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Neurosensory System Questions and Answers for NCLEX-PN and NCLEX-RN
Question 1: An adult man fell off a ladder and hit his head and lost consciousness. After regaining consciousness several minutes later, he was drowsy and had trouble staying awake. He is admitted to the hospital for evaluation. The nursing care plan will most likely include:
Given the patient’s history of head trauma and drowsiness, the nursing care plan should include the following:
- Frequent neurological assessments: The nursing staff should perform frequent neurological assessments to monitor the patient’s level of consciousness, responsiveness, and any signs of neurological deterioration.
- Vital sign monitoring: The patient’s vital signs, including blood pressure, heart rate, and respiratory rate, should be monitored closely to detect any changes that may indicate worsening of the patient’s condition.
- Elevating the head of the bed: The patient’s head should be elevated to at least 30 degrees to improve cerebral blood flow and reduce the risk of increased intracranial pressure.
- Maintaining a quiet and calm environment: The nursing staff should ensure that the patient’s environment is quiet and calm to reduce stimulation and prevent agitation.
- Administering medications as ordered: The patient may require medications to control pain, prevent seizures, or manage other symptoms. These should be administered as ordered by the physician.
- Maintaining adequate hydration and nutrition: The nursing staff should ensure that the patient is adequately hydrated and nourished to support healing and recovery.
Providing emotional support: The patient and family members may be anxious or distressed following the injury. The nursing staff should provide emotional support and reassurance as needed.
Question 2: A teenager is admitted following a seizure. The next day, the nurse goes into his room and finds him lying on the floor starting to have a seizure. What action should the nurse take at this time?
If a patient is having a seizure, there are several steps that the nurse should take:
- Call for assistance: The nurse should call for help immediately, alerting other healthcare providers or emergency services as needed.
- Protect the patient from injury: The nurse should try to move any nearby furniture or objects that could harm the patient during the seizure, and place a pillow or other soft object under the patient’s head.
- Turn the patient on their side: If possible, the nurse should turn the patient onto their side to prevent them from choking on any fluids that may be in their mouth or throat.
- Time the seizure: The nurse should note the time that the seizure begins and ends, as this information can be helpful in determining appropriate treatment.
- Stay with the patient: The nurse should stay with the patient throughout the seizure, monitoring their breathing and making sure they are safe.
- Document the seizure: The nurse should document the details of the seizure, including the time it began and ended, any movements or behaviors observed, and any interventions that were performed.
After the seizure has ended, the nurse should continue to monitor the patient’s vital signs and level of consciousness, and report any changes or concerns to the healthcare provider.
Question 3: An adult is being treated with phenytoin (Dilantin) for a seizure disorder. Five days after starting the medication, he tells the nurse that his urine is reddish-brown in color. What action should the nurse take?
Reddish-brown urine can be an indication of a serious side effect of phenytoin, known as Stevens-Johnson syndrome. The nurse should take the following actions:
- Assess the patient’s condition to determine if there are other symptoms present that may indicate a more serious reaction.
- Stop the medication immediately and notify the prescriber of the patient’s symptoms.
- Encourage the patient to drink plenty of fluids to help flush the medication out of the body.
- Monitor the patient’s vital signs and urine output closely.
- Obtain orders for laboratory tests such as a complete blood count, liver function tests, and electrolyte levels.
- Document the patient’s symptoms and the actions taken in the medical record.
The nurse should also instruct the patient to seek immediate medical attention if any other symptoms develop, such as a fever, skin rash, or difficulty breathing. It is important to monitor the patient closely for any further signs of a serious reaction, as this can be a life-threatening situation.
Question 4: The nurse is caring for a client who has recently had a cerebrovascular accident (CVA). When positioning the client and supporting her extremities, the nurse must remember that when voluntary control of muscles is lost:
When voluntary control of muscles is lost, it is important for the nurse to remember the following when positioning and supporting the extremities of a client who has recently had a cerebrovascular accident (CVA):
- Proper positioning is critical to prevent contractures and maintain joint range of motion. The nurse should reposition the client frequently and use pillows, cushions, or other supports to maintain proper body alignment.
- The nurse should support the affected extremities during positioning and transfer to prevent further injury or discomfort.
