesterol diet d) HDL levels may be increased by bed rest 29. The client has been diagnosed to have Guillain-Barre Syndrome (GBS). Which of the following should the nurse include in the nursing care plan of the client? a) check ability to hear b) check bladder distention c) check blood pressure every 2 hours d) check deep tendon reflexes every shift

30. Who among these hypertensive clients should the nurse follow-up first? a) the white American client with BP of 160/100 mmHg, which went down to 140/90 mmHg one hour after taking Nifedipine. b) the black American with BP of 161/98 who took anti-hypertensive medication twice but no progress noted c) the native American client with BP ranging between 140/90 to 160/100 for the last 3 days d) the Asian American client with BP of 116/84 and claims that he had been taking antihypertensive medication since 2 years ago 31. The client experiences hypoglossal nerve damage. Which of the following assessment findings does the nurse expect in the client? a) difficulty of swallowing and protrusion of tongue b) asymmetry of the face c) severe pain on the side of the face d) inability to rotate the head and move shoulders 32. Which of the following indicates stimulation of the sympathetic nervous system (SNS)? a) hypotension b) urinary frequency c) diarrhea d) dilatation of pupils 33. A client with moderate Alzheimer's disease removes her clothes in the hall. Which of the following is the most appropriate nursing action? a) help the client put on her dress b) usher the client back to his room c) tell the client that such behavior is unacceptable d) remind her that when she undresses, she should do it inside her room 34. Which of the following nursing interventions should be included in the nursing care plan for the client with cerebral concussion? a) check leakage of cerebrospinal fluid through the nose b) check vital signs every 2 hours c) check neurologic status every 4 hours d) check pupillary reflexes once in each shift 35. The client who had cerebrovascular accident (CVA) has left-sided weakness. Which of the following instructions should be included regarding proper use of the cane? a) hold the cane on the right hand

b) hold the cane on the left hand c) hold the cane alternately on each hand d) hold the cane with both hands 36. Which of the following nursing diagnosis should be given highest priority by the nurse in a client diagnosed with Guillain-Barre Syndrome (GBS)? a) activity intolerance related to muscle weakness b) ineffective breathing pattern related to respiratory muscle weakness c) ineffective sexuality pattern related to paralysis d) ineffective coping related to body changes 37. A client has been diagnosed to have Alzheimer's disease. Which of the following is most appropriate nursing action to prevent sundowning syndrome? a) make the client stay in his room before dark b) turn lights on before dark c) feed the client before dark d) administer the client's medication before dark 38. Which of the following manifestations is most likely observed in a child with hydrocephalus? a) depressed anterior fontanel b) sunsetting eyes c) loud, vigorous cry d) short and thick neck 39. The client has been diagnosed to have ALS (amyotrophic lateral sclerosis). Which of the following manifestations characterize the disease? Select all that apply a) muscle weakness b) intention tremors c) muscle atrophy d) fatigue e) shuffling gait f) respiratory difficulty 40. The client had undergone cerebral angiography. Which of the following potential complications should the nurse be most alert for? a) nausea and vomiting b) skin rashes c) hypertension d) hypotension 41. When lumbar puncture is done, the needle is inserted into which of the following intervertebral spaces?

a) cervical 4 and 5 b) thoracic 4 and 5 c) lumbar 4 and 5 d) sacral 4 and 5 42. The cerebral cortex is responsible for regulating which of the following functions? a) motor activities, speech b) touch, temperature c) hearing, taste d) vision, reading 43. A client with Alzheimer's disease lives in a board and care facility. The client frequently wanders outside the care facility. Which of the following is the most essential measure to avoid injury in the client? a) the staff members should frequently orient the client b) the staff members should go for a walk with the client several times a day c) the staff members should assign a nursing assistant to stay with the client in her room during an entire shift d) the staff members should allow the client to go out of his room only during meals times 44. Which of the following questions would evaluate that the client suffered from frontal lobe defect? a) what would you do if your house is on fire? b) what is the color of this flower? c) what sound do you hear now? d) what is the temperature of this fluid? 45. The charge nurse assigned the RN to a client with increased intracranial pressure. Which action by the RN needs intervention by the charge nurse? a) the RN places the client in semi-fowler's position b) the RN places the client in side-lying position with the neck flexed c) the RN places the client in supine position d) the RN places the client in side-lying, semi-fowler's position 46. Which of the following assessment findings indicated increased intracranial pressure? Select all that apply a) headache b) tachycardia c) slow respiration

