ATI LPN
Test Bank for Medical Surgical Nursing: Concepts for Interprofessional Collaborative Care 10th Edition
Chapter 41 : Assessment of the Nervous System Questions
Question 1 of 5
A nurse assesses a client's recent memory. Which client statement confirms that the client's recent memory is intact?
Correct Answer: D
Rationale: Asking clients about recent events that can be verified, such as what they ate for breakfast, assesses recent memory. The other options assess different cognitive functions: making up a rhyme tests higher cognition, recalling birth details tests remote memory, and repeating words tests immediate memory.
Question 2 of 5
A nurse assesses a client who demonstrates a positive Romberg's sign with eyes closed but not with eyes open. Which condition is most likely?
Correct Answer: A
Rationale: A positive Romberg's sign with eyes closed but not with eyes open indicates difficulty with proprioception, as the client relies on vision to compensate for impaired position sense. The other options do not specifically describe this clinical finding.
Question 3 of 5
A nurse asks a client to take deep breaths during an electroencephalography. The client asks, 'Why are you asking me to do this?' How should the nurse respond?
Correct Answer: C
Rationale: Hyperventilation produces cerebral vasoconstriction and alkalosis, which increases the likelihood of seizure activity, enhancing the EEG's ability to detect abnormalities. The other responses are inaccurate regarding the physiological effects of hyperventilation.
Question 4 of 5
A nurse assesses a client recovering from a cerebral angiography via the client's right femoral artery. Which assessment should the nurse complete?
Correct Answer: A
Rationale: Cerebral angiography involves threading a catheter through the femoral artery, and the extremity is immobilized post-procedure. Checking bilateral lower extremity pulses ensures adequate circulation. Orthostatic blood pressure readings are not feasible due to bedrest, and fundoscopic examination or gag reflex assessment is unrelated to the procedure.
Question 5 of 5
A nurse obtains a focused health history for a client who is scheduled for magnetic resonance angiography. Which priority question should the nurse ask before the test?
Correct Answer: B
Rationale: Allergies to iodine or shellfish are critical to assess because the contrast used in magnetic resonance angiography may cause a similar allergic reaction. The other options do not affect the safety or outcome of the procedure.