ATI RN
Review of Systems Neurological Questions Questions
Question 1 of 5
What should the nurse do when providing care for a patient with an acute attack of trigeminal neuralgia?
Correct Answer: C
Rationale: In caring for a patient experiencing an acute attack of trigeminal neuralgia, maintaining a quiet, comfortable, draft-free environment (option C) is crucial. Trigeminal neuralgia is a condition characterized by severe facial pain, often triggered by touch or movement, so a calm environment helps reduce stimuli that may exacerbate the pain. Option A, carrying out all hygiene and oral care, may worsen the pain as any touch to the face can trigger excruciating discomfort in patients with trigeminal neuralgia. Option B, using conversation to distract the patient, may not be effective as talking or movement around the patient can inadvertently increase pain. Option D, having the patient examine the mouth for residual food, is not a priority during an acute attack and may even worsen the pain due to movement. Educationally, understanding the specific care needs of patients with trigeminal neuralgia highlights the importance of creating a therapeutic environment that minimizes stimuli that can trigger pain. Nurses must prioritize pain management strategies that promote comfort and reduce sensory input to provide optimal care for patients with neurological conditions like trigeminal neuralgia.
Question 2 of 5
The patient is told by the health care provider that the size of the patient's muscle has decreased. How should the nurse document this occurrence?
Correct Answer: B
Rationale: In this scenario, the correct answer is B) Atrophy. Atrophy refers to the decrease in size of a muscle due to various reasons like lack of use, nerve damage, or malnutrition. It is crucial for nurses to accurately document changes in a patient's condition to ensure effective communication within the healthcare team and provide appropriate care. Option A) Hyaline is incorrect because hyaline refers to a type of cartilage, not muscle size changes. Option C) Isometric is incorrect as it refers to a type of muscle contraction where the length of the muscle remains the same, not a decrease in muscle size. Option D) Hypertrophy is also incorrect as it refers to an increase in muscle size, opposite to what is described in the question. Educationally, understanding these terms is essential for healthcare professionals, especially nurses, as it impacts their ability to assess, document, and communicate changes in a patient's condition accurately. Recognizing and documenting muscle atrophy can help in determining the underlying cause, developing appropriate treatment plans, and monitoring the effectiveness of interventions over time.
Question 3 of 5
The patient has a burning, sharp pain on the sole of the foot, especially in the morning. The nurse knows that this describes what common musculoskeletal problem?
Correct Answer: C
Rationale: In this scenario, the correct answer is C) Plantar fasciitis. Plantar fasciitis is a common musculoskeletal problem characterized by a burning, sharp pain on the sole of the foot, especially in the morning. This condition typically results from inflammation of the plantar fascia, a thick band of tissue that connects the heel bone to the toes. Option A) Pes planus refers to flat feet and is not typically associated with the described symptoms. Option B) Tenosynovitis is inflammation of the tendon sheath and presents with different symptoms such as swelling, pain, and difficulty moving the affected joint. Option D) Muscle atrophy is the wasting or loss of muscle tissue and is not directly related to the symptoms described in the question. Educationally, understanding common musculoskeletal problems like plantar fasciitis is essential for healthcare providers, especially nurses, as they play a crucial role in identifying, managing, and educating patients about these conditions. Recognizing the specific symptoms associated with different musculoskeletal issues enables appropriate interventions and timely referrals to optimize patient outcomes.
Question 4 of 5
A diagnosis of a ruptured cerebral aneurysm has been made in a patient with manifestations of a stroke. The nurse anticipates which treatment option that would be considered for the patient?
Correct Answer: B
Rationale: In the case of a ruptured cerebral aneurysm with stroke symptoms, the correct treatment option that the nurse would anticipate is surgical clipping of the aneurysm (Option B). This intervention involves surgically closing off the aneurysm to prevent further bleeding and potential complications. Surgical clipping is the preferred treatment for a ruptured cerebral aneurysm as it directly addresses the source of bleeding, reducing the risk of re-rupture and allowing for better long-term outcomes. This procedure is often performed emergently to minimize the chances of neurological deficits and mortality associated with aneurysm rupture. The other options are not the first-line treatments for a ruptured cerebral aneurysm: A) Hyperventilation therapy is used to lower intracranial pressure in certain neurological conditions but is not the primary treatment for a ruptured aneurysm. C) Administration of hyperosmotic agents may be used to reduce cerebral edema, but it does not directly treat the aneurysm itself. D) Thrombolytic therapy is used for ischemic strokes caused by blood clots, not for ruptured aneurysms. Educationally, understanding the rationale behind the treatment of a ruptured cerebral aneurysm is crucial for nurses caring for patients with neurological conditions. It is essential for nurses to recognize the urgency of surgical intervention in such cases to provide timely and appropriate care, potentially saving lives and preventing further complications.
Question 5 of 5
What could the nurse delegate to unlicensed assistive personnel (UAP)?
Correct Answer: C
Rationale: In this scenario, the correct answer is C) Obtain the suction equipment from the supply cabinet. Delegating this task to unlicensed assistive personnel (UAP) is appropriate as it falls within their scope of practice and does not require specialized training or critical thinking. UAPs are often trained to perform basic tasks that do not involve assessment or interpretation. Option A, completing the admission assessment, involves gathering crucial patient information that requires a licensed healthcare provider's skills. Option B, explaining the call system to the patient, involves communication and education, which should be done by a healthcare provider. Option D, placing a padded tongue blade on the wall above the patient's bed, involves a potential risk of harm and should only be done by a licensed professional to ensure patient safety. In an educational context, it is important for nurses and other healthcare providers to understand the principles of delegation to optimize patient care and workflow efficiency. Knowing which tasks can be safely delegated to UAPs based on their training and competency levels is essential in providing quality patient care while adhering to legal and ethical standards.