d) narrowing of pulse pressure e) slow, bounding pulse f) hyperthermia 47. Which of the following nursing measures should be included when caring for a client with Parkinson's disease? a) put color on rails in going upstairs b) provide high toilet seat c) provide soft mattress d) apply restraints to reduce tremors 48. Michael suddenly went into seizures. To protect a child from injury the nurse should: a) retrain the child's arm and legs b) place a tongue blade in the child's mouth c) place a pillow under the child's head d) provide a waterproof pad for the bed 49. The first nursing priority when providing nursing care for Michael is to: a) administer antibiotic as ordered as soon as possible b) keep the room quiet and dim c) explain all the procedures to the patients d) begin low-flow oxygen per mask 50. Which room should the nurse assign to Ashley? a) room 201 with Joey, age 2 who underwent surgery for repair of hernia b) room 206 with Rica, age one who had pneumonia c) room 210 with Jack age 2 who has cerebral palsy d) room 214 with no roommate 51. A 75-year old woman is admitted to a nursing home with a diagnosis of primary dementia of the Alzheimer's type. In the nursing home, which of these behaviors of the client is of greatest danger to her? a) she wanders into other patient's room b) she climbs over the side rails of her bed c) she eats the food off other resident's plates d) she refuses to change her clothes 52. An elderly client is diagnosed with Alzheimer's disease. When planning care, the nurse should include which of these vital considerations? a) allowing him to plan his own day

b) encouraging outside diversional activities c) limiting his caloric intake d) providing a calm, predictable environment 53. While in the dining room having lunch, a nursing home client with Alzheimer's disease suddenly begins shouting and banging on the table. Which action should be taken by the nurse first? a) speak in a firm voice asking the client to stop the behavior b) put the client in the corner of the dining room by himself c) take the client back to his room to finish lunch d) remove the lunch tray until the client can control himself 54. A patient with hepatic encephalopathy is given instructions regarding his diet. Which of the following foods should the patient avoid? a) proteins b) calcium c) fats d) carbohydrates 55. A male client, 89 years old who has a mild Alzheimer's disease was admitted 2 days ago. Which of the following signs and symptoms are expected in the client? a) poor attention span b) poor personal hygiene c) unable to remember misplaced objects d) irritable e) intention tremors f) shuffling gait 56. Which of the following is a sign of neuroleptic malignant syndrome? a) Temperature of 39.9 C b) muscle weakness c) red-purplish blotchy areas in the skin d) weight gain 57. A nurse is caring for a client diagnosed to have head injury. Which of the following situations needs intervention by the nurse? a) the padded side rails are up b) the bed is adjusted to low level c) the client's spouse turns on the TV one hour in the afternoon and 2 hours in the evening d) the head of bed is elevated at 30 degree angle

58. Which of the following should be included when giving health teachings to a client with left hemianopsia? a) tell her to fully turn her head from side to side b) tell her to fully turn her head on her right side only c) tell her not to turn her head from side to side d) tell her to look forward most of the time 59. The client is diagnosed to have amyotrophic lateral sclerosis. Which of the following signs and symptoms should concern the nurse most? a) tremors b) difficulty in swallowing c) ptosis of the eyelid d) muscle atrophy 60. A client with closed head injury manifests increased urine output. What should the nurse do next? a) measure urine specific gravity b) start an IV fluid c) monitor blood glucose levels d) administer mannitol drip

Neurology Board Review: ANSWERS AND RATIONALE 1) B - Propanolol is a drug that is used for angina pectoris, MI, arrythmias, hypertension, migraine, essential tremor, pheochromocytoma. Its main effect is to block catecholamine effect in heart and blood pressure, thereby, lowering BP and heart rate. The main potential adverse effect of the drug is bradycardia, heart failure, and hypotension. Thus it is very important to always check the patient's apical pulse and blood pressure before administering the drug. If the patient has bradycardia (below 60), withhold giving the drug and notify physician.

always give with food to increase absorption advise not to discontinue abruptly as it can exacerbate angina and precipitate MI advise to continue taking the drug even he is already feeling well this drug should not be given to patients with asthma do not discontinue before surgery for pheochromocytoma

Clonidine (Catapres) is an antihypertensive drug. Although it affects both blood pressure and pulse rate so that these vital signs must be checked before administering catapres, its effect on heart rate is not as much as that of propanolol. If the patient has hypotension and bradycardia, the drug should not be given and the doctor notified.