- The nurse should use a gentle touch and slow movements when handling the client, as sudden movements may cause pain or spasticity.
- The nurse should educate the client and family members about proper positioning and support techniques to promote safety and prevent injury.
- The nurse should monitor the client’s extremities for signs of swelling, redness, or discoloration, which may indicate poor circulation or skin breakdown.
- The nurse should encourage the client to participate in passive range-of-motion exercises to maintain joint mobility and prevent contractures.
- The nurse should assess the client’s pain level and provide appropriate pain management interventions, as pain can exacerbate muscle spasticity and interfere with positioning and movement.
Overall, the nurse should take a holistic approach to care for clients who have recently had a CVA, considering not only their physical needs but also their emotional and psychosocial needs.
Question 5: A stroke victim regains consciousness three days after admission. She has right-sided hemiparesis and hemiplegia and also has expressive aphasia. She becomes upset when she is unable to say simple words. The best approach for the nurse is to do:
- Encouraging the patient to use other forms of communication, such as writing, drawing, or pointing to pictures.
- Using simple language and speaking slowly and clearly to the patient.
- Providing reassurance and emotional support to the patient, who may be experiencing frustration or anxiety due to her difficulty communicating.
- Collaborating with a speech therapist to develop a communication plan tailored to the patient’s needs and abilities.
- Monitoring the patient for signs of depression, which is common in stroke patients, and ensuring that she receives appropriate mental health support if needed.
Question 6: A young man was swimming at the beach when an exceptionally large wave caused him to be drawn under the water. His family members found him in the water and pulled him ashore. He states that he heard something snap in his neck. When a nurse arrives, he is conscious and lying on his back. He states that he has no pain. He is unable to move his legs. How should he be transported?
If a patient experiences a neck injury and has possible spinal cord damage, it is critical to handle the patient carefully and transport them in a way that minimizes movement of the neck and spine to prevent further injury. In this case, since the young man is conscious and lying on his back, with possible spinal cord damage, the following steps should be taken for safe transport:
- Stabilize the neck: The nurse should first make sure that the patient’s neck is immobilized by using a cervical collar or manually holding the neck in place until a cervical collar is available.
- Use a backboard: The patient should be placed on a rigid backboard to prevent any further movement of the neck and spine.
- Secure the patient: The patient should be securely strapped to the backboard using straps or belts to prevent any movement during transport.
- Elevate the head: The head of the backboard should be slightly elevated to help reduce any swelling in the neck or head.
- Transfer carefully: The backboard should be moved carefully and smoothly, avoiding any sudden movements or jolts that could cause further injury to the patient’s spine.
- It is important to transport the patient to a hospital with a spine injury center, where the appropriate diagnostic and treatment measures can be taken. The patient should also be continuously monitored during transport for any changes in his condition.
Question 7: A client who is recovering from a spinal cord injury complains of blurred vision and a severe headache. His blood pressure is 210/140. The most appropriate initial action for the nurse to take is to:
The client’s symptoms of blurred vision and severe headache, along with a very high blood pressure reading, suggest a potential hypertensive crisis, which is a medical emergency. As a nurse, the most appropriate initial action to take would be to immediately notify the healthcare provider and activate the facility’s rapid response team to provide prompt medical intervention.
In the meantime, the nurse can take measures to ensure the client’s safety by lowering the head of the bed to promote adequate cerebral perfusion, monitoring the client’s vital signs, and administering oxygen if needed. The nurse should also ensure that the client is calm and comfortable while waiting for medical assistance to arrive.
It is essential to act quickly in this situation to prevent further complications and promote positive outcomes for the client.
Question 8: A 27-year-old woman is admitted to the hospital complaining of numbness in both legs, difficulty walking, and double vision of one week in duration. Multiple sclerosis is suspected. Orders include bed rest with bathroom privileges, brain scan, EEG, lumbar puncture, adrenocorticotropic hormone (ACTH) 40 units intramuscularly (IM) bid × 3 days, then 30 units IM bid × 3 days, then 20 units IM bid × 3 days; and passive range of motion (ROM) progressing to active ROM as tolerated. In planning care for this client, which activity is most important to include?
