ATI LPN
Medical Surgical Nursing Neurological Disorders Questions
Question 1 of 5
On the first postoperative day, the nurse finds an older male client disoriented and trying to climb over the bed railing. Previously he was oriented to person, place, and time on admission. Which intervention should the nurse implement first?
Correct Answer: D
Rationale: Acute confusion post-op may stem from pain, hypoxia, or other causes. Assessment (e.g., pain) is the first step before intervention. [Level: Analysis]
Question 2 of 5
Prior to initiating peritoneal dialysis, which nursing action is most important for the nurse to implement?
Correct Answer: B
Rationale: Baseline vital signs assess stability before dialysis. C is a typo (auscultate lungs?), others are secondary. [Level: Application]
Question 3 of 5
The intracranial pressure of a brain-injured client who is on a ventilator has increased from 15 mm Hg to 25 mm Hg within the last 30 minutes. The client is beginning to flex all extremities intermittently. Based on these findings, which immediate action should the nurse take?
Correct Answer: C
Rationale: Rising ICP and decorticate posturing suggest hypoxia or obstruction; airway patency is the first check. A/B follow if needed. [Level: Analysis]
Question 4 of 5
What will the nurse tell the patient who has cerebral atherosclerosis about taking clopidogrel (Plavix)?
Correct Answer: B
Rationale: Clopidogrel is an antiplatelet; tarry stools indicate bleeding, a key side effect to report. C/D are inaccurate—prevents clots, not dissolves/reduces plaque. [Level: Application]
Question 5 of 5
A patient with a left-brain stroke suddenly bursts into tears when family members visit. How should the nurse respond?
Correct Answer: D
Rationale: Left-brain strokes affect emotional regulation; educating family normalizes this. A dismisses, B/C assume depression. [Level: Application]