clonidene may cause a weakly positive Coomb's test and decreases excretion of vanilymandelic acid avoid giving with propanolol and betablockers as it results in rebound hypertension avoid giving with Verapamil as it may cause AV block and severe hypotension avoid giving with herbal supplement capsicum as it may reduce antihypertensive effect of catapres avoid orthostatic hypotension by rising slowly and changing position slowly side effect drowsiness will diminish after 4 to 6 weeks the last dose should be taken immediately before going to bed advise not to discontinue drug abruptly as it may cause rebound hypertension

Lipitor and lovastatin are drugs used to lower LDL and total cholesterol and triglyceride levels. 2) A - letters b,c,d are examinations and findings that are more often carried out and associated with disease conditions of the heart. Hypertension is a persistent systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mmHg. It is characterized by elevated peripheral vascular resistance from constriction of arterioles, which may be caused by sympathetic responses and stimulation of the renin angiotensin mechanism. It is classified as primary or essential hypertension in which there is no known etiology, and secondary, which develops as a result of some other condition. On Physical Examination:

opthalmoscopic exam: the eyes will usually reveal narrowed arterioles, hemorrhage, exudates and papilledema or swelling of the optic nerve apical and peripheral pulses vital signs and BP edema of extremities

Patients may complain of:

headache at the back of the head and neck nocturia confusion nausea and vomiting visual disturbances

3) A - the most common side effect of antihypertensive drugs is orthostatic hypotension. To prevent it, instruct the patient to avoid changing position suddenly and standing for prolonged periods of time. Advise patient to sit down if he feels dizzy. 4) D - hypertensive patients without renal damage are often placed on a fat/cholesterol, low sodium

and low calorie diet. Processed, preserved and fast foods are often high in sodium and must be avoided in a low sodium diet Proteins are not eliminated in the diet but its intake is limited to the recommended daily allowance to prevent overloading the kidney, adding calories and weight gain. Using salt substitutes that contain potassium may interact with the antihypertensive drugs being taken by the patient, especially when patient is taking ACE inhibitors as it may result in hyperkalemia. 5) C - the purpose of the diagnostic tests is to identify possible causes of hypertension and to identify the organs already affected by the disorder in order to institute the most effective treatment regimen for the patient. The routine laboratory tests conducted before initiating treatment include CBC, urinalysis and blood chemistry including glucose, electrolytes, cholesterol, serum creatinine and blood urea nitrogen. Serum creatinine and blood urea nitrogen reflect renal function. Hypertension can significantly decrease blood supply to the kidney which can damage the renal system and impair kidney function resulting in fluid retention and inability of the kidney to regulate electrolytes balance and excrete metabolic waste products such as urea. Hematocrit and hemoglobin are monitored as they reflect changes in fluid volume. 6) D - hypotension causes headache and dizziness. Angioedema (swelling of face and hands) may also occur as side effect of capoten. 7) A - gentle, smooth ROM exercises promote well-being of the client; prevent stiffness of joints, and contractures. Exercises should be done in a manner that prevents increase in ICP. 8) Decerebration - is abnormal extension. It indicates brainstem function impairment. 9) C - Bell's palsy is paralysis of the facial nerve (CN VII). It is characterized by asymmetry of the face with ptosis of the eyelid on the affected eye. 10) A - high paCO2 level in the blood causes respiratory acidosis. In Guillain-Barre Syndrome, there is weakness/paralysis of respiratory muscles. This causes carbon dioxide retention.

11) C - the abducens innervate the lateral rectus muscles of the eyes. These muscles move the eyes from side to side (right <-> left). 12) C - meningococcal infection is readily transmitted by droplet infection from nasopharyngeal secretions. 13) B - thickened liquid diet like chocolate milk or pureed foods are best tolerated by clients with dysphagia 14)D - the CN VI (abducens) innervates the lateral rectus muscles of the eyes. These muscles move the eyes from side to side. 15) A - multiple sclerosis may lead to weakness/paralysis of respiratory muscles. Assessment of pulmonary functions is necessary. 16) B - Alzheimer's disease is characterized by loss of memory or problem with ability to think. The client with this disease will benefit most in a simple, structured environment. (Structured /routine activities/schedule). 17) A - cerebellum is responsible for balance/equilibrium. Ataxia - uncoordinated movement Apraxia - inability to perform fine motor activities Agnosia - inability to perceive sensory stimuli Agraphia - inability to write 18) A - capoten is best taken on an empty stomach to promote adequate absorption. 19) C - widening of pulse pressure (the difference between systolic pressure and diastolic pressure is more than 30 to 40 mmHg) is an indication of increased ICP. Always consider increase in ICP as emergency because it causes cerebral hypoxia. 20) B - the wife exhibits acceptance with her husband's decision. Her presence when the husband is