The most important activity to include in the care of a client with suspected multiple sclerosis is monitoring and assessment of neurological status. This includes monitoring the client’s level of consciousness, vital signs, and the development of any new symptoms such as weakness, numbness, or changes in vision. Additionally, it is important to assess the client’s ability to perform activities of daily living and to monitor for signs of complications such as bladder or bowel dysfunction. Passive range of motion exercises and active range of motion exercises are important for maintaining mobility, but monitoring and assessment of neurological status take priority.
Question 9: The doctor orders a Tensilon test for a woman suspected of having myasthenia gravis. Which statement is true about this test?
The Tensilon test is a diagnostic test used to help confirm the diagnosis of myasthenia gravis (MG), an autoimmune disorder that affects the neuromuscular junction. The test involves the administration of edrophonium chloride (Tensilon), a medication that temporarily blocks the breakdown of acetylcholine, a neurotransmitter that is important for muscle contraction.
During the test, the patient’s muscle strength is evaluated before and after the administration of Tensilon. If the patient has MG, the medication will improve muscle strength and alleviate symptoms of weakness, drooping eyelids, or difficulty speaking that may be present. This improvement in symptoms is usually rapid, occurring within 30 seconds to 2 minutes after Tensilon administration.
Therefore, the true statement about the Tensilon test is that it can help confirm the diagnosis of myasthenia gravis by temporarily improving muscle strength and alleviating symptoms of weakness.
Question 10: When planning care for a woman with myasthenia gravis, the nurse asks her what time of day she feels strongest. The nurse would expect which replies?
Myasthenia gravis is a neuromuscular disorder that causes muscle weakness and fatigue, which can affect various muscle groups in the body. The weakness is typically worse after exertion and improves with rest. Therefore, the nurse might expect the following replies when asking the woman with myasthenia gravis what time of day she feels strongest:
In the morning: Many people with myasthenia gravis feel strongest in the morning after a good night’s rest, and their muscle strength tends to decline as the day goes on.
After taking medication: Medications such as anticholinesterase agents and immunosuppressants are commonly used to manage myasthenia gravis, and they can help improve muscle strength. Therefore, the woman might feel strongest after taking her medication.
After resting: Since myasthenia gravis causes fatigue and weakness, the woman might feel strongest after resting for a while, especially if she has been experiencing muscle weakness or fatigue.
It is important for the nurse to ask the woman about her preferred time of day for activities and schedule her care around it. By doing so, the nurse can help the woman conserve her energy and avoid exacerbating her symptoms.
Question 11: Which would be included in the nursing care plan for a client with Parkinson’s disease?
Parkinson’s disease is a chronic and progressive neurological disorder that affects movement and coordination. The nursing care plan for a client with Parkinson’s disease should focus on managing symptoms, promoting safety, and enhancing quality of life. Here are some key components that may be included in the nursing care plan:
- Assessment: Conduct a comprehensive assessment of the client’s physical, cognitive, and psychosocial status. Assess the client’s ability to perform activities of daily living (ADLs), gait, balance, tremors, rigidity, and dyskinesia.
- Medication management: Parkinson’s disease is commonly treated with medications that help manage symptoms such as tremors, rigidity, and bradykinesia. The nursing care plan should include monitoring the client’s response to medications, managing adverse effects, and promoting medication adherence.
- Mobility and safety: Clients with Parkinson’s disease are at risk for falls due to impaired gait and balance. The nursing care plan should include interventions to promote mobility and safety, such as teaching the client how to use assistive devices, assessing the home environment for safety hazards, and implementing fall prevention strategies.
- Nutrition: Clients with Parkinson’s disease may experience difficulty chewing, swallowing, and maintaining adequate nutrition. The nursing care plan should include monitoring the client’s nutritional status, providing education on appropriate diets and meal planning, and referring the client to a dietitian if necessary.
- Psychosocial support: Parkinson’s disease can have a significant impact on a client’s quality of life and mental health. The nursing care plan should include interventions to promote psychosocial well-being, such as providing emotional support, facilitating participation in support groups, and referring the client to a mental health professional if necessary.
- Collaboration with healthcare team: Parkinson’s disease is a complex condition that requires a multidisciplinary approach to care. The nursing care plan should include collaboration with the healthcare team, such as physicians, physical therapists, occupational therapists, and speech therapists, to ensure comprehensive and coordinated care.
