ATI RN
Neurological System NCLEX Questions Questions
Question 1 of 5
A patient is admitted with an open fracture of the tibia following a bicycle accident. During assessment of the patient, what specifically should the nurse question the patient about?
Correct Answer: B
Rationale: The correct answer is B) The status of tetanus immunization. When a patient presents with an open fracture, there is a risk of tetanus infection due to exposure to dirt or foreign bodies. Tetanus is a serious bacterial infection that can lead to muscle stiffness and spasms, which can be life-threatening. Therefore, knowing the patient's tetanus immunization status is crucial for timely intervention. Option A) Any previous injuries to the leg is not directly related to the immediate management of an open fracture and tetanus prevention. While it may provide some historical context, it is not as critical as tetanus immunization status in this scenario. Option C) The use of antibiotics in the last month is important in general medical history taking but is not as directly relevant to the prevention of tetanus in the setting of an open fracture. Option D) Whether the injury was exposed to dirt or gravel is related to the mechanism of injury, but the focus should be on the potential for tetanus infection and the need for immunization. In an educational context, this question highlights the importance of thorough assessment in patients with open fractures, emphasizing the need to prioritize information gathering based on the immediate risks associated with the condition. Understanding the rationale behind prioritizing specific questions can help nurses make informed clinical decisions and provide optimal care to patients in similar situations.
Question 2 of 5
Priority Decision: Following change-of-shift handoff, which patient should the nurse assess first?
Correct Answer: D
Rationale: In this scenario, the correct answer is D) A 68-year-old male with a new lower leg cast complaining that the cast is too tight and he cannot feel his toes. This patient's complaint indicates a potential neurovascular compromise, which is a critical situation requiring immediate assessment and intervention to prevent complications like compartment syndrome or impaired circulation leading to tissue damage. Option A is incorrect because phantom pain, while distressing, is not an immediate priority over a potential neurovascular issue. Option B is not as urgent as the patient's condition is stable post-hip fracture repair. Option C's request for traction weight relief, while important, does not pose an immediate threat compared to the potential neurovascular compromise in option D. In an educational context, this question highlights the importance of prioritizing patient care based on potential life-threatening complications. Nurses need to quickly assess and address urgent issues to ensure patient safety and prevent adverse outcomes in critical situations like neurovascular compromise. Understanding these priorities is essential for nursing practice and success on exams like the NCLEX.
Question 3 of 5
The patient has lateral angulation of the large toe toward the second toe. The nurse knows that treatment will include what?
Correct Answer: C
Rationale: In this scenario, the correct answer is C) Surgery to remove the bursal sac and bony enlargement. This presentation of lateral angulation of the large toe towards the second toe indicates a condition known as a bunion or hallux valgus. Surgical intervention is often necessary to correct this deformity by removing the bony enlargement and the bursal sac that has formed. Conservative measures like metatarsal arch support (option A) and trimming with a scalpel after softening (option B) may provide symptomatic relief but do not address the underlying structural issue. Intraarticular corticosteroids and passive manual stretching (option D) are not typically indicated for the treatment of bunions. From an educational perspective, it is crucial for nurses to understand the appropriate management of common musculoskeletal conditions like bunions to provide optimal care to patients. Recognizing when conservative measures are insufficient and surgical intervention is necessary is essential in promoting positive patient outcomes and quality of life. Nurses must be knowledgeable about the rationale behind different treatment options to advocate for their patients effectively and ensure comprehensive care.
Question 4 of 5
The patient has had RA for some time but has not had success with previous medications. Although there is an increased risk for tuberculosis, which monoclonal antibody is used with methotrexate to best treat symptoms?
Correct Answer: C
Rationale: In this case, the correct answer is C) Tocilizumab (Actemra). Tocilizumab is a monoclonal antibody that targets interleukin-6 (IL-6) receptors, which plays a crucial role in the inflammatory process seen in rheumatoid arthritis (RA). When used in combination with methotrexate, Tocilizumab has shown effectiveness in treating RA symptoms, especially in patients who have not responded well to other medications. A) Parenteral gold is not commonly used in current RA treatment guidelines due to its potential for serious side effects and the availability of more effective and safer options like biological therapies. B) Certolizumab (Cimzia) is a TNF-alpha inhibitor and is not specifically indicated for use with methotrexate in RA cases resistant to other treatments. D) Hydroxychloroquine (Plaquenil) is typically used in mild cases of RA or in combination with other more potent medications. It is not a monoclonal antibody and has a different mechanism of action compared to Tocilizumab. In an educational context, understanding the rationale behind selecting the appropriate medication for RA is crucial for nursing students preparing for the NCLEX. It is essential to grasp the mechanism of action of each medication, their indications, potential side effects, and their place in the treatment algorithm for RA. This knowledge enables nurses to provide safe and effective care to patients with RA, ensuring optimal symptom management and disease control.
Question 5 of 5
During an acute exacerbation, a patient with SLE is treated with corticosteroids. The nurse would expect the corticosteroids to begin to be tapered when which serum laboratory results are evident?
Correct Answer: B
Rationale: In the context of Systemic Lupus Erythematosus (SLE) and corticosteroid treatment, an increase in complement levels indicates disease activity is controlled. Therefore, the correct answer is B) Increased complement. Corticosteroids help suppress inflammation and immune response in SLE, leading to a decrease in complement consumption. This reduction in complement levels signifies that the treatment is effective, and tapering can be initiated. A) Decreased anti-DNA is incorrect because while a decrease may indicate some improvement, it is not as specific as complement levels in assessing disease activity in SLE. C) Increased red blood cells (RBCs) and D) Decreased erythrocyte sedimentation rate (ESR) are not directly related to the disease activity or response to corticosteroid treatment in SLE. Educational Context: Understanding the rationale behind laboratory monitoring in SLE patients receiving corticosteroid therapy is crucial for nurses and healthcare providers. Monitoring complement levels helps in assessing disease activity and treatment effectiveness, guiding clinical decision-making regarding tapering or adjusting medications. This knowledge ensures optimal patient care and management of SLE, emphasizing the importance of evidence-based practice in nursing.