dying will provide great psychological support to him. 21) A - rhinorrhea indicates CSF leakage. Options B, C, and D are normal findings. 22) A - regular schedule of elimination is very important in a client with spinal cord injury. Bladder distention and fecal impaction may cause autonomic dysreflexia. 23) B - autonomic dysreflexia is characterized by hypertension. This is the most dangerous effect of the condition. If BP remains uncontrolled CVA may occur. 24) C - GBS involves paralysis of respiratory muscles that may lead to respiratory arrest. 25) B - gingival hyperplasia is a common toxic effect of phenytoin. Preventive measures are as follows: good oral care, use soft-bristled toothbrush, and massage the gums. 26) B - pyridoxine blocks effect of levodopa. Reddish brown discoloration of urine is a harmless side effect of levodopa. 27) B - amyotrophic lateral sclerosis is a degenerative motor neuron disorder that affects muscles. Choice A describes Parkinson's disorder. Choice C describes multiple sclerosis Choice D describes guillain-barre's syndrome 28) A - regular pattern of activity/exercise and estrogen may increase HDL levels (good cholesterol). High density lipoprotein is necessary to prevent atherosclerosis. 29) B - GBS is an acute infectious polyneuritis of the cranial and peripheral nerves. It involves destruction of myelin sheath. It is usually preceded by a mild upper respiratory infection or gastroenteritis. It is characterized by ascending paralysis. Poor bladder tone is a characteristic manifestation. 30) B - the client might go to hypertensive crisis since he is not responding to medications. This increases risk to cerebrovascular accident (CVA). Therefore, this client should be given highest

priority by the nurse. 31) A - hypoglossal nerve provides motor nerve supply to the tongue. Hypoglossal nerve damage is characterized by difficulty of swallowing, protrusion of the tongue, deviation of the tongue to one side of the mouth. Asymmetry of the face is affectation of the facial nerve. Severe pain on the side of the face is affectation of the trigeminal nerve. Inability to rotate the head and move shoulders is affectation of the spinal accessory nerve. 32) D - SNS secretes norepinephrine and causes dilatation of pupils. Choices A, B, and C are effects of PNS. (SNS: everything is high and fast, except GI and GU). 33) D - a client with Alzheimer's disease experiences memory loss. Reminding the client will help him/her remember, e.g. undressing is done inside the room. 34) A - in head injury, it is very important to assess for CSF leakage. This indicates basilar head injury. This may lead to brainstem compression resulting to cardiopulmonary arrest. 35) A - use the cane on the stronger/unaffected area - the right hand. 36) B - in GBS, respiratory muscle weakness and paralysis occur. 37) B - turning lights on before dark prevents sundowning syndrome. 38) B - sunsetting eyes characterize hydrocephalus. Other signs and symptoms include: sudden enlargement of head, bulging fontanels, dilated scalp veins, separated sutures, Macewen sign, frontal enlargement/bossing, and thinning of skull bones. 39) A, C, D, F - amyotrophic lateral scerosis (ALS) is a motor neuron disorder. It is characterized by fatigue, awkwardness of fine finger movement, muscle wasting, dysphagia, muscle weakness, atrophy, fasciculations, dysarthria, jaw clonus, respiratory difficulty, spasticity of flexor muscles. This disease is also known as "Lou Gehrig's disease."

