NUR 257 FINAL EXAM
VERSION WITH 200 VERIFIED QUESTIONS
AND
CORRECT ANSWERS LATEST UPDATE
LATEST
A patient with increased ICP has a ventriculostomy for monitoring ICP. The
nurse's most recent assessment reveals that the patient is now exhibiting
nuchal rigidity and photophobia. The nurse would be correct in suspecting
the presence of what complication?
A) Encephalitis
B) CSF leak
C) Meningitis
D) Catheter occlusion - ANSWER>>C
The nurse is participating in the care of a patient with increased ICP. What
diagnostic test is contraindicated in this patient's treatment?
A) Computed tomography (CT) scan
B) Lumbar puncture
C) Magnetic resonance imaging (MRI)
D) Venous Doppler studies - ANSWER>>B
The nurse is caring for a patient who is in status epilepticus. What
medication does the nurse know may be given to halt the seizure
immediately?
A) Intravenous phenobarbital (Luminal)
B) Intravenous diazepam (Valium)
C) Oral lorazepam (Ativan)
D) Oral phenytoin (Dilantin) - ANSWER>>B
The nurse has created a plan
of care for a patient who is at risk for increased ICP. The patient's care plan
should specify monitoring for what early sign of increased ICP?
,A) Disorientation and restlessness
B) Decreased pulse and respirations
C) Projectile vomiting
D) Loss of corneal reflex - ANSWER>>A
The neurologic ICU nurse is
admitting a patient following a craniotomy using the supratentorial
approach. How should the nurse best position the patient?
A) Position the patient supine.
B) Maintain head of bed (HOB) elevated at 30 to 45 degrees.
C) Position patient in prone position.
D) Maintain bed in Trendelenberg position. - ANSWER>>B
A clinic nurse is caring for a patient diagnosed with migraine headaches.
A) Alcohol causes hormone fluctuations. During the
patient
B) Alcohol causes vasodilation of the blood vessels. teaching
session, the
C) Alcohol has an excitatory effect on the CNS.
patient
D) Alcohol diminishes endorphins in the brain. - ANSWER>>B
questions
the nurse regarding alcohol consumption. What would the nurse be correct
in telling the patient about the effects of alcohol?
A patient has developed diabetes insipidus after having increased ICP
following head trauma. What nursing assessment best addresses this
complication?
A) Vigilant monitoring of fluid balance
B) Continuous BP monitoring
C) Serial arterial blood gases (ABGs)
D) Monitoring of the patient's airway for patency - ANSWER>>A
What should the nurse suspect when hourly assessment of urine output on
a patient postcraniotomy exhibits a urine output from a catheter of 1,500
mL for two consecutive hours?
A) Cushing syndrome
B) Syndrome of inappropriate antidiuretic hormone (SIADH)
C) Adrenal crisis
,D) Diabetes insipidus - ANSWER>>D
During the examination of an unconscious patient, the nurse observes that
the patient's pupils are fixed and dilated. What is the most plausible clinical
significance of the nurse's finding?
A) It suggests onset of metabolic problems.
B) It indicates paralysis on the right side of the body.
C) It indicates paralysis of cranial nerve X.
D) It indicates an injury at the midbrain level. - ANSWER>>D
A patient is being admitted to the neurologic ICU following an acute head
injury that has resulted in cerebral edema. When planning this patient's
care, the nurse would expect to administer what priority medication?
A) Hydrochlorothiazide (HydroDIURIL)
B) Furosemide
(Lasix)
C) Mannitol (Osmitrol)
D) Spirolactone (Aldactone) - ANSWER>>C
The nurse is providing care for a patient who is unconscious. What nursing
intervention takes highest priority?
A) Maintaining accurate records of intake and output
B) Maintaining a patent airway
C) Inserting a nasogastric (NG) tube as ordered
D) Providing appropriate pain control - ANSWER>>B
The nurse is caring for a patient in the ICU who has a brain stem herniation
and who is exhibiting an altered level of consciousness. Monitoring reveals
that the patient's mean arterial pressure (MAP) is 60 mm Hg with an
intracranial pressure (ICP) reading of 5 mm Hg. What is the nurse's most
appropriate action?
