Chapter 45: Care of Critically Ill Patients with Neurologic Problems

Chapter 45: Care of Critically Ill Patients with Neurologic Problems

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A client is in the emergency department reporting a brief episode during which he was dizzy, unable to speak, and felt like his legs were very heavy. Currently the client’s neurologic examination is normal. About what drug should the nurse plan to teach the client?
   1. Alteplase (Activase)
   2. Clopidogrel (Plavix)
   3. Heparin sodium
   4. Mannitol (Osmitrol)

ANS:   B

This client’s manifestations are consistent with a transient ischemic attack, and the client would be prescribed aspirin or clopidogrel on discharge. Alteplase is used for ischemic stroke. Heparin and mannitol are not used for this condition.

DIF:     Remembering/Knowledge                 REF: 930                     KEY: Neurologic disorders| antiplatelet medications| patient education  MSC:    Integrated Process: Teaching/Learning                       NOT:                                                 Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A client had an embolic stroke and is having an echocardiogram. When the client asks why the provider ordered “a test on my heart,” how should the nurse respond?
   1. “Most of these types of blood clots come from the heart.”
   2. “Some of the blood clots may have gone to your heart too.”
   3. “We need to see if your heart is strong enough for therapy.”
   4. “Your heart may have been damaged in the stroke too.”

ANS:   A

An embolic stroke is caused when blood clots travel from one area of the body to the brain. The most common source of the clots is the heart. The other statements are inaccurate.

DIF:     Understanding/Comprehension         REF: 931                     KEY: Neurologic disorders| stroke| patient education                                 MSC: Integrated Process: Teaching/Learning                       NOT:                                                 Client Needs Category: Physiological Integrity: Physiological Adaptation

3. A nurse receives a report on a client who had a left-sided stroke and has homonymous hemianopsia. What action by the nurse is most appropriate for this client?
   1. Assess for bladder retention and/or incontinence.
   2. Listen to the client’s lungs after eating or drinking.
   3. Prop the client’s right side up when sitting in a chair.
   4. Rotate the client’s meal tray when the client stops eating.

ANS:   D

This condition is blindness on the same side of both eyes. The client must turn his or her head to see the entire visual field. The client may not see all the food on the tray, so the nurse rotates it so uneaten food is now within the visual field. This condition is not related to bladder function, difficulty swallowing, or lack of trunk control.

DIF:            Applying/Application                         REF:    936                   KEY: Neurologic disorders| stroke| visual disorders                                           MSC: Integrated Process: Nursing Process: Implementation                                                      NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

4. A client with a stroke is being evaluated for fibrinolytic therapy. What information from the client or family is most important for the nurse to obtain?
   1. Loss of bladder control
   2. Other medical conditions
   3. Progression of symptoms
   4. Time of symptom onset

ANS:           D

The time limit for initiating fibrinolytic therapy for a stroke is 3 to 4.5 hours, so the exact time of symptom onset is the most important information for this client. The other information is not as critical.

DIF:            Applying/Application                         REF:    938                   KEY: Stroke| neurologic disorders| nursing assessment| fibrinolytic therapy MSC:                        Integrated Process: Nursing Process: Assessment                                               NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A client is being prepared for a mechanical embolectomy. What action by the nurse takes priority?
   1. Assess for contraindications to fibrinolytics.
   2. Ensure that informed consent is on the chart.
   3. Perform a full neurologic assessment.
   4. Review the client’s medication lists.

ANS:           B

For this invasive procedure, the client needs to give informed consent. The nurse ensures that this is on the chart prior to the procedure beginning. Fibrinolytics are not used. A neurologic assessment and medication review are important, but the consent is the priority.

DIF:            Applying/Application                         REF:    938                   KEY: Neurologic disorders| stroke| informed consent                                        MSC: Integrated Process: Communication and Documentation  NOT:                                           Client Needs Category: Safe and Effective Care Environment: Management of Care