40) D - the contrast medium used in cerebral angiography has profound diuretic effect. Therefore, it may cause hypotension. 41) C - the spinal needle is inserted in L3 and L4, L4 and L5, L5 ans S1 intervertebral spaces to prevent trauma to the spinal cord, which ends at L1. 42) A - the cerebral cortex regulates motor activities, speech, logical operations (number skills, reasoning, scientific skills), insights, art awareness, imagination, music awareness, personality development, future planning. Choice B - parietal lobe is responsible for touch and temperature Choice C - the temporal lobe is responsible for hearing and taste Choice D - the occipital lobe is responsible for vision and hearing. 43) A - Alzheimer's disease is characterized by memory loss. Frequent orientation of the client is necessary. 44) A - frontal lobe is responsible for thought processes, logical operations, and reasoning. Choice B evaluates function of the occipital lobe. Choice C evaluates function of the temporal lobe. Choice D evaluates function of the parietal lobe. 45) B - the client with increased intracranial pressure should be positioned with the neck in neutral position. This prevents compression of jugular veins and will prevent cerebral venous congestion. 46) A, C, E, F - increased ICP is characterized by headache, nausea and vomiting, diplopia, increased systolic BP, slow respiration, slow bounding pulse, widening of pulse pressure, hyperthermia/hypothermia, altered LOC, papilledema, lateralizing sign. 47) B - the client with Parkinson's disease experiences stiffness/rigidity due to inadequate dopamine production. Dopamine is a neurotransmitter that promotes muscle relaxation. High toilet seat facilitates the client's ability to sit during elimination. 48) C - the child should never be restrained during a seizure because such action by the nurse can cause

fracture of the bones. Tongue blade must not be inserted when the child is already having a seizure because of the risk of injury. Placing waterproof pad at this time is no longer advisable. It is correct to slip pillow under the head to protect the head of the child from banging on any hard object. 49) A - the priority is to treat the patient with antibiotics at the soonest time possible because the longer the disease goes on without treatment, the greater the risk of seizures and of permanent neurologic damage, such as hearing loss, brain damage, blindness, loss of speech, learning disabilities and behavior problems. Non-neurologic complications may include kidney and adrenal gland failure. Bacterial infections of the central nervous system progress quickly. Within hours of the onset of symptoms, the disease can lead to shock and death. 50) D - Bacterial meningitis is a highly contagious. Therefore the patient must be placed in a private room to prevent transmitting it to other patients. Nurses who will be in contact with patients with meningitis should wear mask, the mask should be discarded right away when it gets moist or wet. The different types of bacterial meningitis are:

Pneumococcus - this bacterium is the most common cause of meningitis in adults and children. It most often occurs when the bacterium Streptococcus pneumoniae (pneumococcus), the same bacterium that causes pneumonia and ear infections, enters the bloodstream and migrates to the brain and spinal cord. Mode of transmission is the same as pneumonia: droplet, direct contact and through respiratory discharges. Meningococcus - this bacterium is another common cause of meningitis in children under age 5, in teens and in young adults. Meningococcal meningitis commonly occurs when bloodstream. It's highly contagious and may cause localized epidemics in college dormitories, boarding schools and on military bases. Five strains of the Neisseria meningitidis bacterium cause meningococcal meningitis. Mode of transmission is by direct contact and respiratory droplets. This type of meningitis is communicable until the meningococci are no longer present from nose and mouth. Prophylactic treatment is Rifampicin taken for 4 days at a dose of 20 mg/kg/day. Haemophilus - the Haemophilus influenzae (H. influenzae) bacterium is the leading cause of bacterial meningitis in children under age 5. The use of the Hib vaccine prevents this type of meningitis. When it occurs, it tends to follow an upper respiratory infection, ear infection (otitis media) or sinusitis. Mode of transmission is by droplet infection and discharges from nose and throat during the infectious period. This type of meningitis is no longer communicable 48 hours after starting antibiotic therapy 51) B - falls is one of the greatest dangers among confused client. 52) D - a simple, structured environment should be provided to the client with Alzheimer's disease to help him cope up with his/her memory loss.

53) C - remove the client from the environment that may have triggered agitation. But continue provide care, like allowing him to finish his meal. 54) A - the natural end-product of protein is ammonia. Increased ammonia production causes hepatic encephalopathy. 55) A, B, C, D - the main problem with Alzheimer's disease is memory loss. Intention tremors and shuffling gait are manifestations of Parkinson's disease. 56) A - fever is a characteristic manifestation of neuroleptic malignant syndrome 57) C - in a client with head injury, increased ICP occurs. External stimuli should be reduced to prevent seizures. 58) A - scanning technique will help the client with hemianopsia to see the entire visual field. 59) B - difficulty in swallowing may cause aspiration. This in turn may cause airway obstruction. 60) A - closed head injury causes increased intracranial pressure. This causes compression of the posterior pituitary gland that leads to hyposecretion of antidiuretic hormone (ADH). Diabetes insipidus occurs. Diabetes insipidus is characterized by polyuria and low urine specific gravity.