- Overall, the nursing care plan for a client with Parkinson’s disease should focus on managing symptoms, promoting safety, and enhancing quality of life. The plan should be individualized to meet the specific needs of the client and should be regularly evaluated and modified as necessary.
Question 12: The nurse is caring for a client admitted with Guillain-Barré syndrome. On day three of hospitalization, his muscle weakness worsens, and he is no longer able to stand with support. He is also having difficulty swallowing and talking. The priority in his nursing care plan should be to prevent:
Guillain-Barré syndrome (GBS) is a rare neurological disorder in which the body’s immune system attacks the nerves, resulting in muscle weakness and paralysis. In this scenario, the client’s symptoms have worsened, and he is experiencing difficulty standing, swallowing, and talking. The priority in his nursing care plan should be to prevent respiratory compromise and ensure airway patency.
As the client’s muscle weakness progresses, he may become unable to maintain a patent airway, which can result in respiratory distress and failure. The inability to swallow and speak also increases the risk of aspiration, which can lead to aspiration pneumonia and further compromise respiratory function.
Therefore, the nurse’s priority should be to closely monitor the client’s respiratory status, including oxygen saturation, respiratory rate, and depth of breathing. The nurse should also assess the client’s ability to cough effectively and suction the airway as needed to prevent aspiration. Additionally, the nurse should consult with the healthcare provider about the need for mechanical ventilation or other respiratory support measures.
Other important components of the nursing care plan for a client with GBS include monitoring for complications such as autonomic dysfunction and deep vein thrombosis, providing appropriate pain management, promoting skin integrity, and supporting the client’s emotional well-being.
However, in this scenario, preventing respiratory compromise and ensuring airway patency is the priority concern.
Question 13: An adult client is admitted for removal of a cataract from her right eye. Which would the client likely have experienced as a result of the cataracts?
Cataracts are a common eye condition that can occur in both eyes but may develop at different rates. A cataract occurs when the clear lens of the eye becomes cloudy, causing blurred vision, decreased color perception, and increased sensitivity to glare. The extent of vision loss depends on the size and location of the cataract.
The client admitted for the removal of a cataract from her right eye likely experienced the following symptoms:
Blurred vision: The cataract clouds the lens of the eye, making it difficult for the client to see objects clearly. The client may experience blurry vision, especially at night or in low-light conditions.
Increased sensitivity to glare: The cataract scatters light as it enters the eye, causing the client to see halos around lights or have difficulty driving at night due to the glare of oncoming headlights.
Decreased color perception: As the cataract grows, it can make colors appear less bright or faded, and the client may have difficulty distinguishing between shades of similar colors.
Poor night vision: The cataract can also make it difficult for the client to see in dimly lit environments, such as at night or in movie theaters.
Double vision: In some cases, a cataract can cause double vision in one eye.
These symptoms can worsen over time and may affect the client’s ability to perform activities of daily living, such as reading, driving, and cooking. However, cataract removal surgery is a safe and effective procedure that can restore vision and improve quality of life for clients with cataracts.
Question 14: A client has had a cataract extraction performed. Which suggestion needs for the client?
After cataract extraction surgery, clients need to follow specific instructions to promote healing, prevent complications, and achieve the best possible visual outcome. Here are some suggestions that a nurse may provide to a client after cataract surgery:
- Take prescribed eye drops: Clients will typically be prescribed eye drops to reduce inflammation and prevent infection. The nurse should instruct the client on the proper administration technique and schedule for the eye drops.
- Avoid rubbing or touching the eye: Clients should avoid rubbing or touching the eye to prevent injury or infection. The nurse should instruct the client to use a tissue or clean cloth to gently wipe away any discharge or tears.
- Wear eye protection: Clients may need to wear a protective eye shield or glasses to prevent accidental injury or rubbing of the eye. The nurse should instruct the client on the proper use and care of the eye protection.
- Avoid strenuous activity: Clients should avoid strenuous activity, heavy lifting, and bending over for several days after surgery to prevent increases in intraocular pressure that can damage the eye. The nurse should instruct the client on appropriate activity restrictions.
