1.
Question: A nurse is caring for a client who has global aphasia. Which of the following actions
should the nurse take?
Answer: Talk to the client about one idea at a time
Rationale: The nurse should speak using sentences that contain one clear thought or idea for
better communication and understanding.
2.
Question: A nurse is caring for a client who has had a hemorrhagic stroke following a ruptured
cerebral aneurysm. Which of the following manifestations should the nurse expect?
Answer: Manifestations preceeded by a severe headache
Rationale: A hemorrhagic stroke is caused by bleeding into the brain tissues, ventricles, or
subarachnoid space. It can be caused by hypertension, an aneurysm, or an arteriovenous
malformation. A sudden, severe headache is an expected initial manifestation of a hemorrhagic
stroke.
3.
Question: A nurse is caring for a client who has Parkinson's disease and is taking
diphenhydramine 25 mg PO TID. Which of the following therapeutic outcomes should the nurse
expect to see?
Answer: Decreased tremors
Rationale: Clients who have Parkinson's disease often experience trembling, muscle rigidity,
difficulty walking, and problems with balance and coordination. Antihistamines, like
diphenhydramine, have a mild anticholinergic effect and may be helpful in controlling tremors in
the early stage of the disease.
4.
Question: A nurse is teaching a client who is taking benztropine to treat Parkinson's disease. The
nurse should instruct the client to report which of the following adverse effects?
Answer: Difficulty voiding
, Rationale: The nurse should instruct the client to report difficulty voiding, which may indicate
urinary retention, as an adverse effect of benztropine. Benztropine is an anticholinergic
medication that helps decrease the rigidity and tremors of Parkinson's disease.
5.
Question: A nurse who is off duty finds a woman who has collapsed and has right-sided
weakness and slurred speech. Which of the following actions should the nurse take?
Answer: Call emergency services
Rationale: The client might have had a stroke, and if she has, she needs emergency medical
intervention and transport to a stroke center.
6.
Question: A nurse is planning care for a client who has a cerebral aneurysm. Which of the
following actions should the nurse plan to take?
Answer: Maintain the client on absolute bed rest
Rationale: The nurse should place the client on absolute bed rest in a quiet environment. Activity
can elevate blood pressure and increase the risk for bleeding.
7.
Question: A nurse caring for a client who had a right-sided stroke and is exhibiting homonymous
hemianopsia when eating. Which of the following actions should the nurse take?
Answer: Remind the client to look at the left side of the tray
Rationale: The nurse's action to remind the client to look for food on the left side of the tray will
train the client to scan the tray by moving his head and eyes, which will help to resolve the
problem of homonymous hemianopsia.
8.
Question: A nurse is caring for a client who is scheduled to have an MRI scan. The client asks the
nurse what to expect during the procedure. Which of the following statements should the nurse
make?
Answer: “An MRI scan is very noisy, and you will be allowed to wear earplugs while in the
scanner.”