A) Position the patient in the high Fowler's position as tolerated.
B) Administer osmotic diuretics as ordered.
C) Participate in interventions to increase cerebral perfusion pressure.
D) Prepare the patient for craniotomy - ANSWER>>C
, The nurse is caring for a patient who is postoperative following a
craniotomy. When writing the plan of care, the nurse identifies a diagnosis
of "deficient fluid volume related to fluid restriction and osmotic diuretic
use." What would be an appropriate intervention for this diagnosis?
A) Change the patient's position as indicated.
B) Monitor serum electrolytes.
C) Maintain NPO status.
D) Monitor arterial blood gas (ABG) values. - ANSWER>>B
A patient with a documented history of seizure disorder experiences a
generalized seizure. What nursing action is most appropriate?
A) Restrain the patient to prevent injury.
B) Open the patient's jaws to insert an oral airway.
C) Place patient in high Fowler's position.
D) Loosen the patient's restrictive clothing. - ANSWER>>D
A patient who has been on long-term phenytoin (Dilantin) therapy is
admitted to the unit. In light of the adverse of effects of this medication, the
nurse should prioritize which of the following in the patient's plan of care?
A) Monitoring of pulse oximetry
B) Administration of a low-protein diet
C) Administration of thorough oral hygiene
D) Fluid restriction as ordered - ANSWER>>C
A nurse is admitting a patient
with a severe migraine headache and a history of acute coronary
syndrome. What migraine medication would the nurse question for this
patient?
A) Rizatriptan (Maxalt)
B) Naratriptan (Amerge)
C) Sumatriptan succinate (Imitrex)
D) Zolmitriptan (Zomig) - ANSWER>>C
The nurse is caring for a patient with increased intracranial pressure (ICP).
The patient has a nursing diagnosis of "ineffective cerebral tissue
perfusion." What would be an expected outcome that the nurse would
document for this diagnosis?
VERSION WITH 200 VERIFIED QUESTIONS
AND
CORRECT ANSWERS LATEST UPDATE
LATEST
A patient with increased ICP has a ventriculostomy for monitoring ICP. The
nurse's most recent assessment reveals that the patient is now exhibiting
nuchal rigidity and photophobia. The nurse would be correct in suspecting
the presence of what complication?
A) Encephalitis
B) CSF leak
C) Meningitis
D) Catheter occlusion - ANSWER>>C
The nurse is participating in the care of a patient with increased ICP. What
diagnostic test is contraindicated in this patient's treatment?
A) Computed tomography (CT) scan
B) Lumbar puncture
C) Magnetic resonance imaging (MRI)
D) Venous Doppler studies - ANSWER>>B
The nurse is caring for a patient who is in status epilepticus. What
medication does the nurse know may be given to halt the seizure
immediately?
A) Intravenous phenobarbital (Luminal)
B) Intravenous diazepam (Valium)
C) Oral lorazepam (Ativan)
D) Oral phenytoin (Dilantin) - ANSWER>>B
The nurse has created a plan
of care for a patient who is at risk for increased ICP. The patient's care plan
should specify monitoring for what early sign of increased ICP?
,A) Disorientation and restlessness
B) Decreased pulse and respirations
C) Projectile vomiting
D) Loss of corneal reflex - ANSWER>>A
The neurologic ICU nurse is
admitting a patient following a craniotomy using the supratentorial
approach. How should the nurse best position the patient?
A) Position the patient supine.
B) Maintain head of bed (HOB) elevated at 30 to 45 degrees.
C) Position patient in prone position.
D) Maintain bed in Trendelenberg position. - ANSWER>>B
A clinic nurse is caring for a patient diagnosed with migraine headaches.
A) Alcohol causes hormone fluctuations. During the
patient
B) Alcohol causes vasodilation of the blood vessels. teaching
session, the
C) Alcohol has an excitatory effect on the CNS.
patient
D) Alcohol diminishes endorphins in the brain. - ANSWER>>B
questions
the nurse regarding alcohol consumption. What would the nurse be correct
in telling the patient about the effects of alcohol?