- Attend follow-up appointments: Clients will need to attend follow-up appointments with their healthcare provider to monitor healing and ensure the best possible visual outcome. The nurse should provide the client with information about the date, time, and location of their follow-up appointments.
- Report any concerning symptoms: Clients should report any concerning symptoms, such as increased pain, redness, or discharge, to their healthcare provider immediately. The nurse should instruct the client on how to contact their healthcare provider if necessary.
- Overall, the nurse should provide clear and concise instructions to the client after cataract extraction surgery, emphasizing the importance of following these instructions to promote healing and prevent complications.
Question 15: A 50-year-old client is admitted with the diagnosis of open-angle glaucoma. Which symptoms would the nurse expect the client to have?
Open-angle glaucoma is a type of eye disease that is often asymptomatic in its early stages. As the disease progresses, the client may experience the following symptoms:
- Gradual loss of peripheral vision: The client may not notice this until the disease has progressed significantly.
- Tunnel vision: The client may start to see objects only straight ahead or in the center of their field of vision.
- Patchy blind spots: The client may experience areas of vision loss or “blind spots” in their visual field.
- Blurred vision: The client may experience blurred vision, especially in the early morning or evening.
- Halos around lights: The client may see halos around lights, especially at night.
- Eye pain or headache: The client may experience eye pain or headache, especially when the pressure in the eye is high.
- It is important to note that some clients with open-angle glaucoma may not experience any symptoms until the disease has progressed significantly. Therefore, routine eye exams are essential for early detection and management of this condition.
If left untreated, open-angle glaucoma can lead to irreversible vision loss. Therefore, the nurse should educate the client on the importance of adhering to their prescribed treatment plan and attending regular follow-up appointments with their healthcare provider.
Question 16: The nurse is administering eye drops to a client. Which action is correct?
Administering eye drops is a common nursing task, and it is important to follow the correct procedure to ensure that the medication is delivered effectively and safely. Here are the correct steps for administering eye drops:
- Identify the client: Verify the client’s identity using two identifiers, such as their name and date of birth.
- Explain the procedure: Explain the procedure to the client and provide them with any necessary instructions, such as how to position their head and where to look.
- Prepare the medication: Check the medication order and prepare the medication according to the instructions. If using a multidose bottle, check the expiration date and shake the bottle to ensure that the medication is well-mixed.
- Wash hands and put on gloves: Wash hands thoroughly and put on gloves to prevent the spread of infection.
- Position the client: Have the client sit upright with their head tilted back or lie down with their head turned to one side.
- Hold the dropper: Hold the dropper near the tip with your dominant hand and use your other hand to gently pull down the client’s lower eyelid.
- Administer the drops: Instill the prescribed number of drops into the client’s eye, aiming for the lower conjunctival sac. Avoid touching the dropper to the eye or eyelashes, as this can contaminate the medication.
- Release the eyelid: Release the client’s lower eyelid and instruct them to keep their eyes closed for several seconds to allow the medication to distribute.
- Apply gentle pressure: Apply gentle pressure to the inner corner of the eye with a clean tissue to prevent the medication from draining into the nasolacrimal duct.
- Document the procedure: Document the procedure in the client’s medical record, including the medication name, dose, time, and any adverse effects or client responses.
It is important to ensure that the correct medication and dosage are administered, and that the client’s eyes are not injured during the procedure. The nurse should also provide the client with any necessary instructions, such as how often to administer the drops and any potential side effects or adverse reactions.
Question 17: A 10-year-old boy comes to the school clinic holding his broken pair of glasses. He says that he got hit in the face playing ball and his eye hurts and feels like there’s something in it. What should the nurse do before taking him to the emergency room?
If a child presents to the school clinic with a broken pair of glasses and complaints of eye pain and feeling like something is in their eye after being hit in the face, the nurse should take the following steps before taking the child to the emergency room:
- Assess the child’s eye: The nurse should examine the child’s eye to check for any visible injuries, such as cuts, swelling, or bruising. If there is any foreign object in the eye, the nurse should not attempt to remove it, as this could cause further damage.
- Rinse the eye: If there is no visible injury or foreign object in the eye, the nurse can gently rinse the eye with sterile saline solution to remove any dust or debris that may be causing the child’s discomfort.
