NCLEX-PN
NCLEX Questions on Neurological Disorders Quizlet Questions
Extract:
Question 1 of 5
How can the nurse best help the client deal with personal fears at this time?
Correct Answer: A
Rationale: Encouraging verbalization of feelings helps the client process fears and promotes emotional coping during an MS exacerbation.
Question 2 of 5
The client diagnosed with atrial fibrillation complains of numbness and tingling of her left arm and leg. The nurse assesses facial drooping on the left side and slight slurring of speech. Which nursing interventions should the nurse implement first?
Correct Answer: B
Rationale: Symptoms suggest an acute stroke, requiring immediate activation of a Code STROKE (
B) to expedite diagnosis and treatment. MRI (
A), notifying HCP (
C), and swallowing tests (
D) follow protocol activation.
Question 3 of 5
The nurse caring for a client who has been abusing amphetamines writes a problem of 'cardiovascular compromise.' Which nursing interventions should be implemented?
Correct Answer: A,C
Rationale: Amphetamine abuse can cause tachycardia and hypertension. Monitoring telemetry and vital signs (
A) detects cardiovascular changes, and a calm atmosphere (
C) reduces stimulation. Verbalizing reasons (
B) is psychosocial, and bedrest/low-sodium diet (
D) is not indicated.
Question 4 of 5
The nurse’s client with a T2 SCI is dysreflexic and has a BP of 170/90 mm Hg. Place the nurse’s interventions in the order that these should be performed.
Order the Items
Source Container
Correct Answer: C,A,B,G,F,E,D
Rationale: Elevate the HOB to 90 degrees. This initial quick action may help lower the client’s BP. Lower the end of the bed so feet are dependent. Placing the feet lower than the head will help decrease blood return and may help lower the BP. Remove elastic stocking and other constricting devices; assess below the level of injury. Anything constricting below the level of injury can be the stimulus that precipitates autonomic dysreflexia. The nurse can assess for other precipitating factors, such as a full bladder, while removing constricting devices. Retake the BP after being upright for 2 to 3 minutes. Elevating the HOB, lowering the feet, and removing constricting devices may have lowered the BP. If not, further interventions are needed. Administer a pm prescribed sublingual nifedipine for continued elevated BP. If the BP remains elevated, the prescribed antihypertensive medication, such as nifedipine (Procardia), should be given next to quickly lower the BP. Perform digital removal of impacted stool (last BM found to be 10 days ago). Digitally removing stool impaction may cause a further spike in BP, so that should be completed after the BP medication is administered. Inform the HCP of the incident, measures taken, and client response. This is last because a pro antihypertensive medication had already been prescribed. Care of the client is priority.
Question 5 of 5
The client is diagnosed with ALS. Which client problem would be most appropriate for this client?
Correct Answer: A
Rationale: ALS causes progressive muscle weakness, leading to disuse syndrome (
A) from immobility. Body image (
B) is secondary, fluid/electrolyte issues (
C) are not primary, and pain (
D) is less common.