A patient has developed diabetes insipidus after having increased ICP
following head trauma. What nursing assessment best addresses this
complication?
A) Vigilant monitoring of fluid balance
B) Continuous BP monitoring
C) Serial arterial blood gases (ABGs)
D) Monitoring of the patient's airway for patency - ANSWER>>A
What should the nurse suspect when hourly assessment of urine output on
a patient postcraniotomy exhibits a urine output from a catheter of 1,500
mL for two consecutive hours?
A) Cushing syndrome
B) Syndrome of inappropriate antidiuretic hormone (SIADH)
C) Adrenal crisis
,D) Diabetes insipidus - ANSWER>>D
During the examination of an unconscious patient, the nurse observes that
the patient's pupils are fixed and dilated. What is the most plausible clinical
significance of the nurse's finding?
A) It suggests onset of metabolic problems.
B) It indicates paralysis on the right side of the body.
C) It indicates paralysis of cranial nerve X.
D) It indicates an injury at the midbrain level. - ANSWER>>D
A patient is being admitted to the neurologic ICU following an acute head
injury that has resulted in cerebral edema. When planning this patient's
care, the nurse would expect to administer what priority medication?
A) Hydrochlorothiazide (HydroDIURIL)
B) Furosemide
(Lasix)
C) Mannitol (Osmitrol)
D) Spirolactone (Aldactone) - ANSWER>>C
The nurse is providing care for a patient who is unconscious. What nursing
intervention takes highest priority?
A) Maintaining accurate records of intake and output
B) Maintaining a patent airway
C) Inserting a nasogastric (NG) tube as ordered
D) Providing appropriate pain control - ANSWER>>B
The nurse is caring for a patient in the ICU who has a brain stem herniation
and who is exhibiting an altered level of consciousness. Monitoring reveals
that the patient's mean arterial pressure (MAP) is 60 mm Hg with an
intracranial pressure (ICP) reading of 5 mm Hg. What is the nurse's most
appropriate action?
A) Position the patient in the high Fowler's position as tolerated.
B) Administer osmotic diuretics as ordered.
C) Participate in interventions to increase cerebral perfusion pressure.
D) Prepare the patient for craniotomy - ANSWER>>C
, The nurse is caring for a patient who is postoperative following a
craniotomy. When writing the plan of care, the nurse identifies a diagnosis
of "deficient fluid volume related to fluid restriction and osmotic diuretic
use." What would be an appropriate intervention for this diagnosis?
A) Change the patient's position as indicated.
B) Monitor serum electrolytes.
C) Maintain NPO status.
D) Monitor arterial blood gas (ABG) values. - ANSWER>>B
A patient with a documented history of seizure disorder experiences a
generalized seizure. What nursing action is most appropriate?
A) Restrain the patient to prevent injury.
B) Open the patient's jaws to insert an oral airway.
C) Place patient in high Fowler's position.
D) Loosen the patient's restrictive clothing. - ANSWER>>D
A patient who has been on long-term phenytoin (Dilantin) therapy is
admitted to the unit. In light of the adverse of effects of this medication, the
nurse should prioritize which of the following in the patient's plan of care?
A) Monitoring of pulse oximetry
B) Administration of a low-protein diet
C) Administration of thorough oral hygiene
D) Fluid restriction as ordered - ANSWER>>C
A nurse is admitting a patient
with a severe migraine headache and a history of acute coronary
syndrome. What migraine medication would the nurse question for this
patient?
A) Rizatriptan (Maxalt)
B) Naratriptan (Amerge)
C) Sumatriptan succinate (Imitrex)
D) Zolmitriptan (Zomig) - ANSWER>>C
The nurse is caring for a patient with increased intracranial pressure (ICP).
The patient has a nursing diagnosis of "ineffective cerebral tissue
perfusion." What would be an expected outcome that the nurse would
document for this diagnosis?