- Check vision: The nurse should check the child’s vision in both eyes to ensure that there is no significant loss of vision or other visual changes.
- Administer pain relief: If the child is in pain, the nurse can administer over-the-counter pain relievers, such as acetaminophen or ibuprofen, as appropriate for the child’s age and weight.
- Cover the eye: The nurse can cover the affected eye with a clean, dry patch or dressing to prevent further injury or irritation.
- Notify parents/guardians: The nurse should contact the child’s parents or guardians to inform them of the situation and obtain permission to take the child to the emergency room for further evaluation and treatment.
It is important to take any complaints of eye pain or discomfort seriously, as these symptoms can be a sign of a serious eye injury or condition. The nurse should prioritize the child’s safety and comfort, and seek appropriate medical attention as soon as possible.
Question 18: How should a nurse walk a client who is blind?
Assisting a blind client to walk safely and confidently requires some specific considerations and techniques. Here are some steps a nurse can take to walk a client who is blind:
- Approach the client: Approach the client in a calm and gentle manner, and introduce yourself by name.
- Ask permission: Ask the client if they would like assistance walking, and explain how you can assist them.
- Describe the environment: Describe the surroundings to the client, including any obstacles, changes in elevation, or other potential hazards that may be in their path. Use clear and concise language to help the client visualize the environment.
- Offer your arm: Offer your arm to the client to hold onto, and let them know when you are ready to move. Allow the client to take the lead and set the pace.
- Provide verbal cues: As you walk, provide verbal cues to the client to let them know when they are approaching steps, curbs, or other obstacles. Use descriptive language to help the client visualize the environment, such as “up” or “down” for changes in elevation.
- Avoid sudden movements: Avoid sudden movements or changes in direction that could startle or disorient the client.
- Encourage independence: Encourage the client to use their other senses, such as hearing and touch, to navigate the environment as much as possible.
- Check in frequently: Check in with the client frequently to ensure they are comfortable and confident, and to address any concerns or questions they may have.
It is important to respect the client’s autonomy and provide assistance in a way that promotes their independence and dignity. By following these steps, the nurse can help the client feel safe and supported while walking.
Question 19: The client is a 60-year-old man who had a stapedectomy. He is to ambulate for the first time. Which nursing action should be taken?
After a stapedectomy, which is a surgical procedure to repair or replace the stapes bone in the middle ear, the nurse should take the following nursing actions when the client is ready to ambulate for the first time:
- Explain the procedure: The nurse should explain to the client what a stapedectomy is and what to expect during and after the procedure.
- Assess the client’s vital signs: Before ambulating the client, the nurse should assess their vital signs, including blood pressure, pulse, and respiratory rate, to ensure that the client is stable and able to tolerate activity.
- Check for dizziness or vertigo: The nurse should check the client for any signs of dizziness or vertigo, which can be common after ear surgery.
- Assist the client out of bed: The nurse should assist the client out of bed slowly and carefully, helping them maintain balance and avoid falls.
- Provide support: The nurse should provide the client with a walker or other assistive device to help them maintain balance and prevent falls.
- Monitor the client’s response: The nurse should closely monitor the client’s response to activity, including any signs of dizziness, vertigo, or discomfort.
- Encourage rest: After ambulating, the nurse should encourage the client to rest and avoid strenuous activity for a period of time as directed by the healthcare provider.
- Document the client’s response: The nurse should document the client’s response to activity, including any complaints of pain or discomfort, vital signs, and any other relevant information.
By following these nursing actions, the nurse can help the client safely and comfortably ambulate after a stapedectomy.
Question 20: A client complains of tinnitus and dizziness and has a diagnosis of Ménière’s disease. She asks the nurse, “What is the cause of Ménière’s disease?” What is the nurse’s best response?
Ménière’s disease is a disorder of the inner ear that can cause episodes of vertigo, tinnitus, and hearing loss. While the exact cause of Ménière’s disease is not known, it is believed to be related to fluid buildup in the inner ear, which can disrupt the balance and hearing organs.
The nurse’s best response would be to explain that the exact cause of Ménière’s disease is not fully understood, but researchers believe that it could be related to a combination of factors such as genetics, abnormal immune response, or environmental factors. However, the treatment options are available to manage the symptoms and prevent further episodes.